Migraine with Visual aura and the Risk of Stroke- a Narrative Review |
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| Affiliation: | 1. Department of Ophthalmology, Mackay Memorial Hospital, Taipei, Taiwan;2. Department of Neurology, Mayo Clinic, Scottsdale, AZ, USA;3. Department of Neurology, Mayo Clinic, Rochester, MN 55905, USA;1. Department of Neurosurgery, Juntendo University Shizuoka Hospital, Izunokuni, Shizuoka, Japan;2. Department of Neurosurgery, Juntendo University School of Medicine, Tokyo, Japan;3. Department of Neurosurgery, Shin-Yurigaoka General Hospital, Kawasaki, Kanagawa, Japan;4. Department of Neurosurgery, Juntendo Tokyo Koto Geriatric Medical Centre, Tokyo, Japan;1. Division of Neurology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan;2. Division of Diabetes and Metabolic Diseases, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan;3. Department of Neurological Surgery, Nihon University School of Medicine, Tokyo, Japan;1. Department of Neurology, Seoul St. Mary''s Hospital, College of Medicine, The Catholic University of Korea, Republic of Korea;2. Department of Neurology, St. Vincent''s Hospital, College of Medicine, The Catholic University of Korea, 93, Jungbu-daero, Paldal-gu, Suwon-si, Gyeonggi-do, Republic of Korea;1. International Clinical Research Center, St. Anne''s University Hospital Brno, Brno, Czech Republic;2. 1st Department of Neurology and International Clinical Research Center, St. Anne''s University Hospital Brno, Brno, Czech Republic,;3. Faculty of Medicine, Masaryk University, Brno, Czech Republic;1. Department of Surgery, Lewis Katz School of Medicine, Temple University, Philadelphia, PA, United States;2. Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, United States;3. Department of Neurology, SUNY Downstate Health Sciences University, 450 Clarkson Avenue, MSC 1213, Brooklyn, NY 11203, United States;4. Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, United States;5. Department of Neurology, A.T. Still University, Mesa, AZ; Midwestern University, Glendale, AZ Honor Health Neurocritical care and Stroke Services, Phoenix, AZ, United States;6. The Stroke and Cognition Institute, The Rambam Health Care Campus, Haifa, Israel;7. Department of Neurology, Maine Medical Center, Portland, ME, United States;8. Departments of Neurology and Emergency Medicine, Stroke Center, SUNY Downstate Health Sciences University at Brooklyn, Brooklyn, NY, United States;9. Department of Neurology, Kings County Hospital Center, Brooklyn, NY, United States;10. Jaffe Stroke Center, Maimonides Medical Center, Brooklyn, NY, United States;1. Department of Neurology, Division of Cerebrovascular Diseases, University of Iowa, Iowa City, Iowa, USA;2. Department of Internal Medicine, Division of Hematology/Oncology, University of Iowa, Iowa City, Iowa, USA.;3. Department of Neurosurgery, University of Iowa, Iowa City, Iowa, USA;4. Department of Epidemiology, University of Iowa, Iowa City, Iowa, USA |
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| Abstract: | ![]()
ObjectivesPatients with migraine with visual aura (MwvA) often present to eye care providers for evaluation. A thorough ophthalmological history and examination is needed to exclude ophthalmologic disorders. Additionally, it has been increasingly recognized that MwvA is associated with ischemic stroke (IS). The aim of this narrative review is to provide a comprehensive overview of the differential diagnosis of MwvA and its association with IS.Materials and methodsWe conducted a PubMed search using key words including “migraine aura”, “visual aura without headache”, “late onset migraine accompaniment”, “migraine and stroke”, “migraine and atrial fibrillation”, and “migraine and patent foramen ovale (PFO)”. We narratively summarized the main findings of the identified studies in sections including age of onset and frequency of migraine with aura, stroke subtypes, and the role of cardioembolism in the migraine-stroke association.Results and ConclusionFor women younger than 50 years, MwvA is associated with an increased risk of IS, and the risk further increases in patients who also smoke and use oral contraceptives. Age of onset of MwvA 50 years or greater is associated with IS that occurs in late life. Studies reported that increased frequency of aura is associated with an increased risk of IS in women. MwvA is associated with an increased risk of cardioembolic stroke and a higher incidence of atrial fibrillation compared to migraine without aura. Most studies that assessed the migraine-stroke association were based on patients with MwvA. The risks of stroke associated with other types of migraine aura or aura without headache, as well as such association in men require further investigation. More data is needed to determine the absolute risk of stroke when evaluating MwvA in situations including smoking and low dose estrogen use, new or late onset (>50 years) MwvA, to facilitate the development of practice guidelines for stroke prevention in specific clinical scenarios. |
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