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Migraine has long been considered a painful condition that affects quality of life but is not otherwise dangerous. A number of case-control and cohort studies, however, indicated that migraineurs, particularly those with aura, have a higher risk of ischemic but not hemorrhagic stroke.1 Further, the relationship between migraine (in particular with aura) and stroke was verified in 2 large prospective cohorts: the Women's Health Study2 and the Physicians' Health Study.3 These large-scale cohort studies also showed an increased risk of cardiovascular events in patients with migraine. A possible mechanism to explain these associations is that endothelial function might be compromised in migraine patients.
The study by Bigal et al.4 in this issue of Neurology® looked specifically at the relationship between migraine and vascular events in a representative sample of migraine patients and migraine-free controls in the US population. While this population might not be as sophisticated in recognizing and reporting vascular events, it is representative of the whole age range of migraine patients and represents the whole range of vascular risk factors. In contrast, the Women's Health …
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