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Migrainous Infarction: Aspects on Risk Factors and Therapy

  • Migraine Headache (F Taylor, Section Editor)
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Abstract

Migraine and stroke are related in more than one way. Migraine with aura is a risk factor for ischemic stroke in women under age 45 years, particularly when combined with other risk factors such as smoking and oral contraceptives. Further, individuals with migraine with aura seem to have more white matter lesions and ischemic infarctions than control patients. Migraine has been correlated to cervical artery dissection, the symptoms of which can mimic migraine. Correspondingly, migraine with aura sometimes is mistaken for stroke. Migrainous infarction is a rare but specific type of ischemic stroke developing during an attack of migraine with aura. It is important to recognize this unusual complication of migraine because the management probably is important. In this review, we will discuss the present knowledge of migrainous infarction, the clinical picture, possible mechanisms, and potential prevention and treatment.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance

  1. Mathers CD, Loncar D. Projections of global mortality and burden of disease from 2002 to 2030. PLoS Med. 2006;3:e442.

    Article  PubMed  Google Scholar 

  2. WHO. Global burden of stroke. 2011.

  3. Feigin VL, Lawes CM, Bennett DA, Barker-Collo SL, Parag V. Worldwide stroke incidence and early case fatality reported in 56 population-based studies: a systematic review. Lancet Neurol. 2009;8:355–69.

    Article  PubMed  Google Scholar 

  4. Reeves MJ, Bushnell CD, Howard G, Gargano JW, Duncan PW, Lynch G, Khatiwoda A, Lisabeth L. Sex differences in stroke: epidemiology, clinical presentation, medical care, and outcomes. Lancet Neurol. 2008;7:915–26.

    Article  PubMed  Google Scholar 

  5. Etminan M, Takkouche B, Isorna FC, Samii A. Risk of ischaemic stroke in people with migraine: systematic review and meta-analysis of observational studies. BMJ. 2005;330:63.

    Article  PubMed  Google Scholar 

  6. Schurks M, Rist PM, Bigal ME, Buring JE, Lipton RB, Kurth T. Migraine and cardiovascular disease: systematic review and meta-analysis. BMJ. 2009;339:b3914.

    Article  PubMed  Google Scholar 

  7. Spector JT, Kahn SR, Jones MR, Jayakumar M, Dalal D, Nazarian S. Migraine headache and ischemic stroke risk: an updated meta-analysis. Am J Med. 2010;123:612–24.

    Article  PubMed  Google Scholar 

  8. Kruit MC, Launer LJ, Ferrari MD, van Buchem MA. Infarcts in the posterior circulation territory in migraine. The population-based MRI Camera Study. Brain. 2005;128:2068–77.

    Article  PubMed  Google Scholar 

  9. Aho K, Harmsen P, Hatano S, Marquardsen J, Smirnov VE, Strasser T. Cerebrovascular disease in the community: results of a WHO Collaborative Study. Bull World Health Organ. 1980;58:113–30.

    PubMed  CAS  Google Scholar 

  10. Putaala J, Metso AJ, Metso TM, Konkola N, Kraemer Y, Haapaniemi E, Kaste M, Tatlisumak T. Analysis of 1008 consecutive patients aged 15 to 49 with first-ever ischemic stroke: the Helsinki Young Stroke Registry. Stroke. 2009;40:1195–203.

    Article  PubMed  Google Scholar 

  11. Varona JF, Guerra JM, Bermejo F, Molina JA, Gomez de la Camara A. Causes of ischemic stroke in young adults, and evolution of the etiological diagnosis over the long term. Eur Neurol. 2007;57:212–8.

    Article  PubMed  CAS  Google Scholar 

  12. Bogousslavsky J, Pierre P. Ischemic stroke in patients under age 45. Neurol Clin. 1992;10:113–24.

    PubMed  CAS  Google Scholar 

  13. Kristensen B, Malm J, Carlberg B, Stegmayr B, Backman C, Fagerlund M, Olsson T. Epidemiology and etiology of ischemic stroke in young adults aged 18 to 44 years in Northern Sweden. Stroke. 1997;28:1702–9.

    Article  PubMed  CAS  Google Scholar 

  14. Kittner SJ, Stern BJ, Wozniak M, Buchholz DW, Earley CJ, Feeser BR, Johnson CJ, Macko RF, McCarter RJ, Price TR, Sherwin R, Sloan MA, Wityk RJ. Cerebral infarction in young adults: the Baltimore-Washington Cooperative Young Stroke Study. Neurology. 1998;50:890–4.

