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
If you want to hear more from Dr . Biller , download the full podcast at www . headwisemag . org / ExpertAnswers .
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