69 - MIGRAINE AND MIGRAINE-LIKE CONDITIONS

Summary

This chapter focuses on the complex relationship of migraine with stroke and the different mechanisms by which migraine can predispose to stroke. Mitochondrial encephalomyopathy, lactic acidosis, and stroke-like episodes (MELAS), CADASIL, and mitral valve prolapse (MVP) are all associated with migraine or migraine like episodes and strokes or stroke-like episodes. There is a higher prevalence of migraine in patients with transient global amnesia. Stroke-like migraine attacks after radiation therapy (SMART) is a relatively new syndrome in which stroke-like migraine attacks occur as a late consequence of brain irradiation. Many of the transient episodes in cerebral reversible vasoconstriction syndrome resemble migrainous attacks. Cerebral hemorrhages occasionally are reported after a severe migraine attack. The posited explanation is that initially intense vasoconstriction during the migraine headache leads to ischemia of a local brain region with edema and ischemia of the small vessels perfused by the constricted artery.