Complications of Migraines

A migraine headache.
A migraine headache. Brosa/Getty Images

Many migraineurs fear not only their debilitating migraine attacks but also the potential for developing a migraine complication, like a migraine-triggered stroke or seizure. The good news is that these complications are rare.

Status Migrainosus

The symptoms of status migrainosus are similar to whatever your "typical" migraine symptoms may be. The main difference is that in status migraines the symptoms are more severe and debilitating, and last longer — in fact, symptoms persist for more than 72 hours. That being said, there may be periods of relative relief (up to 12 hours) due to migraine medications or sleep.

Also, sometimes symptoms of status migrainosus can mimic that of medication over-use headache — a headache disorder that occurs as a result of taking migraine or a headache pain-relieving medication for 10 to 15 days a month, for more than 3 months.

Migrainous Infarction

According to the International Headache Society, a migrainous infarction occurs when, during a migraine with aura, a patient also has a stroke in the area of the brain from which the symptoms of the aura originated. In other words, one or more of their aura symptoms persist (at least more than one hour). The stroke is visualized by a doctor on neuroimaging, like an MRI of the brain.

While this diagnosis is rare, doctors are alerted to it when a person has aura symptoms that do not go away. In addition, there may be a connection between migraines and a hole in a person's heart called the patent foramen ovale, or PFO — a tiny hole between the upper chambers of the heart that does not close at birth in about 20 percent of the population. Studies have found a link between people with a migraine with auras and the presence of a PFO. The risk of PFO is a stroke, as tiny blood clots can move from the heart through this hole to the brain. This being said, closure of PFOs in patients with migraines is not a standard practice to prevent stroke, as the science behind it is still inconclusive.

Persistent Aura Without Infarction

Unlike migrainous infarction, persistent aura without infarction (PMA) occurs when aura symptoms persist for one week or more without any evidence of stroke on a CT scan or MRI of the brain. It may be surprising to learn that PMA has been known to last days to years — even up to 28 years, according to a one 2010 study in Headache. The scientific basis for this migraine complication is still unclear, as is treatment. An anti-convulsant medication, Lamictal (lamotrigine) may be the most effective medication.

Migraine Seizure

A migraine seizure is a seizure that occurs during or within one hour of a migraine with aura. Like migraine infarction, this is a rare complication and requires a thorough evaluation. In fact, migraine-aura triggered seizures are sometimes misdiagnosed, as auras can sometimes mimic seizures and vice versa, This is why a careful evaluation is needed by a neurologist.

Bottom Line

Be assured that the vast majority of migraines resolve and complications, like stroke and seizures, are uncommon. That being said, it's important to seek medical attention right away if you are experiencing a persistent migraine aura, or an aura and/or a headache that is different from your usual ones.

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Article Sources
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  • Thissen, S., et al. Persistent migraine aura: new cases, a literature review, and ideas about pathophysiology. Headache, 2014 Sep;54(8):1290-309.