Xuanwu Hospital of Capital Medical University Gao Hua Interviewed expert: Dr. Ji Xunming, vice president and chief neurosurgeon of Xuanwu Hospital of Capital Medical University 36-year-old Ms. Li was admitted to the ophthalmology department of Xuanwu Hospital recently because she suddenly had blurred vision in both eyes. However, a neurology consultation revealed that she was blind on the left side of both eyes, and a brain MRI showed acute cerebral infarction in the right occipital lobe. She had been suffering from migraine for 5 years, mostly in the right temple area, sometimes alternating with bilateral temples, and almost always with blinding or flashing eyes before each attack, followed by migraine attacks, which were relieved by taking painkillers and sleeping. The doctor considered her to have a migraine-related stroke based on her medical history. The doctor considered her to have a migraine-related stroke based on her medical history. What caused Ms. Li to have a stroke? Migraine stroke prefers women, suggests Professor Ji Xunming of Xuanwu Hospital: Migraine with aura is a strong risk factor for stroke, as are hypertension, obesity and smoking, and a new risk factor that was previously overlooked. Migraine is an episodic autonomic dysfunction, resulting in vasodilator dysfunction, and is characterized by unilateral or bilateral throbbing headache, accompanied by nausea and vomiting in severe cases, lasting 2-7 hours. Migraine with aura accounts for about 10% of migraine patients. Before or at the onset of headache, the most common symptoms are visual aura, such as blurred vision, dark spots, flashing lights, bright spots and bright lines, or distortion of visual objects; followed by sensory aura, with sensory symptoms mostly distributed in the face-hand region. A large number of studies have suggested that migraine is a risk factor for ischemic stroke. Especially in migraineurs with aura, the risk of stroke is significantly higher in women with migraine < 45 years of age, with an approximately 4-fold increased risk. Young women who smoke and take oral contraceptives are particularly at risk. The risk of migraine-associated stroke may decrease with age. A meta-analysis published recently in the journal Neurology showed that migraine is associated with structural changes in the brain, particularly in the presence of aura. The study found that migraine headaches increased stroke risk by a small margin, with the incidence of white matter injury in patients with migraine with aura exceeding 68% compared to those without migraine. Abnormal brain changes and brain volume changes in clinically asymptomatic cerebral infarction (subclinical stroke) were also found to be associated with migraine. However, the mechanism by which migraine induces stroke during an attack is still unclear so far. Professor Ji Xunming of Xuanwu Hospital said that microcirculatory vasoconstriction and intracranial macrovascular spasm, resulting in a persistent decrease in local cerebral blood flow, may be the main cause of migraine-induced stroke. Migrainous cerebral infarction is a typical stroke that occurs during migraine attacks with aura, and the neurological deficit occurs in the same vascular distribution as the aura. The alterations begin in the occipital cortex, and the posterior cerebral artery, which is responsible for its blood supply, is the most densely innervated one. Given its vascular and neurological characteristics, the occipital lobe is more prone to infarction, which could also explain the appearance of visual aura symptoms. This would explain the onset of Ms. Li's stroke. Treatment and prevention of migraine-related stroke There is no specific therapy to eradicate migraine. The choice of medication should be individualized according to the degree of headache, concomitant symptoms, and previous medication use. In general, pain management is based on pain relievers, sedatives and tranquilizers, ergotamine caffeine, and Chinese herbal preparations. In addition to the treatment of headache, other risk factors for ischemic stroke, such as hypertension, diabetes, obesity, hyperlipidemia and smoking, should also be evaluated and appropriate measures should be taken. Migraine patients with suspected stroke should be examined thoroughly. Patients with migraine should be given conventional stroke treatment and secondary stroke prevention measures such as smoking cessation, discontinuation of oral contraceptives, use of antiplatelet agents, and avoidance of ergotamine derivatives and tretinoin. The most effective way of prevention is to avoid headache triggers, ① Stay away from tyrosine foods, which are the main trigger of vasospasm and cause headache attacks. Such foods include: cheese, chocolate, citrus foods, and pickled sardines, chicken liver, tomatoes, corn, milk, lactic acid drinks, etc. ② Reduce alcohol consumption; all alcoholic beverages can trigger headaches, especially red wine which contains more headache-inducing chemicals. ③ Relaxation, exercises that focus on breathing exercises and toning (e.g. yoga, Tai Chi) can help patients reduce symptoms such as anxiety and muscle tightness. Such as migraine preventive treatment to reduce the frequency of attacks and migraine progression, cardiovascular risk factor control, etc., maintaining a good state of mind and emotional stability, ensuring adequate sleep and appropriate activities will help prevent the purpose of stroke in migraine patients.