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Aktuelle Neurologie 2011; 38(08): 436-441
DOI: 10.1055/s-0031-1287811
DOI: 10.1055/s-0031-1287811
Übersicht
Migräne, Schlaganfall und „white matter lesions“
Migraine, Stroke and White Matter LesionsFurther Information
Publication History
Publication Date:
24 October 2011 (online)
Zusammenfassung
Zwischen Migräne und ischämischem Schlaganfall besteht eine komplexe bi-direktionale Komorbidität, die zu Grunde liegenden pathophysiologischen Zusammenhänge sind multifaktoriell. Aus klinischer Sicht besonders relevant ist die Bedeutung der Migräne als Risikofaktor für zerebrale Ischämien. Für klinisch manifeste Schlaganfälle ist das Risiko um den Faktor 2 erhöht, zusätzliche Risikofaktoren sind Migräne mit Aura, weibliches Geschlecht, Rauchen und Einnahme oraler Kontrazeptiva. Die absolute Risikozunahme ist jedoch gering, Patienten sollten daher nicht unnötig verunsichert werden. Migränepatienten haben ferner eine erhöhte Prävalenz von ‚white matter lesions‘ (WML) und subklinischen Infarkten (v. a. in der hinteren Strombahn). Nach neuen Daten ist der Effekt hinsichtlich WML nicht spezifisch für Migräne, sondern scheint auch für andere schwere Kopfschmerzen zuzutreffen. Ferner ist die klinische und funktionelle Bedeutung dieser bildgebenden Befunde aktuell nicht abschließend geklärt.
Abstract
There is a complex, bidirectional comorbidity between migraine and ischaemic stroke, and the underlying pathophysiological mechanisms are multifactorial. From a clinical point of view, the significance of migraine as a risk factor for cerebral ischaemia is of particular relevance. For clinically manifest stroke, there is a 2-fold risk increase, with migraine with aura, female gender, smoking and use of oral contraceptives as additional risk factors. However, patients should not be unnecessarily alarmed, since the absolute risk increase is low. In addition, migraine patients have an increased prevalence of white matter lesions (WML) and subclinical infarcts (especially in the posterior circulation). According to recent data, the effect with regard to WML is not specific for migraine but seems to apply also to other severe forms of headache. Finally, the clinical and functional relevance of these imaging findings have not yet been fully elucidated.
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