Are "silent migraines" associated with stroke risk?
January 6, 2013 2:43 PM   Subscribe

Common Migraine + Aura Sans Pain = oh noes your brain explodes? (Or, is there an increased stroke risk, and is something to be discussed with a doctor?)

YANMD, I know. But this is more a question to see if one should go see a doctor in this instance, and also to get more info on migraines, which are interesting to learn about, and which seem to understood differently than when some sufferers were first diagnosed.

Based on what I've read and been told (and IANAD), there is an increased stroke risk associated with classic migraines - i.e. migraines accompanied by aura. This risk, apparently, does not hold the same for those who experience common migraines, or migraine pain that is not preceded by an aura. "Silent migraines," or migraine auras without pain, are weird and wacky, involve looking through a scintillating disturbance in one's field of vision, are the equivalent of a migraine aura, but are not followed up by pain. I do not know if they have any association with stroke risk.

Long, long, long ago, I experienced a silent migraine, thought my retinas were detaching, and went to see a nurse about it. She said that it was an aura without pain, was nothing to worry about, and just meant that I wouldn't be able to read for the hour that it takes place. Since then, I've had such auras regularly, but infrequently, about once a year or so.

Since my early twenties, however, I've had menstrual migraines, fairly regularly (about 6-10 times a year). They suck, the pain sucks, the nausea sucks, but they are never, ever preceded by an aura, just the prodome phase. A doctor I had (not the nurse above) basically diagnosed me with simple menstrual migraines, said he was sorry, offered some drugs or suggestions, and that was that.

Never, though, has a health care provider reconciled these two conditions: I infrequently experience an aura, but it is never followed by pain, and I frequently get migraines, but they are never accompanied by aura.

The questions:
1. Is this something to be concerned about, and should I go to another doctor to get re-diagnosed or re-evaluated?
2. Is there information out there about increased stroke risk with "silent migraines," or about whether any such events should be labelled as classic migraines in individuals who suffer from pain at other times?
3. Is there any recent and groundbreaking research on migraines, of all types, and their long-term health risks, out there? Do you have links? Information? Fun facts about whether or not they make your brain burst, and maybe how to prevent that?
posted by vivid postcard to Health & Fitness (9 answers total) 5 users marked this as a favorite
1. It is fairly unlikely that you will suffer a stroke because you suffer from migraine. One element that might increase your risk, on a minute scale, is birth control pills. More likely, though, is that they'll just increase the frequency of your migraines. That being said, different doctors have different opinions about migraine, and the one who spoke to you seemed to kind of wave you off. Have you thought about seeing a naturopath or acupuncturist?

As for the other two questions, really don't know the answers. But I recommend Heal Your Headache by David Bucholz, if you're keen on preventing them.

That being said, I have menstrual migraines, too, and there's nothing you can do to prevent them. They are a bitch. Sorry you're suffering.
posted by Miss T.Horn at 2:49 PM on January 6, 2013

I've suffered from migraines since I was 5, so I've also been curious to learn more about them. Unfortunately, a lot of what is out there is "we just don't know". Some books I've read that have been interesting if not always super informative:

Migraine by Oliver Sacks. Older book, but it's Sacks writing so it was fascinating.

A Brain Wider Than the Sky by Andrew Levy. Not a lot of information about what causes migraine; it's mostly a diary of his years getting migraines, but he writes very well.

Migraine: Manifestations, Pathogenesis, and Management - medical textbook, so it was very difficult going for me, but it's incredibly detailed, so I made my way through most of it.

Are you on birth control pills? If you're getting menstruel migraines, your doctor should not just shrug and tell you to put up with it. There are a ton of different pills out there that you can try, or you could try a non-pill method of birth control. It's not that there's nothing that you can do to prevent them, just that some doctors are resistant to helping you trying to get rid of them.

I have (knocking really really hard on wood right now) finally gotten my migraines under control by switching to Lo Loesterine pills after trying a bunch of different options with my doctor & stopping wearing contacts - I have astigmatism, and unfortunately wearing soft contact lenses daily seemed to aggravate my headaches, so I am stuck wearing glasses these days.
posted by lyra4 at 3:15 PM on January 6, 2013

I am not a neurologist, but from what I can see, having silent migraines is not associated with an increased stroke risk. The question about what the risk is if you have migraines without aura, but then have auras separately, is best asked to a neurologist. However, migraine sufferers are not generally given different treatment based on risk for stroke, and a risk is just an abstract measure - if stroke happens to you, it happens, and if it doesn't, it doesn't. Stroke can happen to you whether you are a migraine sufferer or not. So knowing the risk, in my opinion, is less important than ensuring you are getting the proper treatment for the actual illness that you have. (i.e. if you found out that there was a risk of stroke with your migraines, how would it change your life? Would you alter your diet or exercise regimen? Would you sit around worrying about getting a stroke more?) If you are concerned because you have read that migraine with aura can actually cause a stroke, that is very rare, and that is specific to migraine with aura.

