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Headache, migraine, and stroke

Muhammad Ramzan, MD
Marc Fisher, MD
Section Editors
Jerry W Swanson, MD, MHPE
Scott E Kasner, MD
Deputy Editor
John F Dashe, MD, PhD


The relationship between headache, migraine, and stroke is complex. All of these conditions are common and can be temporally related, but whether the association is causal has not been definitively proven in clinical studies. In addition to being causal, a number of additional possible relationships between these entities might exist:

Headache may be coincidental with stroke

Headache may be a consequence of stroke

Stroke and cerebrovascular lesions may have clinical features of migraine

Headache or migraine may increase the risk of stroke

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Literature review current through: Oct 2017. | This topic last updated: Mar 21, 2017.
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  1. Gorelick PB, Hier DB, Caplan LR, Langenberg P. Headache in acute cerebrovascular disease. Neurology 1986; 36:1445.
  2. Mitsias P, Ramadan NM. Headache in ischemic cerebrovascular disease. Part I: Clinical features. Cephalalgia 1992; 12:269.
  3. van Os HJ, Mulder IA, van der Schaaf IC, et al. Role of atherosclerosis, clot extent, and penumbra volume in headache during ischemic stroke. Neurology 2016; 87:1124.
  4. Mitsias P, Ramadan NM. Headache in ischemic cerebrovascular disease. Part II: Mechanisms and predictive value. Cephalalgia 1992; 12:341.
  5. Seifert CL, Schönbach EM, Magon S, et al. Headache in acute ischaemic stroke: a lesion mapping study. Brain 2016; 139:217.
  6. Pavlakis SG, Frank Y, Chusid R. Hypertensive encephalopathy, reversible occipitoparietal encephalopathy, or reversible posterior leukoencephalopathy: three names for an old syndrome. J Child Neurol 1999; 14:277.
  7. Lamy C, Mas J-L. Hypertensive encephalopathy. In: Stroke: pathophysiology, diagnosis, and management, Mohr JP, Choi DW, Grotta JC, et al. (Eds), Churchill Livingstone, Philadelphia 2004. p.641.
  8. Reigel MM, Hollier LH, Sundt TM Jr, et al. Cerebral hyperperfusion syndrome: a cause of neurologic dysfunction after carotid endarterectomy. J Vasc Surg 1987; 5:628.
  9. Hinchey J, Chaves C, Appignani B, et al. A reversible posterior leukoencephalopathy syndrome. N Engl J Med 1996; 334:494.
  10. Diener HC, Welch KMA, Mohr JP. Migraine and stroke. In: Stroke: pathophysiology, diagnosis, and management, Mohr JP, Choi DW, Grotta JC, et al. (Eds), Churchill Livingstone, Philadelphia 2004. p.629.
  11. Bruyn GW. Intracranial arteriovenous malformation and migraine. Cephalalgia 1984; 4:191.
  12. Monteiro JM, Rosas MJ, Correia AP, Vaz AR. Migraine and intracranial vascular malformations. Headache 1993; 33:563.
  13. Haas DC. Arteriovenous malformations and migraine: case reports and an analysis of the relationship. Headache 1991; 31:509.
  14. Ramadan NM, Tietjen GE, Levine SR, Welch KM. Scintillating scotomata associated with internal carotid artery dissection: report of three cases. Neurology 1991; 41:1084.
  15. Silverman IE, Wityk RJ. Transient migraine-like symptoms with internal carotid artery dissection. Clin Neurol Neurosurg 1998; 100:116.
  16. Silbert PL, Mokri B, Schievink WI. Headache and neck pain in spontaneous internal carotid and vertebral artery dissections. Neurology 1995; 45:1517.
  17. Fisher CM. The headache and pain of spontaneous carotid dissection. Headache 1982; 22:60.
  18. Narbone MC, Leggiadro N, La Spina P, et al. Migraine stroke: a possible complication of both migraine with and without aura. Headache 1996; 36:481.
  19. Rothrock J, North J, Madden K, et al. Migraine and migrainous stroke: risk factors and prognosis. Neurology 1993; 43:2473.
