Agostoni E, Fumagalli L, Santoro P, Ferrarese C
Stroke Unit, Headache Center, Department of Neurology, University of Milano-Bicocca, Ospedale San Gerardo, Via Donizetti 106, I-20052 Monza (MI), Italy.
Neurol Sci. 2004 Oct;25 Suppl 3:S123-5. doi: 10.1007/s10072-004-0268-6.
The association between migraine and stroke is a dilemma for neurologists. Migraine is associated with an increased stroke risk and it is considered an independent risk factor for ischaemic stroke in a particular subgroup of patients. The pathogenesis is not known but several studies report some common biochemical mechanisms between the two diseases. A classification of migraine-related stroke that encompasses the full spectrum of the possible relationship between migraine and stroke has been proposed and it includes three main entities: coexisting stroke and migraine, stroke with clinical features of migraine, and migraine-induced stroke. The concept of migraine-induced stroke is well represented by migrainous infarction; it is described in the revised classification of the International Headache Society (IHS), and it represents the strongest demonstration of the relationship between ischaemic stroke and migraine. A very interesting common condition in stroke and migraine is patent foramen ovale (PFO) which could play a pathogenetic role in both disorders. The association between migraine and cervical artery dissection (CAD) is reported in recent studies. Migraine is more frequent in patients with CAD. This supports the hypothesis that an underlying arterial wall disease could be a predisposing condition for migraine. The neuroradiological evidence of subclinical lesions most typical in the white matter and in the posterior artery territories in patients with migraine, opens a new field of research. In conclusion the association between migraine and stroke remains conflicting. Solving the above mentioned issues is fundamental to understanding the epidemiologic, pathogenetic and clinical aspects of migraine-related stroke.
偏头痛与中风之间的关联对神经科医生来说是个难题。偏头痛与中风风险增加相关，在特定亚组患者中，它被视为缺血性中风的独立危险因素。其发病机制尚不清楚，但多项研究报告了这两种疾病之间一些共同的生化机制。有人提出了一种偏头痛相关性中风的分类方法，涵盖了偏头痛与中风之间可能关系的全谱，包括三个主要类型：中风与偏头痛并存、具有偏头痛临床特征的中风、偏头痛诱发的中风。偏头痛诱发的中风这一概念在偏头痛性梗死中得到了很好的体现；它在国际头痛协会（IHS）的修订分类中有描述，是缺血性中风与偏头痛之间关系的最有力证明。中风和偏头痛中一个非常有趣的共同情况是卵圆孔未闭（PFO），它可能在这两种疾病中都发挥致病作用。近期研究报道了偏头痛与颈动脉夹层（CAD）之间的关联。CAD患者中偏头痛更为常见。这支持了一种假说，即潜在的动脉壁疾病可能是偏头痛的易感因素。偏头痛患者白质和后动脉区域最典型的亚临床病变的神经放射学证据，开辟了一个新的研究领域。总之，偏头痛与中风之间的关联仍然存在争议。解决上述问题对于理解偏头痛相关性中风的流行病学、发病机制和临床方面至关重要。