If you are satisfied with the current way you treat your migraines, then I don't think you need to follow up with anyone in particular on this. If you are unsatisfied with the suggestions from your primary care physician and do not feel that his suggestions were adequate to treat the migraines, you should ask for a referral to a neurologist.

Migraines don't make your brain burst.
I am not your doctor and this is not medical advice.
posted by treehorn+bunny at 3:56 PM on January 6, 2013

The study treehorn linked doesn't conclude what she implies and I have issues with that specific use of the Framingham study as their data.

Anyway, I think a more helpful way to frame this discussion is that the vasospasm secondary to the cortical spreading depression, which is the current leading explanation as to the pathophysiology of migraine and aura could:

1) mimic the symptoms of Transient Ischemic Attack & stroke
2) have a direct association with, or mimic the risk factors of, TIA & stroke, but does not MEANINGFULLY raise your risk.

Also just because you are having migraines doesn't mean you couldn't have a TIA later in life, or a retinal detachment. While the objective risk is pretty low, it is a grim piece of news to keep in mind.

My last thought on this topic is, does it really matter if your stroke or TIA had anything to do with your migraines, after the fact? Like someone pointed out upthread, migraines that fluctuate with the hormone levels of menses have a lot of treatments and success at lowering that rate is pretty good, if you manage to find a physician that is willing to experiment a little bit.
posted by hobo gitano de queretaro at 4:29 PM on January 6, 2013

Response by poster: Sorry if this was unclear or hyperbolic. I know my brain is not about to burst (and that I am a sucker for alliteration). I guess what I was interested in was:

i.e. if you found out that there was a risk of stroke with your migraines, how would it change your life? Would you alter your diet or exercise regimen?

Yes, absolutely. I already eat well, and though I am not a gym bunny, at least meet the minimum required amount of moderate exercise they suggest. And I'm totally cool if the answer is, "there is a statistical correlation, but things are too wooly and complicated, and there is no indication of what this means for you, as an individual." But if it turns out that the increased risk is enough to recommend discussing preventive efforts with a doctor, like developing a regular and vigorous exercise plan, or keeping in mind to never go on Drug X in the future, I'd like to know. Or if it turns out that those who experience both simple migraines and silent migraines respond better to a certain drug, over others, that would be interesting to hear, too. If none of the above applies, then that's cool, too.

Also, treehorn's link was interesting, but seems to apply to populations over the age of 50. I am in my late-20s. And the silent migraines started in my early teens. Which may or may not mean, or impact, anything. But I guess that's why I wanted to see what research/insight was out there, and also to see if there was anything neat and interesting in the literature, like how migraines are correlated to increased mastery of underwater basketweaving skills, or something (It seems like a condition that has a lot of new and evolving research around it, I mean).

It seems that treatment of the pain has no connection to stroke risk, so that's good to know.
Carry on. I just wanted to clarify.
posted by vivid postcard at 5:39 PM on January 6, 2013

I get migraines, all kinds. I can tell you that in Europe my doctor would not prescribe me the pill at all so there's some differing opinions on the risk of stroke.
posted by fshgrl at 7:16 PM on January 6, 2013

Other people have addressed the stroke-risk aspect, but re. migraine auras...for what it's worth, there are other types besides visual ones. For instance, I get the occasional visual aura with and without migraine pain, but I do get painful migraines with auditory, taste, mood, and scent auras frequently.
posted by skye.dancer at 7:35 PM on January 6, 2013

Not sure what the hobo gitano means by what he/she said, but this is a quote from the article, should anyone not want to be bothered to read the whole thing:

"One of the characteristic features that distinguish migraine accompaniments from TIAs is a benign course in the former.[1] ... In addition, migraine has been identified as an independent risk factor for ischemic stroke in men older than 40 years[25] and in women younger than 45 years.[26] [27] [28] [29] [30] However, the absolute risk of stroke associated with migraine is small.[31] In this study we did not find an increased stroke risk in association with migrainous visual symptoms, confirming the experience derived from previous clinical series."

If what was meant was that using the Framingham data is retrospective, true, but I didn't see any better studies in my quick search, and you're welcome to link other higher quality trials if you find them.

vivid postcard, keep in mind that young people very rarely have strokes, so to study stroke risk for people whose symptoms start at a young age would either require an extremely long follow up period of many decades, or an extremely large sample population to try to pick up an increased frequency of a very rare event. Either way I doubt that study has been done, although I did not conduct an exhaustive literature search by any means, and would happily cede the point if anyone found studies that contradicted the above.
posted by treehorn+bunny at 11:25 AM on January 7, 2013

Interviews with migraine and stroke expert Dr David Dodick of Mayo Clinic:
Dec 2012, Diane Rehm (Control-F "stroke")

New York Times article (2 years old)
posted by scrambles at 3:24 PM on January 7, 2013

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