Migraine & Stroke Risk in Women

Hans-Christoph Diener, MD, PhD expands on stroke risks specific to women with migraine with aura.

There is still much research to be done on the relationship between stroke and migraine, but studies have confirmed that young women with migraine with aura are at an increased risk. Hans-Christoph Diener, MD, PhD, a Senior Professor of Clinical Neurosciences at the University of Duisburg-Essen in Germany, has been studying headache as it relates to stroke for more than 20 years. He recently spoke with the American Headache Society about the unique ways vascular issues like stroke can impact women with migraine with aura.

Tell us about the relationship between stroke and migraine

It was first observed about 20 years ago when the first large-scale registries were done. The registry originally was implemented to investigate risk factors for stroke, myocardial infarction, and cancer. One question that was addressed in these huge registries was, “Is there a relationship perhaps between migraine and stroke?” As it turned out, there was a relationship, and it showed that women below the age of 45 who have migraine with aura have an increased risk of ischemic stroke.

So are some patients with migraine or headache more at risk than others?

Men with migraine with and without aura do not have any significant risk of stroke. Women with migraine without aura don’t show any significant risks either. It’s just women who have migraine with aura who are at a higher risk, especially if there are any additional risk factors for vascular disease at play, like high blood pressure, obesity and especially smoking. I would say smoking poses the highest added risk for women who have migraine with aura.

What recommendations can you make for patients with migraine or headache looking to lower their risk of stroke?

Women with migraine shouldn’t live in fear of having a stroke because that’s not really the issue. Instead, they should look for other vascular risk factors present. It’s really worthwhile to go to a physician at least once a year for a check up on hypertension, high cholesterol, diabetes, obesity, and other lifestyle factors that may put you at an increased risk for stroke.

Some people say that there’s a risk between contraceptive use and stroke, is that escalated in migraine patients?

We observed this in studies that took place about 20 years ago. At that time, most contraceptives had a much higher estrogen content than they do today, not to say that there is no longer any risk. And we recently found that risk isn’t just increased for ischemic stroke, it’s for all vascular diseases. Women with migraine with aura are at an increased risk for myocardial infarction, needing coronary bypass surgery, needing a heart stent and they have a slightly increased risk of vascular death.

What further research needs to be done in order to understand a link between migraine and stroke and how to evaluate patients?

The big unanswered question is “how much of this is genetic?” because that’s not something we as doctors can influence directly through treatment. We also need to do more research on the additional vascular risk factors that may be present in women with migraine with aura in order to truly know their influence.

Is there anything else you’d like to share on the topic?

There’s another interesting issue that affects women with migraine with aura. As you may know, women with migraine with aura frequently show mild changes on MRI scans. These are called “white matter lesions” and often appear as small black holes. These are important because if a radiologist doesn’t know that a patient has migraine, or doesn’t know that these can be a symptom of migraine, they may make a misdiagnosis of multiple sclerosis or stroke. That’s a very frightening diagnosis to receive if you only have migraine. I think that it’s important for this to become common knowledge so women with migraine with aura know to get a diagnosis of either reviewed by a headache specialist.

Hans-Christoph Diener, MD, PhD, is a member of the American Headache Society, a professional society for doctors and other healthcare workers who specialize in studying and treating headache and migraine. The Society’s objectives are to promote the exchange of information and ideas concerning the causes and treatments of headache and related painful disorders, and to share and advance the work of its members. Learn more about the American Headache Society’s work and find out how you canbecome a member today.