The diagnosis of migraine-related stroke is reviewed and case histories provided from the Center for Stroke Research, Department of Neurology, Henry Ford Hospital, Detroit, MI. The collaborative group for the study of stroke in young women defined the relative risk for thrombotic stroke as two-fold for women with migraine when compared with a neighbor but not with a hospital control. In 448 total stroke cases 4% were attributed to migraine. The classification of migraine-related stroke is in three categories: 1) Coexisting stroke and migraine, 2) stroke with clinical features of migraine, and 3) migraine-induced stroke. Several arteriovenous malformations frequently masquerade as migraine with aura, oral contraceptives increase stroke risk and may cause coexisting stroke and migraine and ergot therapy for migraine is sometimes complicated by stroke. The pathogenesis of migraine-induced stroke includes coagulation, hemodynamic and neuronal factors. The initiation of a migraine attack is a primary neuronal phenomenon with metabolic and cerebral hemodynamic consequences. A low cerebral blood flow combined with factors which predispose to coagulopathy may lead rarely to intravascular thrombosis and migraine-induced cerebral infarction. [1]

COMMENT. Stroke associated with migraine in children is rare and is an indication for exclusion of an underlying structural cerebral lesion, e.g. arteriovenous malformation, congenital cerebral arterial occlusion, and encephalomalacia. Classical migraine associated with intractable epilepsy and multiple strokes has been described with mitochondrial encephalopathies. (Dvorkin GS, Andermann F et al, 1987).