It isn’t news that migraine patients are at increased risk for stroke and cardiovascular disease. We’ve been talking about it for many years (check out Migraine and Heart Disease: 7 Critical Things to Know Now).
But w’re still a surprisingly long way from understanding the relationship.
In the new book, Headache and Migraine Biology and Management, edited by Dr. Seymour Diamond, Dr. Michael Star and Dr. JosÃ© Biller summarize the relationship between stroke and migraine with aura in particular.
The estimate is that people who have migraine with aura have roughly double the stroke risk of the general population. If they also smoke, the risk is tripled. If they smoke and use birth control pills, their risk is septupled (that’s seven times the risk – I was just looking for an excuse to use the word “septupled”).
Of course there are various types of stroke. Ischemic strokes, caused by blood clots in the brain, are the most common. Hemorrhagic strokes, caused by bleeding in the brain, have also been linked to migraine (see Increased risk of hemorrhagic stroke in patients with migraine: a population-based cohort study. from 2013).
But why the increased risk? Some theories:
- Biological differences in the body of a migraine patient, such as low levels of high-density lipoprotein (HDL – “good cholesterol”) and high levels of c-reactive protein.
- A genetic connection between migraine and stroke.
- Migraine medications that increase the risk of stroke (a concern with triptans, although this remains controversial).
- The migraine chain-reaction itself may trigger a stroke (for example, migrainous infarction.
Although a lot of research has been done, we still have a long way to go. The very fact that we have no obviously dominant theory may tell us that there is a complex web of reasons why migraine and stroke are related.
Once again, although “double the risk” sounds scary, the risk is still low. If you maintain a generally healthy lifestyle, your risk is still low even though you suffer from migraine.
Still, it is something that needs to be considered as you try to find a balance in your treatment.