People who have frequent migraines will quickly tell you that the pain can be excruciating. And for some sufferers, these headaches may also herald an increased vulnerability to small blood vessel damage in the brain and resulting strokes.
Approximately one in six adults in the United States reports having migraines. About a third of these people experience visual disturbances, known as aura, that precede the headache. While everyone with a history of migraines has a slightly elevated stroke risk, the likelihood double or triples in people with aura.
Other factors can further elevate risk. Dr. Cenk Ayata, a neurologist and stroke researcher at Massachusetts General Hospital, notes, “A woman under age 50 who has migraine with aura will have four to six times the risk of stroke than a person in the general population. If that same woman smokes and uses birth control pills, her risk increases to 34 times that of the average.” Strokes are very rare in young women, but those factors substantially raise the risk.
Very rarely, a migraine attack can bring on a stroke, says Dr. Ayata. More likely, both conditions stem from a common source. Possible culprits include genetic traits that affect neurological activity or underlying vascular conditions that propel small blood clots into the tiny vessels of the brain. Larger clots may shut off blood flow completely, causing a stroke, while tiny pieces of debris may trigger only a migraine. Side effects of common medications used to treat migraines may also contribute. Migraine drugs called triptans as well as certain antidepressants used in headache treatment can constrict the brain’s blood vessels, which could lead to stroke.
What can you do?
“It may turn out that a history of migraine with aura becomes a well-documented stroke risk factor with established treatments,” says Dr. Ayata. But in the meantime, migraine sufferers should just be aware of the stroke connection and reduce their other stroke risk factors. Women under age 50 with migraines should avoid smoking and taking oral contraceptives, which exacerbate the danger. For people of all ages—with or without migraines—adhering to basic stroke prevention strategies such as controlling blood pressure, diabetes, and lipid levels is a wise move.?