Author Response: Microembolism and Other Links Between Migraine and Stroke: Clinical and Pathophysiologic Update
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We read with interest the comments by Scutelnic et al. on our Review article.1 Their comments confirm the scientific community's ongoing interest in the association between vascular comorbidities and migraine. We agree with the comments of Dr. Scutelnic et al. regarding the clinical presentation of migrainous infarction. Migrainous infarction can present with migraine aura symptoms, but typical neurologic deficits ensue, leading to the diagnostic suggestion of an ischemic stroke.2 Aura symptoms are transient, positive, and progressive while typical ischemic neurologic symptoms are negative and reach their maximum soon after the onset of a stroke or transient ischemic attack.3 Differentiating migrainous infarction from usual migraine depends on the difference between aura and ischemic symptoms. We also agree that aura symptoms can change during life. Nevertheless, the clinical characteristics of ischemic and aura symptoms usually allow the differentiation between the 2 entities.4 Finally, we recognize that the relationship between atrial fibrillation and migraine with aura is complex and can be either direct or indirect.5 However, our review focused on microembolism and its role in migraine and stroke pathophysiology. Other associations between cardiac arrhythmias and stroke risk in patients with migraine were beyond this Review's scope.
Footnotes
Author disclosures are available upon request (journal{at}neurology.org).
- Received March 27, 2023.
- Accepted in final form March 27, 2023.
- © 2023 American Academy of Neurology
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