Dr. Brian M. Plato provides insights on ways to reduce the risk

Published: January 5, 2024

Some people who experience migraine face an increased stroke risk, but there are ways to lessen the danger, according to Brian M. Plato, D.O., headache and migraine specialist with Norton Neuroscience Institute.

Nearly 1 in 5 women have migraine three times the rate for men. In the United States alone, 28 million women experience migraine.

There are two types of migraine: with or without aura.

Migraine with aura or MA is linked to a higher risk for ischemic stroke and heart attack. An ischemic stroke is caused by a blood clot in the brain. Hemorrhagic stroke, the other major type of stroke, is caused by a leaking blood vessel.

Migraine aura – flashes of light, blind spots or other changes in vision – typically precedes the headache pain. Migraine aura symptoms usually strike less than an hour before migraine’s intense head pain, nausea and heightened sensory sensitivity.

Migraine without aura does not seem to pose the higher stroke or heart attack risk that migraine with aura does. Most people with migraine do not have aura. Some people get both types of migraine.

Studies of women with MA attacks found the risk for stroke is independent of typical heart disease risk factors like age, diabetes and high blood pressure. Research looking at data from a number of studies found migraine is associated with a 1.5-fold increased ischemic stroke risk.

The combination of smoking and MA significantly increases the risk of having a stroke. Oral contraceptive use increases the risk even more.

Women who smoke and have migraine with aura should avoid oral contraceptives that contain estrogen, according to Dr. Plato, because the combined risks from all three increase the risk of stroke significantly.

The link between migraine and heart disease does not mean migraine is the cause of a stroke or heart attack. According to Dr. Plato, the higher risk is likely the result of several factors. Possible contributors include:

• The use of nonsteroidal anti-inflammatory drugs (NSAIDs) to treat migraine
• Inflammation
• Issues with the lining of blood vessels
• Lifestyle factors related to migraine, including reduced physical activity
• Genetics
• A common condition called patent foramen ovale, a hole between the left and right upper chambers of the heart
• Increased risk for a tear in an artery in the neck

An ischemic stroke is caused by a plaque buildup on the wall of a blood vessel breaking off and forming a clot that blocks blood flow to the brain. Cardiovascular disease also can contribute to a heart attack as the plaque blocks blood flow to the heart muscle.

For some, stroke symptoms and a migraine attack may seem similar. However, they are very different conditions. While stroke is caused by interrupted blood flow to the brain, migraine is thought to have more to do with chemical compounds and hormones. Rarely, a migraine attack appears to be associated with an ischemic stroke (migrainous stroke or migrainous infarction). 

Dr. Plato’s advice to patients is to work on lifestyle changes that decrease stroke and heart attack risks, including regular aerobic (cardiovascular) exercise, a healthy diet and not smoking.

Since the frequency of migraine aura attacks appears to be associated with higher cardiovascular risk, migraine preventive treatment might be beneficial, according to Dr. Plato.

Younger women shouldn’t be overly concerned about the migraine with aura stroke risk or heart attack. For women under 50, even those who have MA, the odds of having a stroke is lower than being struck by lightning.