Relationship between migraine and stroke: how true and how close

Migraine is a common chronic disorder with episodic headache. Up to one third of patients with migraine experience headache characterized by neurological symptoms most often involving the visual fields and less often the sensory or speech. Migraine physiology has been well elucidated but several lacunae still remain. Several mechanisms have been implicated to explain the link between migraine and the occurrence of stroke and cardiovascular disease. None have been definitively proven. In the absence of robust evidence, the best possible advice will be: in an otherwise healthy young person with migraine, no cause for concern exists because of the very low absolute risk of stroke. Advice to stop smoking seems prudent, as does oestrogen or only progesterone to young women with migraine. Further research is imperative on the association between migraine and mortality from stroke and cardiovascular disease and all causes including studies to identify whether there are specific subgroups of people with migraine who are at enhance risk because of genetic or environmental factors.