    PubMed  CAS  Google Scholar 

  15. Adams Jr HP, Kappelle LJ, Biller J, Gordon DL, Love BB, Gomez F, Heffner M. Ischemic stroke in young adults. Experience in 329 patients enrolled in the Iowa Registry of Stroke in young adults. Arch Neurol. 1995;52:491–5.

    Article  PubMed  Google Scholar 

  16. Rasura M, Spalloni A, Ferrari M, De Castro S, Patella R, Lisi F, Beccia M. A case series of young stroke in Rome. Eur J Neurol. 2006;13:146–52.

    Article  PubMed  CAS  Google Scholar 

  17. Lipton RB, Stewart WF, Diamond S, Diamond ML, Reed M. Prevalence and burden of migraine in the United States: data from the American Migraine Study II. Headache. 2001;41:646–57.

    Article  PubMed  CAS  Google Scholar 

  18. Oral contraceptives and stroke in young women. Associated risk factors. JAMA. 1975;231:718–722.

    Google Scholar 

  19. Henrich JB, Horwitz RI. A controlled study of ischemic stroke risk in migraine patients. J Clin Epidemiol. 1989;42:773–80.

    Article  PubMed  CAS  Google Scholar 

  20. Tzourio C, Tehindrazanarivelo A, Iglesias S, Alperovitch A, Chedru F, d'Anglejan-Chatillon J, Bousser MG. Case–control study of migraine and risk of ischaemic stroke in young women. BMJ. 1995;310:830–3.

    Article  PubMed  CAS  Google Scholar 

  21. MacClellan LR, Giles W, Cole J, Wozniak M, Stern B, Mitchell BD, Kittner SJ. Probable migraine with visual aura and risk of ischemic stroke: the stroke prevention in Young Women Study. Stroke. 2007;38:2438–45.

    Article  PubMed  Google Scholar 

  22. Garg P, Servoss SJ, Wu JC, Bajwa ZH, Selim MH, Dineen A, Kuntz RE, Cook EF, Mauri L. Lack of association between migraine headache and patent foramen ovale: results of a case–control study. Circulation. 2010;121:1406–12.

    Article  PubMed  Google Scholar 

  23. Woods TD, Harmann L, Purath T, Ramamurthy S, Subramanian S, Jackson S, Tarima S. Small- and moderate-size right-to-left shunts identified by saline contrast echocardiography are normal and unrelated to migraine headache. Chest. 2010;138:264–9.

    Article  PubMed  Google Scholar 

  24. Feurer R, Sadikovic S, Sepp D, Esposito L, Schleef M, Bockelbrink A, Schwarze J, Hemmer B, Sander D, Poppert H. Patent foramen ovale is not associated with an increased risk of stroke recurrence. Eur J Neurol. 2010;17:1339–45.

    PubMed  CAS  Google Scholar 

  25. Thaler DE, Saver JL. Cryptogenic stroke and patent foramen ovale. Curr Opin Cardiol. 2008;23:537–44.

    Article  PubMed  Google Scholar 

  26. Tzourio C, Benslamia L, Guillon B, Aidi S, Bertrand M, Berthet K, Bousser MG. Migraine and the risk of cervical artery dissection: a case–control study. Neurology. 2002;59:435–7.

    PubMed  CAS  Google Scholar 

  27. The international classification of headache disorders: 2nd edition. Cephalalgia Int J Headache. 2004;24(Suppl 1):9–160.

    Google Scholar 

  28. Rothrock JF, Walicke P, Swenson MR, Lyden PD, Logan WR. Migrainous stroke. Arch Neurol. 1988;45:63–7.

    Article  PubMed  CAS  Google Scholar 

  29. Bogousslavsky J, Regli F, Van Melle G, Payot M, Uske A. Migraine stroke. Neurology. 1988;38:223–7.

    PubMed  CAS  Google Scholar 

  30. Broderick JP, Swanson JW. Migraine-related strokes. Clinical profile and prognosis in 20 patients. Arch Neurol. 1987;44:868–71.

    Article  PubMed  CAS  Google Scholar 

  31. Sochurkova D, Moreau T, Lemesle M, Menassa M, Giroud M, Dumas R. Migraine history and migraine-induced stroke in the Dijon Stroke Registry. Neuroepidemiology. 1999;18:85–91.