  20. Ebinger F, Boor R, Gawehn J, Reitter B. Ischemic stroke and migraine in childhood: coincidence or causal relation? J Child Neurol 1999; 14:451.
  21. Welch KM, Levine SR. Migraine-related stroke in the context of the International Headache Society classification of head pain. Arch Neurol 1990; 47:458.
  22. Dayno JM, Silberstein SD. Migraine-related stroke versus migraine-induced stroke. Headache 1997; 37:463.
  23. Headache Classification Committee of the International Headache Society (IHS). The International Classification of Headache Disorders, 3rd edition (beta version). Cephalalgia 2013; 33:629.
  24. Fisher CM. Late-life migraine accompaniments as a cause of unexplained transient ischemic attacks. Can J Neurol Sci 1980; 7:9.
  25. Tzourio C, Tehindrazanarivelo A, Iglésias S, et al. Case-control study of migraine and risk of ischaemic stroke in young women. BMJ 1995; 310:830.
  26. Chang CL, Donaghy M, Poulter N. Migraine and stroke in young women: case-control study. The World Health Organisation Collaborative Study of Cardiovascular Disease and Steroid Hormone Contraception. BMJ 1999; 318:13.
  27. Oral contraceptives and stroke in young women. Associated risk factors. JAMA 1975; 231:718.
  28. Kittner SJ, McCarter RJ, Sherwin RW, et al. Black-white differences in stroke risk among young adults. Stroke 1993; 24:I13.
  29. Marini C, Carolei A, Roberts RS, et al. Focal cerebral ischemia in young adults: a collaborative case-control study. The National Research Council Study Group. Neuroepidemiology 1993; 12:70.
  30. Sochurkova D, Moreau T, Lemesle M, et al. Migraine history and migraine-induced stroke in the Dijon stroke registry. Neuroepidemiology 1999; 18:85.
  31. Henrich JB, Sandercock PA, Warlow CP, Jones LN. Stroke and migraine in the Oxfordshire Community Stroke Project. J Neurol 1986; 233:257.
  32. Arboix A, Massons J, García-Eroles L, et al. Migrainous cerebral infarction in the Sagrat Cor Hospital of Barcelona stroke registry. Cephalalgia 2003; 23:389.
  33. Linetsky E, Leker RR, Ben-Hur T. Headache characteristics in patients after migrainous stroke. Neurology 2001; 57:130.
  34. Schürks M, Rist PM, Bigal ME, et al. Migraine and cardiovascular disease: systematic review and meta-analysis. BMJ 2009; 339:b3914.
  35. Spector JT, Kahn SR, Jones MR, et al. Migraine headache and ischemic stroke risk: an updated meta-analysis. Am J Med 2010; 123:612.
  36. Rist PM, Buring JE, Kase CS, et al. Migraine and functional outcome from ischemic cerebral events in women. Circulation 2010; 122:2551.
  37. Hu X, Zhou Y, Zhao H, Peng C. Migraine and the risk of stroke: an updated meta-analysis of prospective cohort studies. Neurol Sci 2017; 38:33.
  38. Timm FP, Houle TT, Grabitz SD, et al. Migraine and risk of perioperative ischemic stroke and hospital readmission: hospital based registry study. BMJ 2017; 356:i6635.
  39. Li L, Schulz UG, Kuker W, et al. Age-specific association of migraine with cryptogenic TIA and stroke: Population-based study. Neurology 2015; 85:1444.
  40. Diener HC, Beck CA. Migraine and risk of cardiovascular disease in women: learning about relative and absolute risk. Neurology 2009; 73:576.
  41. Sacco S, Ornello R, Ripa P, et al. Migraine and hemorrhagic stroke: a meta-analysis. Stroke 2013; 44:3032.
  42. Rose KM, Wong TY, Carson AP, et al. Migraine and retinal microvascular abnormalities: the Atherosclerosis Risk in Communities Study. Neurology 2007; 68:1694.
  43. Kurth T, Gaziano JM, Cook NR, et al. Migraine and risk of cardiovascular disease in men. Arch Intern Med 2007; 167:795.
  44. Bigal ME, Kurth T, Santanello N, et al. Migraine and cardiovascular disease: a population-based study. Neurology 2010; 74:628.
  45. Kurth T, Winter AC, Eliassen AH, et al. Migraine and risk of cardiovascular disease in women: prospective cohort study. BMJ 2016; 353:i2610.
