Women's Heart Advisor April 2018 Issue

Migraine with Aura and Stroke

Women who suffer from migraines preceded by aura are at particularly high risk for stroke within a year of diagnosis.

Migraines are known to increase the risk of stroke, heart attack and other cardiovascular problems. A study published online Feb. 1, 2018, in BMJ found the risk of a cardiovascular event is highest among women experiencing migraine with aura and is most likely to occur within the first year after diagnosis. Although the underlying reason for this connection has not been pinpointed, a type of hole in the heart called a patent foramen ovale (PFO) is thought to be a potential reason for the higher risk of stroke.

“PFOs are present in about 25 percent of the population, but in 40-60 percent of people with migraine with aura. PFOs are also found in about 60 percent of patients under age 55 who suffer from strokes of unknown etiology (cause). This leads us to believe PFOs may be responsible for at least some strokes associated with migraine with aura,” says Efrain Salgado, MD, Director of the Stroke Center at Cleveland Clinic Florida.

What Is a PFO?

Before birth, blood bypasses the lungs by circulation through a hole between the upper chambers of the heart called a foramen ovale. After birth, the hole generally closes. If it does not, it is known as a patent (open) foramen ovale, or PFO. PFOs increase the risk of a blood clot passing from the right side of the heart into the left side, where it gets pumped into the circulation and travels to the brain, causing a cardioembolic stroke.

Reduce Your Risk

Whether PFOs should be closed is controversial. Most are left alone, since eliminating the hole will not necessarily reduce the risk of stroke.

Fortunately, there are things migraine with aura sufferers can do to reduce their risk of stroke.

“We tell these women to avoid smoking and estrogen-based birth control bills, since these cause stroke risk to skyrocket,” says Dr. Salgado.

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