In the past few weeks, I’ve probably had a dozen conversations, with residents and various faculty alike, about the associations between stroke and migraine. Here’s a very recent review article on the topic.
Of particular interest to me is the observation that migraine can be symptomatic of a cerebral infarction or a vascular lesion. Here’s a great paper on this topic. A few things I’ve seen over the years include:
- Acute stroke coinciding with spells of slowly spreading visual hallucinations
- Remote stroke with subsequent migraines with aura in patients with no prior history of migraine (some of whom did have a family history).
- Catheter-related carotid spasm followed in delayed fashion by stereotyped spells of focal hemispheric dysfunction and no permanent clinical deficit or infarct on MRI.
- Lifelong migraines in patients later found to have complex vasculopathies with tortuous, ectatic vessels, multiple aneurysms, etc.
Amyloid spells may fall into this group as well.
I’ve come to think that it might make sense to consider migraines in a similar way we do seizures: Clinical-neurophysiological events that may arise in an otherwise normal brain or in a brain harboring a wide variety of structural pathologies.