  46. Kurth T, Schürks M, Logroscino G, Buring JE. Migraine frequency and risk of cardiovascular disease in women. Neurology 2009; 73:581.
  47. Bigal ME, Kurth T, Hu H, et al. Migraine and cardiovascular disease: possible mechanisms of interaction. Neurology 2009; 72:1864.
  48. Kurth T, Gaziano JM, Cook NR, et al. Migraine and risk of cardiovascular disease in women. JAMA 2006; 296:283.
  49. Gudmundsson LS, Scher AI, Aspelund T, et al. Migraine with aura and risk of cardiovascular and all cause mortality in men and women: prospective cohort study. BMJ 2010; 341:c3966.
  50. Rose KM, Carson AP, Sanford CP, et al. Migraine and other headaches: associations with Rose angina and coronary heart disease. Neurology 2004; 63:2233.
  51. Loder E. Migraine with aura and increased risk of ischaemic stroke. BMJ 2009; 339:b4380.
  52. Thomas DJ. Migraine and ischaemic stroke. BMJ 2005; 330:54.
  53. Wolf ME, Szabo K, Griebe M, et al. Clinical and MRI characteristics of acute migrainous infarction. Neurology 2011; 76:1911.
  54. Kruit MC, van Buchem MA, Hofman PA, et al. Migraine as a risk factor for subclinical brain lesions. JAMA 2004; 291:427.
  55. Kruit MC, Launer LJ, Ferrari MD, van Buchem MA. Infarcts in the posterior circulation territory in migraine. The population-based MRI CAMERA study. Brain 2005; 128:2068.
  56. Scher AI, Gudmundsson LS, Sigurdsson S, et al. Migraine headache in middle age and late-life brain infarcts. JAMA 2009; 301:2563.
  57. Bashir A, Lipton RB, Ashina S, Ashina M. Migraine and structural changes in the brain: a systematic review and meta-analysis. Neurology 2013; 81:1260.
  58. Kurth T, Tzourio C. Migraine and cerebral infarct-like lesions on MRI: an observation, not a disease. JAMA 2009; 301:2594.
  59. Kruit MC, Launer LJ, Ferrari MD, van Buchem MA. Brain stem and cerebellar hyperintense lesions in migraine. Stroke 2006; 37:1109.
  60. Hamedani AG, Rose KM, Peterlin BL, et al. Migraine and white matter hyperintensities: the ARIC MRI study. Neurology 2013; 81:1308.
  61. Henrich JB. The association between migraine and cerebral vascular events: an analytical review. J Chronic Dis 1987; 40:329.
  62. Woods RP, Iacoboni M, Mazziotta JC. Brief report: bilateral spreading cerebral hypoperfusion during spontaneous migraine headache. N Engl J Med 1994; 331:1689.
  63. Olesen J, Friberg L, Olsen TS, et al. Ischaemia-induced (symptomatic) migraine attacks may be more frequent than migraine-induced ischaemic insults. Brain 1993; 116 ( Pt 1):187.
  64. Rothrock JF, Walicke P, Swenson MR, et al. Migrainous stroke. Arch Neurol 1988; 45:63.
  65. Kurth T, Chabriat H, Bousser MG. Migraine and stroke: a complex association with clinical implications. Lancet Neurol 2012; 11:92.
  66. Eikermann-Haerter K, Lee JH, Yuzawa I, et al. Migraine mutations increase stroke vulnerability by facilitating ischemic depolarizations. Circulation 2012; 125:335.
  67. Mawet J, Kurth T, Ayata C. Migraine and stroke: in search of shared mechanisms. Cephalalgia 2015; 35:165.
  68. D'Andrea G, Hasselmark L, Alecci M, et al. Platelet secretion from dense and alpha-granules in vitro in migraine with or without aura. J Neurol Neurosurg Psychiatry 1994; 57:557.
  69. Kalendovsky Z, Austin JH. "Complicated migraine" its association with increased platelet aggregability and abnormal plasma coagulation factors. Headache 1975; 15:18.
  70. Zeller JA, Frahm K, Baron R, et al. Platelet-leukocyte interaction and platelet activation in migraine: a link to ischemic stroke? J Neurol Neurosurg Psychiatry 2004; 75:984.
  71. Ferrari MD, Odink J, Tapparelli C, et al. Serotonin metabolism in migraine. Neurology 1989; 39:1239.
  72. Gallai V, Sarchielli P, Firenze C, et al. Endothelin 1 in migraine and tension-type headache. Acta Neurol Scand 1994; 89:47.
