Migrainous Infarction: Diagnosis and Clinical Features

This transcript has been edited for clarity.

Migrainous infarction refers to that rare time when a patient with migraine has a stroke in the setting of a migraine episode. So there is known to be a roughly threefold increased risk of stroke in people who have migraine, and most of that risk is concentrated in the female population, in particular the female population who have migraine with aura and particularly those who have migraine with aura and take an oral contraceptive that’s estrogen based.^[1,2]

It’s not very many people, thankfully. It’s probably no more than around 1000 cases per year in the US who have migrainous infarction. But it’s defined as a stroke occurring in a patient who has a history of migraine with aura—an established history—and who has an acute episode of migraine with aura, but this time, the aura symptoms don’t go away. They persist for more than 24 hours, or there’s imaging evidence of stroke on an MRI (magnetic resonance imaging) scan or CT (computed tomography) scan, or both. The typical patient will have a history of visual aura with sensory motor aura with some other headache attacks. They’ll lose vision and have weakness and numbness on one side of the body. With the migrainous infarction episode, that aura doesn’t melt away as it typically does. It stays with the patient. It’s a very rare complication of migraine and receives a lot of attention, but it is fortunately very rare.