Migraine and cardiovascular risk contemporary views and prevention.

Abstract

Migraine is increasingly recognized not only as a disabling neurological disorder but also as a marker of vascular vulnerability, particularly when aura is present. Contemporary evidence from large population datasets, cohort studies, and reviews shows the most consistent association between migraine with aura and ischemic stroke, while links with broader cardiovascular disease (CVD)—such as myocardial infarction, atrial fibrillation, and cardiovascular mortality—are generally smaller and more heterogeneous across studies. The elevated risk is only partly explained by classic risk factors, suggesting shared mechanisms (endothelial dysfunction, inflammation, prothrombotic changes, and neurovascular dysregulation). Prevention is therefore best approached in two parallel tracks:aggressive control of modifiable vascular risk factors and (2) risk-aware migraine management, especially in patients with known CVD and in women considering estrogen-containing contraception when aura is present.