According to the American Heart Association, women are more likely to have a stroke, and experience declining health or die following a stroke, when compared to men (Willis, 2020). A recent study by Tietjen and Maly (2020) has linked a history of migraines with aura to a higher incidence of ischemic stroke. An aura is described as experiencing visual abnormalities, including seeing flashes of light or zigzag lines, which precede a migraine. An ischemic stroke is a stroke caused by a blood clot, as opposed to a hemorrhagic stroke which occurs when a blood vessel in the brain bursts and causes bleeding.
The study states that since there is a correlation between migraines with aura and ischemic stroke, the treatment approach changes for these patients. Women suffering from migraines with auras are found to have risk factors for stroke including high cholesterol, high blood pressure, atrial fibrillation and preeclampsia when pregnant (Vogt, 2020). Oral contraceptives can increase the incidence of migraines with auras and clotting abnormalities. Women experiencing migraines with aura should receive the same treatment as patients having transient ischemic attacks (Tietjen & Maly, 2020).
Transient ischemic attacks are also referred to as “mini strokes”. They are caused by clots which trigger temporary stroke symptoms, returning the patient to normal functioning when the obstructions dislodge. The workup involves MRIs and CT scans of the brain, carotid artery ultrasounds, and an echocardiogram. Changes should be implemented, including medication and lifestyle modification, because they may decrease the risk of clotting, which in turn can reduce the risk of stroke and the frequency of migraines.
A recent study by Jain et al. (2020) showed lifestyle changes made by women, including individuals in their 50s, decreased long-term risk of stroke. The most important lifestyle modifications include exercising, eating healthy foods, quitting smoking, and maintaining a healthy weight (Jain et al., 2020). The study, which followed 60,000 middle-aged women over 26 years old, showed that those who made lifestyle modifications decreased their risk of stroke by 25% and reduced the risk of ischemic stroke by more than 33% (Jain et al., 2020). Exercising 30 minutes a day has been shown to decrease the risk of stroke by 20% (Willis, 2020).
It is important for all adults of any age to make healthy lifestyle choices. Eating well, exercising, and not smoking, in addition to other modifications, can help prevent stroke as well as other conditions, including heart disease and diabetes. The changes are more important for people who experience migraines with aura, as they are statistically more likely than the average person to have an ischemic stroke. New treatment guidelines initiating specific workups for the migraine with aura patient can reduce the risk of ischemic stroke as well as frequency of migraines.
Jain et al. (2020). Hypothetical Lifestyle Strategies in Middle-Aged Women and the Long-Term Risk of Stroke. Stroke. doi: doi.org/10.1161/STROKEAHA.119.026761
Tietjen G, Maly EF. Migraine and ischemic stroke in women. A narrative review [published online April 4, 2020]. Headache. doi:10.1111/head.13796
Vogt. (2020). Is Migraine Tied to Ischemic Stroke in Women? Retrieved from https://www.consultant360.com/exclusive/neurology/migraine/migraine-tied-ischemic-stroke-women
Willis, K. (2020, April 13). Study: Middle age may not be too late for lifestyle changes to reduce women’s stroke risk. Retrieved from https://www.ajc.com/lifestyles/study-middle-age-may-not-too-late-for-lifestyle-changes-reduce-women-stroke-risk/F3bTWjlJB03zTotc65ZyWN/