Abstract

Traditional concepts of migraine as a benign recurrent headache have been challenged. Recent epidemiologic studies suggest that migraine is related to white matter hyperintensities or silent infarcts. The relation between silent infarcts is more evident in migraine with aura. The risks of symptomatic ischemic or hemorrhage stroke and cardiovascular disease are also increased in migraine in some epidemiologic studies. Although, there are some critics about the possible error in classification of headache or exaggeration of small burden, the association between migraine and vascular disease looks like more than causal. Patent foramen ovale is the possible mediator of the association. Patent foramen ovale is frequently detected in migraine patient, especially in migraine with aura. Empirical data have suggested that closure of patent foramen ovale was effective in improving symptoms of migraine. Although a recent randomized controlled trial failed to prove this hypothesis, microembolisation through right-left shunt can evoke migraine attack and silent infarcts in some experi- mental studies. Therefore, the concept of migraine as a chronic or progressive disorder may highlight the importance of proper management and preventive therapy of migraine.