Migraine, especially
migraine with aura (MA), is an established risk factor for ischemic lesions of the brain. Recent evidence has also linked
migraine to a broader range of ischemic vascular disorders including angina,
myocardial infarction, coronary revascularization, claudication, and cardiovascular mortality. The mechanisms which link
migraine to ischemic
vascular disease remain uncertain and are likely to be complex. Cortical spreading depression, the presumed substrate of
aura, may directly predispose to brain lesions and that would explain why MA is consistently demonstrated as a risk factor for
cerebral ischemia, while for
migraine without aura (MO), the evidence is less consistent. Additionally, individuals with
migraine have a higher prevalence of risk factors known to be associated with
cardiovascular disease (CVD), including
hypertension, diabetes, and
hyperlipidemia. The increased prevalence of CVD risk factors is also higher for MA than for MO. Since the evidence linking
migraine and CVD is getting robust, neurologists should be aware of this association. Individuals with MO seem to be at little increased risk of CVD. MA is associated with an increased risk of
ischemic stroke and likely also for other ischemic CVD events. Accordingly, heightened vigilance is recommended for modifiable cardiovascular risk factors in migraineurs, especially with MA. Ultimately, it will be important to determine whether MA is a modifiable risk factor for CVD and if preventive medications for
migraine or antiplatelet
therapy might reduce the risk of CVD in patients with MA.