What Is a Migrainous Infarction?

Migraine is the cause of some strokes
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Migrainous infarction is a term that was originally coined by the International Headache Society to describe strokes which occur in the setting of a migraine attack. The word infarction, as used in this term, has the same meaning as the word stroke. Thus, this condition is also known as "migraine-induced stroke."

Overview

Not every stroke that occurs in the setting of a migraine can be called a migrainous infarction.

The following characteristics must be present:

  • The migraine attack must be preceded by an aura
  • The migraine attack must be similar in intensity to previous migraine attacks
  • The migraine aura must persist for hours or days
  • A stroke must be seen on a CT or MRI scan
  • The stroke must be located in a part of the brain which explains the symptoms of the stroke
  • All other possible causes of stroke must have been ruled out

Using these strict criteria, migrainous-infarction accounts for approximately 0.8 percent of all strokes, but for approximately 4 percent of strokes that occur in people younger than 50.

Cause

The causes of migrainous infarction are not known. It occurs primarily in younger women who have a history of a migraine with aura, although that may be due to a migraine with aura being more frequent in that population. Almost two-thirds of the patients in one study had a patent foramen ovale, a common heart defect that normally occurs in about a quarter of the population.

The lesions of the stroke are usually found in the posterior circulation.

Signs and Symptoms

The migraine aura is usually a visual aura, which may be followed by sensory dysfunction and aphasia. Symptoms often include visual field deficits, mild hemiparesis (weakness on one side of the body) or tetraparesis (weakness of all four limbs), and aphasia (loss of ability to talk).

Diagnosis

For aura symptoms that last longer than an hour, you should see your doctor determine whether there is a loss of the blood supply in an area of your brain. Your doctor will do imaging tests to look for bleeding in the brain. The imaging usually finds small lesions or multiple lesions in a single area. You will have the same diagnostic workup and the same treatment as for anyone of your age with ischemic stroke.

Treatment

Treatment is focused on avoiding drugs that can induce a migraine and give the patient medications that prevent a migraine. Patients should avoid smoking and oral contraceptives. Some people may be prescribed antihypertensive medications, stains, and anticoagulants. Recovery is often complete without any neurological deficits.

If you have migraines, it is important to about when you should worry about headaches and how to cope with headaches after a stroke.

Sources:

Headache Classification Committee of the International Headache Society. The International Classification of Headache Disorders: 3rd Edition (beta version)Cephalalgia, 33(9):629-808. 2013.

Kreling GAD, Almeida NRD, Santos PJD. Migrainous infarction: a rare and often overlooked diagnosis. Autopsy and Case Reports. 2017;7(2):61-68. doi:10.4322/acr.2017.018.

Lee MJ, Lee C, Chung C-S. The Migraine–Stroke Connection. Journal of Stroke. 2016;18(2):146-156. doi:10.5853/jos.2015.01683.

Migraine. Mayo Clinic. http://www.mayoclinic.org/diseases-conditions/migraine-headache/symptoms-causes/dxc-20202434.

Wolf ME, Szabo K, Griebe M, et al. Clinical and MRI characteristics of acute migrainous infarction. Neurology. 2011;76(22):1911-1917. doi:10.1212/wnl.0b013e31821d74d5.

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