Case Study Indicates Link Between Stroke and Migraine

A recent case study of a patient with a history of migraine with visual aura revealed a pathophysiological link between stroke and migraine, demonstrating the need for additional research that links migrainous infarction (MI) and stroke-related migraine.

The case study, published in the Journal of Pain Research, involved a 44-year-old female with a history of migraine with visual aura who visited the emergency department after a sudden onset of left limb paresis and hypoesthesia. Following brain magnetic resonance imaging, a right fronto-parietal ischemic stroke was found. Furthermore, according to the study, 2 days after hospitalization the patient experienced a prolonged visual aura and an ultrasound revealed evidence of intracranial artery vasospasm.

“The pathophysiology of migrainous infarction is not well understood, although biochemical cascades and cerebral blood flow changes — namely, arterial vasospasm consequent to cortical spreading depression — may play a critical role. Transcranial color Doppler sonography is a non-invasive and effective tool for the early detection and monitoring of intracranial blood flow changes in migraine and its complications, providing new insight into the pathophysiological link between stroke and migraine,” explained the authors.

The research also considered 33 published articles involving 119 patients with MI. Based on the collected data, sustained hyperexcitability of cortical neurons, impairment of γ-aminobutyric acid inhibitory circuitry, altered serotonergic transmission, release of vasoconstrictive molecules, and cerebral blood flow changes have been proposed as pathogenic mechanisms of MI.

“If the clinical suspicion of MI is confirmed, comprehensive clinical and instrumental analyses should be carried out for accurate diagnosis and therapeutic management. Prospective multicenter studies are needed to obtain insight into the pathogenic mechanisms underlying MI and to standardize diagnostic and treatment approaches,” concluded the authors.

The authors emphasized that the case study and literature review demonstrate that arteries of migrainous patients are more likely to develop vasospasm and therefore increasing the risk of stroke. Additional studies must be conducted in order to clarify the role of vasospasm in migraines and the occurrence of MI, according to the authors.

Reference

Vinciguerra L, Cantone M, Lanza G, et al. Migrainous infarction and cerebral vasospasm: Case report And literature review [published online October 21, 2019]. J Pain Res. doi: 10.2147/JPR.S209485.