In the general population, the average age of stroke is 65; but for women who have migraine with aura, their stroke risk is higher than average when they are younger than 45, according to Dr. Christoph Diener, Senior Professor of Clinical Neurosciences at Germany’s University of Duisburg-Essen and Chairman of the West-German Headache Center. But Diener, a pioneer in the headache and stroke fields, says that risk can be reduced by making a few key healthy lifestyle choices.
Nearly two decades ago, Diener and a team of researchers embarked on a large-scale investigation into risk factors for various diseases by compiling registries of individuals’ health issues and experiences, and examining that data to look for patterns and trends. Using the Women’s Health Study, a registry of nearly 40,000 US women, Diener and colleagues uncovered a relationship between migraine and stroke. (Similar subsequent studies have replicated these results.)
What they found was that women below the age of 45 who have migraine with aura face a higher risk of ischemic stroke — a stroke that occurs because of a clot blocking blood flow to the brain. In a recent conversation with AMF, Dr. Gretchen Tietjen, chair of the University of Toledo’s Department of Neurology, explained how the two conditions relate: “people who experience aura might have increased tendency to form blood clots due to temporarily narrowed blood vessels, which can predispose them to stroke.”
Despite the increased risk, “women who have migraine with aura shouldn’t be afraid that they would get a stroke tomorrow,” Dr. Diener says. That’s because these findings show a relative increased risk — an increased risk among young women who have migraine with aura compared to young women who don’t. However, the absolute risk — the risk of any one woman who has migraine with aura experiencing a stroke — remains quite low, he said.
Among young women who have migraine with aura, some face a higher risk than others. “The stroke risk increases if someone has migraine with aura and has additional risk factors for vascular disease like high blood pressure, obesity, and, in particular, smoking,” Diener says. “Smoking is the most important risk factor.”
Because smoking significantly increases stroke risk, avoiding or quitting cigarette smoking is Diener’s top recommendation for women who have migraine with aura. Exercise and eating well are a close second (see the American Migraine Foundation’s free Meal Planner for tips on maintaining a balanced, migraine-friendly diet). Since these are all behavioral factors, women with migraine with aura can reduce their increased stroke risk with lifestyle changes. Regular doctor’s appointments are also critical to help keep a close eye on any changes in overall health, Dr. Diener says. “I think it’s worthwhile to go to your general practitioner once a year and have a checkup for risk factors like hypertension, high cholesterol, diabetes, and obesity,” he said.
Avoiding certain medications is another way women with migraine with aura can take control of their elevated stroke risk. For young women with aura on birth control, Dr. Diener says, contraceptives with high estrogen levels are not recommended. However, there is no increased risk of stroke with progestin-only pills. It should also be noted that a recent study has raised some doubts about the real risk of stroke in women with aura taking contraceptives that include estrogen and progestin, as hormone levels in birth control pills have steadily decreased.
More research is needed about the relationship between migraine and stroke, and headache specialists are optimistic that new findings will help people with migraine further reduce their stroke risk. The American Migraine Foundation works to directly fund research into headache disorders. To learn more about AMF’s fight for more migraine research funding, and how you can help us continue this work, visit our website.
Reviewed for accuracy by the American Migraine Foundation’s subject matter experts, headache specialists and medical advisers with deep knowledge and training in headache medicine. Click here to read about our Editorial Board members.