Nathan Neal, Ngo Angeline, Khoromi Suzan
Department of Neurosciences, University of California-San Diego, 200 W Arbor Drive, San Diego, CA 92103, USA.
J Clin Med. 2024 Sep 11;13(18):5380. doi: 10.3390/jcm13185380.
An increased risk of ischemic stroke in migraine with aura (MA) has been consistently demonstrated. The pathophysiology of risk factors is not yet well understood. Several mechanisms have been proposed to explain the association between MA and ischemic stroke including decreased focal cerebral blood flow and other phenomena linked with cortical spreading depression (CSD) as well as neurovascular pathology, which appear to play a key role in MA. In addition to genetic predisposition, other classic stroke risk factors such as atrial fibrillation, emboli, migraine-associated vasculopathy, endothelial dysfunction, platelet dysfunction, coagulation pathway abnormalities, and inflammatory factors have been examined and investigated. For further clarification, distinctions have been made between features of migrainous infarctions and non-migrainous infarctions among migraineurs. Furthermore, the association is less clear when considering the mixed results studying the risk of ischemic stroke in migraines without aura (MO) and the risk of hemorrhagic stroke in people with all types of migraine. Translational research is investigating the role of biomarkers which can help identify vascular links between stroke and migraine and lead to further treatment developments. We performed a scoping review of the PubMed database to further characterize and update the clinical connections between migraine and stroke.
有先兆偏头痛（MA）患者发生缺血性卒中的风险增加已得到一致证实。危险因素的病理生理学尚未完全明确。已经提出了几种机制来解释MA与缺血性卒中之间的关联，包括局部脑血流量减少以及与皮层扩散性抑制（CSD）相关的其他现象，以及神经血管病理，这些似乎在MA中起关键作用。除了遗传易感性外，还对其他经典的卒中危险因素进行了研究，如心房颤动、栓子、偏头痛相关血管病变、内皮功能障碍、血小板功能障碍、凝血途径异常和炎症因子。为了进一步阐明，对偏头痛患者中偏头痛性梗死和非偏头痛性梗死的特征进行了区分。此外，在考虑无先兆偏头痛（MO）患者发生缺血性卒中风险以及所有类型偏头痛患者发生出血性卒中风险的研究结果不一致时，这种关联就不那么明确了。转化研究正在探究生物标志物的作用，这些生物标志物有助于识别卒中和偏头痛之间的血管联系，并推动进一步的治疗进展。我们对PubMed数据库进行了范围综述，以进一步描述和更新偏头痛与卒中之间的临床联系。
