The Relationship Between Migraine and Ischemic Stroke Risk: A Literature Review

Migraine is a neurovascular disorder associated with an increased risk of ischemic stroke, particularly in individuals experiencing aura. However, the strength and causality of this association remain uncertain. This study aimed to review recent evidence on the relationship between migraine and ischemic stroke, considering migraine subtype, aura status, age, sex, and vascular risk factors. A systematic literature review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Articles published between 2020 and 2026 were identified through PubMed, ScienceDirect, and Google Scholar. Ten studies, comprising cohort and case-control studies, systematic reviews and meta-analyses, and Mendelian randomization analyses, were synthesized descriptively. Most studies reported an increased risk of ischemic stroke among individuals with migraine. Meta-analyses found hazard ratios of 1.205 (95% CI 1.151–1.262) and 1.35 (95% CI 1.03–1.78), while a population-based study reported an odds ratio of 1.38 (95% CI 1.24–1.53). Associations were generally stronger for migraine with aura and among women, younger individuals, and people with chronic migraine. Nevertheless, Mendelian randomization found no significant evidence of a causal relationship (OR 0.935; 95% CI 0.851–1.027). These findings suggest that migraine may serve as a marker of elevated cerebrovascular risk rather than an established direct cause of ischemic stroke. Differences in study design, population characteristics, and adjustment for vascular risk factors may contribute to inconsistent findings. Clinical attention to modifiable vascular risk factors and appropriate migraine management remains important, while further longitudinal and causal studies are needed to clarify the underlying relationship and inform preventive strategies.