Migraine and stroke: a complex association with clinical implications

Summary Migraine and stroke are two common and heterogeneous neurovascular disorders with complex relations. Data show no firm association between stroke and migraine without aura—by far the most common type of migraine—but a doubling of the risk of ischaemic stroke in people who have migraine with aura. Migraine with aura is characterised by a low brain threshold for cortical spreading depression, the biological substrate of the aura, which can be triggered by many factors, including specific diseases that can by themselves increase the risk of ischaemic stroke. Whether the increased risk of ischaemic stroke applies to migraine with aura as a primary headache disorder or is partly due to migraine with aura secondary to other disorders remains to be elucidated.