Migraine comorbidity with cardiac, cardiovascular and cerebrovascular disease

Migraine has complex relationships with disorders of the heart, the cardiovasculature and the cerebrovasculature. The purpose of this review was to summarize data regarding the relationship of migraine with structural cardiac disease, cardiovascular disease and stroke. There are low-quality and/or conflicting data regarding a possible association between migraine with patent foramen ovale and other sources of right-to-left shunt. If these associations exist, migraine with aura, in contrast to migraine without aura, would likely account for the comorbidity. Although low-quality evidence suggested that patent foramen ovale closure results in improved migraine patterns, higher-quality evidence from prospective clinical trials of patent foramen ovale closure failed to achieve their primary end-points. There are conflicting data regarding an increased risk of cardiovascular disease in people with migraine. Overall, data suggest that migraine with aura is probably associated with an increased risk for cardiovascular disease. Consistently, studies have shown migraine with aura to be associated with an increased risk for ischemic stroke. The explanation for the comorbidity between migraine with aura and cardiovascular and cerebrovascular diseases has yet to be adequately defined. Potential causal relationships and shared underlying risk factors are discussed. Migraine with aura is associated with an increased risk for ischemic stroke. Migraine with aura might be associated with an increased risk for cardiovascular disease and an increased likelihood for structural cardiac disease, such as patent foramen ovale. Further investigations will define the existence and nature of the relationship between migraine with aura and these disorders.