Objectives

Patients with migraine with visual aura (MwvA) often present to eye care providers for evaluation. A thorough ophthalmological history and examination is needed to exclude ophthalmologic disorders. Additionally, it has been increasingly recognized that MwvA is associated with ischemic stroke (IS). The aim of this narrative review is to provide a comprehensive overview of the differential diagnosis of MwvA and its association with IS.

Materials and methods

We conducted a PubMed search using key words including “migraine aura”, “visual aura without headache”, “late onset migraine accompaniment”, “migraine and stroke”, “migraine and atrial fibrillation”, and “migraine and patent foramen ovale (PFO)”. We narratively summarized the main findings of the identified studies in sections including age of onset and frequency of migraine with aura, stroke subtypes, and the role of cardioembolism in the migraine-stroke association.

Results and Conclusion

For women younger than 50 years, MwvA is associated with an increased risk of IS, and the risk further increases in patients who also smoke and use oral contraceptives. Age of onset of MwvA 50 years or greater is associated with IS that occurs in late life. Studies reported that increased frequency of aura is associated with an increased risk of IS in women. MwvA is associated with an increased risk of cardioembolic stroke and a higher incidence of atrial fibrillation compared to migraine without aura. Most studies that assessed the migraine-stroke association were based on patients with MwvA. The risks of stroke associated with other types of migraine aura or aura without headache, as well as such association in men require further investigation. More data is needed to determine the absolute risk of stroke when evaluating MwvA in situations including smoking and low dose estrogen use, new or late onset (>50 years) MwvA, to facilitate the development of practice guidelines for stroke prevention in specific clinical scenarios.

中文翻译：

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有视觉先兆的偏头痛和中风的风险——叙事评论

目标

有视觉先兆 (MwvA) 的偏头痛患者经常到眼科护理人员那里进行评估。需要全面的眼科病史和检查以排除眼科疾病。此外，人们越来越认识到 MwvA 与缺血性卒中 (IS) 相关。本叙述性综述的目的是全面概述 MwvA 的鉴别诊断及其与 IS 的关联。

材料和方法

我们使用关键词进行了 PubMed 搜索，包括“偏头痛先兆”、“无头痛的视觉先兆”、“迟发性偏头痛伴发”、“偏头痛和中风”、“偏头痛和心房颤动”以及“偏头痛和卵圆孔未闭（PFO）” )”。我们叙述性地总结了已确定研究的主要发现，包括先兆偏头痛的发病年龄和频率、中风亚型以及心源性栓塞在偏头痛-中风关联中的作用。

结果和结论

对于 50 岁以下的女性，MwvA 与 IS 风险增加有关，同时吸烟和使用口服避孕药的患者风险进一步增加。MwvA 的发病年龄 50 岁或以上与晚年发生的 IS 相关。研究报告称，先兆频率的增加与女性患 IS 的风险增加有关。与无先兆偏头痛相比，MwvA 与心源性卒中风险增加和心房颤动发生率增加相关。大多数评估偏头痛-中风关联的研究都是基于 MwvA 患者。与其他类型的偏头痛先兆或无头痛先兆相关的中风风险以及男性中的此类关联需要进一步调查。