Division of Translational Research, Department of Medical Research, Taipei Veterans General Hospital, Taipei, Taiwan.
Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan.
Headache. 2020 Jan;60(1):217-228. doi: 10.1111/head.13664. Epub 2019 Oct 3.
Migraine and stroke are among the most prevalent and disabling neurological diseases. Epidemiologic studies showed that there is an association between migraine and stroke. Migraineurs, especially those with aura, are more likely to develop subclinical infarct-like lesions in the brain and are at risk for cryptogenic or cardioembolic stroke. Migrainous headache can be found at the onset of acute ischemic stroke in some patients, and in rare instances, an infarction can be directly attributed to a prolonged migraine aura, ie, migrainous infarction. Importantly, recent studies suggest that in the event of cerebral artery occlusion, even a history of migraine is sufficient to accelerate infarct progression and worsen outcomes. The mechanisms underlying the migraine-stroke connection are multifactorial, with genetic predisposition, aura-related electrophysiological mechanisms (cortical spreading depolarization), and cerebral microembolism being the most convincing ones at this point. Here, we provide a comprehensive overview on recent imaging studies that have helped us better understand the complex association between migraine and stroke.
偏头痛和中风是最常见和最致残的神经疾病之一。流行病学研究表明，偏头痛和中风之间存在关联。偏头痛患者，尤其是有先兆的偏头痛患者，更有可能在大脑中出现亚临床梗死样病变，并存在隐源性或心源性中风的风险。在一些患者中，急性缺血性中风发作时可出现偏头痛性头痛，在极少数情况下，可直接归因于长时间偏头痛先兆的梗死，即偏头痛性梗死。重要的是，最近的研究表明，在发生大脑动脉闭塞的情况下，即使有偏头痛病史，也足以加速梗死进展并使预后恶化。偏头痛和中风之间联系的机制是多因素的，遗传易感性、先兆相关的电生理机制（皮质扩散性抑制）和脑微栓塞是目前最有说服力的机制。在这里，我们提供了对最近的影像学研究的全面综述，这些研究帮助我们更好地理解偏头痛和中风之间的复杂关系。