    Article  PubMed  CAS  Google Scholar 

  32. Arboix A, Massons J, Garcia-Eroles L, Oliveres M, Balcells M, Targa C. Migrainous cerebral infarction in the sagrat cor hospital of Barcelona Stroke Registry. Cephalalgia Int J Headache. 2003;23:389–94.

    Article  CAS  Google Scholar 

  33. Laurell K, Artto V, Bendtsen L, Hagen K, Kallela M, Meyer EL, Putaala J, Tronvik E, Zwart JA, Linde M. Migrainous infarction: a Nordic Multicenter Study. Eur J Neurol. 2011;18:1220–6.

    Article  PubMed  CAS  Google Scholar 

  34. Marshall N, Maclaurin WA, Koulouris G. MRA captures vasospasm in fatal migrainous infarction. Headache. 2007;47:280–3.

    Article  PubMed  Google Scholar 

  35. • Wolf ME, Szabo K, Griebe M, Forster A, Gass A, Hennerici MG, Kern R. Clinical and MRI characteristics of acute migrainous infarction. Neurology. 2011;76:1911–7. This is a study based on a stroke register including 8,137 patients (of which 17 patients had migrainous infarction) collected over an 11-year period. Clinical features, vascular risk factors, and MRI findings were in agreement with previous observations.

    Article  PubMed  CAS  Google Scholar 

  36. Lauritzen M, Skyhoj Olsen T, Lassen NA, Paulson OB. Changes in regional cerebral blood flow during the course of classic migraine attacks. Ann Neurol. 1983;13:633–41.

    Article  PubMed  CAS  Google Scholar 

  37. Olesen J, Larsen B, Lauritzen M. Focal hyperemia followed by spreading oligemia and impaired activation of RCBF in classic migraine. Ann Neurol. 1981;9:344–52.

    Article  PubMed  CAS  Google Scholar 

  38. Lauritzen M, Dreier JP, Fabricius M, Hartings JA, Graf R, Strong AJ. Clinical relevance of cortical spreading depression in neurological disorders: migraine, malignant stroke, subarachnoid and intracranial hemorrhage, and traumatic brain injury. J Cereb Blood Flow Metab. 2011;31:17–35.

    Article  PubMed  Google Scholar 

  39. Pezzini A, Del Zotto E, Giossi A, Volonghi I, Grassi M, Padovani A. The migraine-ischemic stroke connection: potential pathogenic mechanisms. Curr Mol Med. 2009;9:215–26.

    Article  PubMed  CAS  Google Scholar 

  40. Kurth T, Chabriat H, Bousser MG. Migraine and stroke: a complex association with clinical implications. Lancet Neurol. 2012;11:92–100.

    Article  PubMed  Google Scholar 

  41. Bates D, Ashford E, Dawson R, Ensink FB, Gilhus NE, Olesen J, Pilgrim AJ, Shevlin P. Subcutaneous sumatriptan during the migraine aura. Sumatriptan Aura Study Group. Neurology. 1994;44:1587–92.

    PubMed  CAS  Google Scholar 

  42. Cavazos JE, Caress JB, Chilukuri VR, Devlin T, Gray L, Hurwitz BJ. Sumatriptan-induced stroke in sagittal sinus thrombosis. Lancet. 1994;343:1105–6.

    Article  PubMed  CAS  Google Scholar 

  43. Jayamaha JE, Street MK. Fatal cerebellar infarction in a migraine sufferer whilst receiving sumatriptan. Intensive Care Med. 1995;21:82–3.

    Article  PubMed  CAS  Google Scholar 

  44. Vijayan N, Peacock JH. Spinal cord infarction during use of zolmitriptan: a case report. Headache. 2000;40:57–60.

    Article  PubMed  CAS  Google Scholar 

  45. Velentgas P, Cole JA, Mo J, Sikes CR, Walker AM. Severe vascular events in migraine patients. Headache. 2004;44:642–51.

    Article  PubMed  Google Scholar 

  46. Skoloudik D, Kral M, Sanak D, Vlachova I, Hlustik P, Michalkova K, Herzig R, Kanovsky P. Thrombolytic treatment of ischaemic stroke occurring during a migrainous attack: a case report. Cephalalgia Int J Headache. 2010;30:368–72.