  73. Soriani S, Borgna-Pignatti C, Trabetti E, et al. Frequency of factor V Leiden in juvenile migraine with aura. Headache 1998; 38:779.
  74. Hering-Hanit R, Friedman Z, Schlesinger I, Ellis M. Evidence for activation of the coagulation system in migraine with aura. Cephalalgia 2001; 21:137.
  75. Tietjen GE, Al-Qasmi MM, Athanas K, et al. Increased von Willebrand factor in migraine. Neurology 2001; 57:334.
  76. Waeber C, Moskowitz MA. Migraine as an inflammatory disorder. Neurology 2005; 64:S9.
  77. Tietjen GE. Migraine as a systemic vasculopathy. Cephalalgia 2009; 29:987.
  78. Eggers AE. New neural theory of migraine. Med Hypotheses 2001; 56:360.
  79. Scher AI, Terwindt GM, Verschuren WM, et al. Migraine and MTHFR C677T genotype in a population-based sample. Ann Neurol 2006; 59:372.
  80. Shechter A, Stewart WF, Silberstein SD, Lipton RB. Migraine and autonomic nervous system function: a population-based, case-control study. Neurology 2002; 58:422.
  81. Aygun D, Altintop L, Doganay Z, et al. Electrocardiographic changes during migraine attacks. Headache 2003; 43:861.
  82. Caplan LR, Hennerici M. Impaired clearance of emboli (washout) is an important link between hypoperfusion, embolism, and ischemic stroke. Arch Neurol 1998; 55:1475.
  83. Rist PM, Diener HC, Kurth T, Schürks M. Migraine, migraine aura, and cervical artery dissection: a systematic review and meta-analysis. Cephalalgia 2011; 31:886.
  84. Silvestrini M, Matteis M, Troisi E, et al. Migrainous stroke and the antiphospholipid antibodies. Eur Neurol 1994; 34:316.
  85. Levine SR, Joseph R, D'Andrea G, Welch KM. Migraine and the lupus anticoagulant. Case reports and review of the literature. Cephalalgia 1987; 7:93.
  86. Cuadrado MJ, Sanna G. Headache and systemic lupus erythematosus. Lupus 2003; 12:943.
  87. Straube A, Padovan CS, Förderreuther S, Wick M. [Antinuclear and anticardiolipin antibodies in primary headache syndromes]. Schmerz 1998; 12:342.
  88. Tietjen GE, Gottwald L, Al-Qasmi MM, et al. Migraine is associated with livedo reticularis: a prospective study. Headache 2002; 42:263.
  89. Tietjen GE, Al-Qasmi MM, Shukairy MS. Livedo reticularis and migraine: a marker for stroke risk? Headache 2002; 42:352.
  90. Rebollo M, Val JF, Garijo F, et al. Livedo reticularis and cerebrovascular lesions (Sneddon's syndrome). Clinical, radiological and pathological features in eight cases. Brain 1983; 106 ( Pt 4):965.
  91. Martinelli A, Martinelli P, Ippoliti M, et al. Sneddon syndrome presenting with hemicranic attacks: a case report. Acta Neurol Scand 1991; 83:201.
  92. Buring JE, Hebert P, Romero J, et al. Migraine and subsequent risk of stroke in the Physicians' Health Study. Arch Neurol 1995; 52:129.
  93. Kurth T, Slomke MA, Kase CS, et al. Migraine, headache, and the risk of stroke in women: a prospective study. Neurology 2005; 64:1020.
  94. Jousilahti P, Tuomilehto J, Rastenyte D, Vartiainen E. Headache and the risk of stroke: a prospective observational cohort study among 35,056 Finnish men and women. Arch Intern Med 2003; 163:1058.
  95. Merikangas KR, Fenton BT, Cheng SH, et al. Association between migraine and stroke in a large-scale epidemiological study of the United States. Arch Neurol 1997; 54:362.
  96. Weir B, Grace M, Hansen J, Rothberg C. Time course of vasospasm in man. J Neurosurg 1978; 48:173.
  97. ACOG Committee on Practice Bulletins-Gynecology. ACOG practice bulletin. No. 73: Use of hormonal contraception in women with coexisting medical conditions. Obstet Gynecol 2006; 107:1453.
  98. Medical eligibility criteria for contraceptive use, 4th ed, World Health Organization, Geneva 2009. http://whqlibdoc.who.int/publications/2010/9789241563888_eng.pdf (Accessed on January 30, 2012).
  99. Petitti DB. Clinical practice. Combination estrogen-progestin oral contraceptives. N Engl J Med 2003; 349:1443.