Migraine as a Risk Factor for White Matter Lesions, Silent Infarctions, and Ischemic Stroke: The Evidence for a Link

For decades, migraine has been considered to be an episodic, neurovascular disorder, without long-term consequences to the brain. Associations between migraine and clinical stroke and migraine and white matter hyperintense lesions have been suggested in numerous studies, but due to various methodological problems no definite conclusion could be drawn from these studies. Recently, data from a population-based cross-sectional MRI study in were published. Data from this study established migraine to be a true and independent risk factor for white matter lesions (in female migraine patients) and subclinical posterior circulation territory infarcts. In this review, the methodology and results of previous investigations of a relationship between migraine and clinical ischemic stroke, silent infarction and white matter lesions are reviewed, and integrated in the results from the new MRI study. The conclusion comprises that brain infarction occurs far more frequently than expected in migraine patients, most pronounced in migraine with aura: 8% have subclinical cerebellar infarcts, although most infarcts remain clinically silent. Female migraine patients are at increased risk of deep white matter lesions, independent of the effects of cardiovascular risk factors. The influence of migraine severity (attack frequency) on the risk of both types of lesions suggests a causal relationship between migraine severity and lesion load. Future studies are needed to assess whether these (probably) ischemic lesions have relevant (long-term) functional correlates.