What are migrainous infarctions?

Updated: Oct 16, 2019
  • Author: Rima M Dafer, MD, MPH, FAHA; Chief Editor: Helmi L Lutsep, MD  more...
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The relationship between migraine, mostly migraine with aura, and ischemic stroke has been well recognized. In fact, migraine, generally a benign condition, has been recognized as an independent risk factor for ischemic stroke. Additionally, migraine (predominantly migraine with aura) is associated with the presence of silent infarctions or white matter changes on brain magnetic resonance imaging (MRI). [62] When a cerebral infarction occurs during a typical migraine aura attack, the term migrainous infarction is used.

The mechanism of migrainous infarction is complex. It remains to be determined whether the relation between migraine and stroke is the consequence of other underlying conditions or the presence of similar ischemic risk factors or whether migraine is associated with conditions that could potentially cause stroke. [63, 64]

Triptans, ergots, and dihydroergotamine are contraindicated in patients with migrainous infarction. These patients may respond to nonsteroidal anti-inflammatory drugs (NSAIDs), antiemetics, and nonnarcotic pain relievers. Prophylaxis with tricyclic antidepressants, beta blockers, calcium channel blockers, or antiepileptic drugs is recommended. Long-term antiplatelet therapy is indicated in patients with migrainous infarction.

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