A typical migraine aura consists of a visual disturbance (partial loss of vision, flickering lights, zigzags, etc) which lasts 15 to 60 minutes and precedes the headache. Auras can also occur without a headache. Auras occurs in 15 to 20% of migraine sufferers and those who experience them have a slightly higher risk of strokes. The reason for this increased risk has remained unclear.
A study just published in Neurology suggests a possible explanation. The study followed 11,939 participants, of whom 426 reported migraines with visual aura, 1,090 migraine without visual aura, 1,018 non-migraine headache, and 9,405 had no headache. Over a 20-year follow-up period, 232 (15%) of 1,516 with migraine developed atrial fibrillation, a type of cardiac arrhythmia (irregular heart beat). Migraine with visual aura was associated with 1.3 times higher risk of atrial fibrillation compared to no headache as well as 1.4 times higher when compared to migraine without visual aura.
Atrial fibrillation is very common and carries a fivefold increase in the risk of stroke compared to those with normal heart rhythm. This risk is even higher in those who are older than 65 years, in women, those who have congestive heart failure, had a prior stroke or transient ischemic attack, hypertension, diabetes and vascular disease. You can’t do anything about your age or being a woman, but good control of hypertension and diabetes (and exercise, weight control, and not smoking) can lower this risk. Patients with atrial fibrillation are usually treated with an anticoagulant (blood thinner), such as apixaban (Eliquis), which can prevent strokes.
