ESOC 2026 | The relationship between migraine and stroke
Anders Hougaard, MD, PhD, Copenhagen University Hospital, Copenhagen, Denmark, discusses the relationship between migraine and stroke. Dr Hougaard explains how cortical spreading depression can be triggered by any cortical pathology, including stroke, which can trigger symptoms clinically indistinguishable from migraine aura symptoms. He then discusses red flags that may indicate a secondary cause. This interview took place at the 12th European Stroke Organisation Conference (ESOC) in Maastricht, The Netherlands.
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Transcript
Yeah, there have been some recent very interesting developments in the relation between migraine and stroke, in particular migraine with aura and stroke, because now it’s very well established that the underlying pathophysiology of migraine aura is cortical spreading depression, spreading depolarization. And we now know that any cortical pathology can trigger a wave of cortical spreading depression...
Yeah, there have been some recent very interesting developments in the relation between migraine and stroke, in particular migraine with aura and stroke, because now it’s very well established that the underlying pathophysiology of migraine aura is cortical spreading depression, spreading depolarization. And we now know that any cortical pathology can trigger a wave of cortical spreading depression. So as we know from symptomatic epilepsy that you can have a seizure coming from a cortical structural abnormality or structural pathology, a cortical pathology can trigger a wave of spreading depression, which means that any injury to the human cortex can trigger spreading depression and cause symptoms that are clinically indistinguishable from migraine aura symptoms. So in short, that means that a stroke in the right area of the human cortex can trigger a clinical presentation that completely resembles an attack of migraine with aura. And since migraine aura is per definition a primary headache disorder, this should not be regarded as a migraine attack. So we are starting to develop a new terminology for this. So in that case, a stroke or ischemia in the cortex triggering migraine aura-like symptoms, we suggest should be called a secondary spreading depression event. Yes, so if there are any red flags indicating that this might be a secondary spreading depression rather than a primary migraine with aura, and those kind of red flags could be migraine aura symptoms always occurring on the same side, that is side-locked symptoms, a patient presenting with a first-time aura-like event at the age of 50 years or older and patients with frequent attacks, meaning daily aura episodes or at least several episodes per week. Those kinds of red flags should trigger a workup with an MRI and possibly an angiography to rule out structural lesions as the reason for these spreading depression clinical events.
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