Vascular risk in migraine: an update

It is well established that migraine is associated with an increased relative risk of ischemic stroke. This relative risk is dramatically increased when migraine with aura is associated with tobacco consumption or contraceptive pill with oestrogen. Migraine is also associated with an increased relative risk of subcortical white matter hypersignals and with patent foramen ovale. Recent Dutch population survey has suggested an increased relative risk of silent infarcts in migraine, especially in cerebellum. Migrainous infarct could not explain these facts: this diagnosis is extremely rare and required a complete and totally negative diagnostic work-up. Recent US epidemiological data suggests an increased risk of coronary artery diseases in migraine with aura in women older than 45. The increased risk of ischemic events is probably multifactorial with more traditional vascular risk factors in migrainers, endothelial dysfunction, decreased level of circulating progenitor cells, prothrombotic circulating factors, and venous thromboembolic disease. Up to now, it is not established that prophylactic treatment of migraine could modify the vascular risk associated with migraine.