Migraine with aura is well known to be associated with an increased risk of ischemic stroke. This risk dramatically increases in smokers and uses of oral contraceptives. Brain MRI studies suggest that migraine is associated with silent brain infarcts. Migraine is also established as a risk factor for significantly more cerebral white matter lesions. Recent data suggest that migraine is also associated with coronary artery disease. Data concerning an increase risk of mortality in migraine are controversial. The pathophysiology of the increased risk of ischemic events is unclear. Migrainous infarcts seem to be very rare. Migraine is associated with an increased risk of cervical artery dissection. Classical vascular risk factors are more common in migraineurs. Triptans are not associated with an increased risk of ischemic events. Another explanation is a probable endothelial dysfunction and a lower level of endothelial progenitor cells in migraine. A prothrombotic state in migraine is also another possible explanation due to genetic polymorphisms. Appropriate management for primary vascular prevention in migraineurs is not different from that proposed for the general population. Oral contraceptives should be avoided in migraineurs with aura, especially if they smoke.
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