    CAS  Google Scholar 

  47. Lees KR, Bluhmki E, von Kummer R, Brott TG, Toni D, Grotta JC, Albers GW, Kaste M, Marler JR, Hamilton SA, Tilley BC, Davis SM, Donnan GA, Hacke W, Allen K, Mau J, Meier D, del Zoppo G, De Silva DA, Butcher KS, Parsons MW, Barber PA, Levi C, Bladin C, Byrnes G. Time to treatment with intravenous alteplase and outcome in stroke: an updated pooled analysis of ecass, Atlantis, ninds, and epithet trials. Lancet. 2010;375:1695–703.

    Article  PubMed  CAS  Google Scholar 

  48. Chernyshev OY, Martin-Schild S, Albright KC, Barreto A, Misra V, Acosta I, Grotta JC, Savitz SI. Safety of TPA in stroke mimics and neuroimaging-negative cerebral ischemia. Neurology. 2010;74:1340–5.

    Article  PubMed  CAS  Google Scholar 

  49. Meyer BC, Hemmen TM, Jackson CM, Lyden PD. Modified national institutes of health stroke scale for use in stroke clinical trials: prospective reliability and validity. Stroke. 2002;33:1261–6.

    Article  PubMed  Google Scholar 

  50. Winkler DT, Fluri F, Fuhr P, Wetzel SG, Lyrer PA, Ruegg S, Engelter ST. Thrombolysis in stroke mimics: frequency, clinical characteristics, and outcome. Stroke. 2009;40:1522–5.

    Article  PubMed  Google Scholar 

  51. Uchino K, Massaro L, Hammer MD. Transient ischemic attack after tissue plasminogen activator: aborted stroke or unnecessary stroke therapy? Cerebrovasc Dis. 2010;29:57–61.

    Article  PubMed  CAS  Google Scholar 

  52. Donnan GA, Baron JC, Ma H, Davis SM. Penumbral selection of patients for trials of acute stroke therapy. Lancet Neurol. 2009;8:261–9.

    Article  PubMed  CAS  Google Scholar 

  53. Hacke W, Furlan AJ, Al-Rawi Y, Davalos A, Fiebach JB, Gruber F, Kaste M, Lipka LJ, Pedraza S, Ringleb PA, Rowley HA, Schneider D, Schwamm LH, Leal JS, Sohngen M, Teal PA, Wilhelm-Ogunbiyi K, Wintermark M, Warach S. Intravenous desmoteplase in patients with acute ischaemic stroke selected by MRI perfusion-diffusion weighted imaging or perfusion ct (dias-2): a prospective, randomised, double-blind, placebo-controlled study. Lancet Neurol. 2009;8:141–50.

    Article  PubMed  CAS  Google Scholar 

  54. Hachinski V, Norris JW, Edmeads J, Cooper PW. Ergotamine and cerebral blood flow. Stroke. 1978;9:594–6.

    Article  PubMed  CAS  Google Scholar 

  55. Evers S, Afra J, Frese A, Goadsby PJ, Linde M, May A, Sandor PS. EFNS guideline on the drug treatment of migraine–report of an EFNS task force. Eur J Neurol. 2006;13:560–72.

    Article  PubMed  CAS  Google Scholar 

  56. D'Andrea G, Colavito D, Dalle Carbonare M, Leon A. Migraine with aura: conventional and non-conventional treatments. Neurol Sci Off J Ital Neurol Soc Ital Soc Clin Neurophysiol. 2011;32 Suppl 1:S121–9.

    Google Scholar 

  57. Goldner JA, Levitt LP. Treatment of complicated migraine with sublingual nifedipine. Headache. 1987;27:484–6.

    Article  PubMed  CAS  Google Scholar 

  58. Lampl C, Katsarava Z, Diener HC, Limmroth V. Lamotrigine reduces migraine aura and migraine attacks in patients with migraine with aura. J Neurol Neurosurg Psychiatry. 2005;76:1730–2.

    Article  PubMed  CAS  Google Scholar 

  59. Collaborative meta-analysis of randomised trials of antiplatelet therapy for prevention of death, myocardial infarction, and stroke in high risk patients. BMJ. 2002;324:71–86.

  60. Rothrock J, North J, Madden K, Lyden P, Fleck P, Dittrich H. Migraine and migrainous stroke: risk factors and prognosis. Neurology. 1993;43:2473–6.

    PubMed  CAS  Google Scholar 

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Laurell, K., Lundström, E. Migrainous Infarction: Aspects on Risk Factors and Therapy. Curr Pain Headache Rep 16, 255–260 (2012). https://doi.org/10.1007/s11916-012-0262-2

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