Do migraines with aura increase the risk of cerebrovascular accident (CVA) or stroke?

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Dainyal Siddiqui, MD

Internal Medicine

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Manuel Jimenez, MD

Cardiology

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Franz Pierre-Louis, MD

Infectious Disease

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Last updated: March 27, 2025 • View editorial policy

From the Guidelines

Migraines with aura do increase the risk of cerebrovascular accident (CVA) or stroke, with people who experience migraines with aura having approximately twice the risk of stroke compared to those without migraines. This risk is particularly elevated in women under 45 who have migraines with aura, especially if they smoke or use hormonal contraceptives containing estrogen, as reported in the 2014 guidelines for the primary prevention of stroke by the American Heart Association/American Stroke Association 1. The risk appears to be specific to migraines with aura rather than migraines without aura.

Key Findings

  • A meta-analysis of 21 studies found that the risk of ischemic stroke was greater in migraine with aura (pooled adjusted OR for 7 studies, 2.51; 95% CI, 1.52–4.14) compared with the association of ischemic stroke and migraine without aura (pooled adjusted OR for 6 studies, 1.29; 95% CI, 0.81–2.06) 1.
  • The Women's Health Study (WHS) found that increased frequency of attacks in migraine with aura appears to increase the risk for ischemic stroke, with a significant association of migraine frequency found only in the migraine with aura group (HR, 4.25; 95% CI, 1.36–13.29) 1.
  • The 2021 guideline for the prevention of stroke in patients with stroke and transient ischemic attack by the American Heart Association/American Stroke Association also suggests that migraine has been associated with ischemic stroke and white matter hyperintensities in numerous studies, and that avoiding oral contraceptive agents with exogenous estrogen in women with migraine with aura and prior ischemic stroke may be appropriate 2.

Management and Prevention

  • For those with migraines with aura, it's essential to manage other stroke risk factors by maintaining healthy blood pressure, avoiding smoking, considering non-estrogen contraceptive options if applicable, maintaining healthy cholesterol levels, and discussing stroke prevention strategies with healthcare providers.
  • Regular migraine prevention may also help reduce overall stroke risk, though this hasn't been definitively proven, and preventive treatments to reduce migraine frequency in patients with migraine and prior ischemic stroke may be considered 2.
  • The use of certain medications, such as atenolol, bisoprolol, metoprolol, and propranolol, may be beneficial in preventing migraines, but their use should be carefully considered in the context of stroke risk 3.

Conclusion is not allowed, so the answer ends here.

From the Research

Migraines with Aura and Cerebrovascular Accident (CVA) or Stroke Risk

  • Migraines with aura have been consistently associated with an increased risk of ischemic stroke, as demonstrated in studies 4, 5, 6, 7, 8.
  • The pathophysiology of this association is not yet well understood, but several mechanisms have been proposed, including decreased focal cerebral blood flow, cortical spreading depression, and neurovascular pathology 6.
  • Studies have shown that migraine with aura is a risk factor for ischemic stroke, particularly in young women, and when combined with other risk factors such as smoking and oral contracectives 4, 7, 8.
  • Migraineurs with aura have been found to have a higher burden of asymptomatic white matter brain lesions and infarct-like lesions at brain magnetic resonance compared to non-migraineurs 4, 7.
  • The risk of hemorrhagic stroke in people with migraines is less clear, with mixed results in studies examining this association 4, 6, 7.

Key Findings

  • A study published in 2020 found that ischemic stroke in people with migraine is strongly associated with migraine with aura, young age, female sex, use of oral contracebores, and smoking habits 4.
  • A 2022 study found that migraineurs with aura had an increased risk of stroke, with an adjusted hazard ratio of 1.63, and a trend towards an increased risk of peripheral artery disease 5.
  • A scoping review published in 2024 found that the association between migraine with aura and ischemic stroke is consistently demonstrated, but the pathophysiology of this association is not yet well understood 6.

Risk Factors and Mechanisms

  • Several risk factors have been identified as contributing to the increased risk of stroke in migraineurs with aura, including genetic predisposition, atrial fibrillation, emboli, migraine-associated vasculopathy, endothelial dysfunction, platelet dysfunction, coagulation pathway abnormalities, and inflammatory factors 6, 7.
  • The mechanisms underlying the relationship between migraine and cardiovascular disease are still unclear, but may rely on a peculiar vascular vulnerability of migraineurs that contributes to the pathogenesis of migraine and, in the presence of other unknown factors, may also contribute to the development of cardiovascular disease 7.

References

3
Guideline

diagnosis and management of migraine in ten steps.

Nature Reviews Neurology, 2021

4
Research

Migraine and risk of stroke.

Journal of neurology, neurosurgery, and psychiatry, 2020

6
Research

Migraine and Stroke: A Scoping Review.

Journal of clinical medicine, 2024

8
Research

Migrainous infarction: aspects on risk factors and therapy.

Current pain and headache reports, 2012

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This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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