Prior stroke will increase your risk of having another stroke.
HW: What makes people who have migraine with aura more susceptible?
Dr. José Biller Dr. Biller: One possibility is that during migraine, there is a component that is known as“ spreading depression” that may cause changes in [ blood ] flow. There is an inflammatory component associated with that as well as a vasodilatation that can lead to reduced, or slowed, flow in the arteries. Combined with the possibility of other risk factors— particularly dehydration, vasospasm, increased viscosity( or stickiness of the blood), clustering or the adhesion of blood elements like platelets— this may cause a coagulation within the blood vessel that can impair delivery of nutrients and subsequently cause a stroke.
HW: How can someone with a lifelong history of head pain learn to recognize the distinct symptoms of stroke? Dr. Biller: As recommended by the International Headache Society, migrainous infarction has a strict definition. Number one, that one or more aura symptoms— the symptoms that antedate the headache phase— last more than an hour and are associated with a neuroimaging study confirming the presence of an ischemic stroke. In somebody who has a history of migraine with aura, the attack will be typical of previous attacks, except for the longer duration of the neurological deficit. And finally— and this is very important to highlight— that other causes of stroke have been ruled out. So in essence, we are talking about a diagnosis of exclusion.
HW: What should migraineurs do if they start noticing stroke symptoms? Dr. Biller: Stroke is a very serious disease that is highly treatable, and the treatment should be done immediately. Therefore, my advice would be for the patient to call 911, and hopefully be transported to the nearest emergency room where he or she can be evaluated by an individual with expertise in the diagnosis and management of stroke.
HW: What are some of the other risk factors for stroke? Dr. Biller: The modifiable risk factors include mainly high blood pressure or arterial hypertension, high cholesterol, diabetes and heart disease( particularly atrial fibrillation, carotid artery disease or carotid stenosis). Prior stroke will increase your risk of having another stroke. And certainly some lifestyle behaviors increase risk— particularly the consumption of cigarettes, excessive consumption of alcohol, obesity, sleep apnea and a sedentary lifestyle.
HW: What can migraineurs do to reduce the risk of stroke? Dr. Biller: First, they should be properly diagnosed to determine whether they have migraine with or without aura. Many patients with migraine have co-morbidities that need to be taken into consideration, and these co-morbidities dictate the best treatment approach, particularly when we are addressing preventive strategies. We want to know whether the migraineur has high blood pressure, diabetes, high cholesterol or heart disease. The patient should be encouraged to maintain adequate lifestyle, particularly as far as the consumption of tobacco products. They should maintain good sleep habits and good nutrition, and recognize their triggering factors. And obviously patients who have risk factors, for, let’ s say, coronary artery disease, should have a proper cardiovascular evaluation before receiving medications, such as triptans, commonly used for migraines. HW www
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