Page 13 - Migraine, the heart and the brain

What is migraine? 1
Migraine is a common, multifactorial, neurovascular brain disorder with great impact on patients. 1-3 The disease affects 12% of adults4 and is characterized by attacks of severe headache accompanied by nausea, vomiting, and hypersensitivity to light and sound, for up to three days (migraine without aura).5 In one-third of patients, attacks may be accompanied by transient neurological visual or sensory symptoms (migraine with aura).5 The frequency of attacks differs among patients, from one each year to several per week. About 50% of the patients suffer attacks at least twice a month, 25% at least weekly,6 and three percent suffer from migraine and headaches at least half the time.3 On average, every day at least 24 million people in the Europe and the US together suffer from migraine. Consequently migraine worldwide ranks among the most disabling diseases.7;8
What is the relation betWeen migraine and brain isChemia?
Already more than 25 years ago the relation between migraine and stroke was rst hypothesized.9 Migraine has been suggested to be an independent risk factor for both cerebral10 and myocardial infarction.11 A meta-analysis of 14 case-control studies showed an increased risk of ischemic stroke in both patients with migraine with and without aura. 12 The increased risk in migraine with aura (but not in migraine without aura) was also found in the large prospective Womens Health study. Nearly 28000 healthy women aged 45 years or older were followed for 10 years, and women who had active migraine with aura had an increased risk for ischemic stroke (OR 1.74, CI 1.23-2.46).13 A later meta-analysis showed that the pooled relative risk of ischemic stroke among migraineurs (both with and without aura) was 1.7 (95% CI 1.3-2.3), however this risk was only in found women. The risk was highest in women below the age of 45.14 The association between migraine and ischemic stroke is further supported by the occurrence of migrainous infarction (ischemic stroke in the same area of the brain coinciding or following a migraine aura), which is a rare complication of migraine. Migrainous infarction makes up 0.2 % of ischemic strokes, and the posterior circulation territory (PCT) is speci cally affected.15 The presence of a patent foramen ovale (to be discussed in the second part of this thesis) in patients with these migrainous infarctions was higher than in the general population.15
Introduction
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