The International Classification of Headache Disorders (ICHD), defines Migrainous Infarction as a stroke developed during an attack of migraine with aura together with brain-imaging evidence of infarction in a relevant area which can last for an hour or more. Migrainous infarction (MI) is a rare difficulty of migraines that contributes to 0.5–1.5% of all ischemic strokes.

Although the pathogenesis of Migrainous Infarction is still debated, cortical spreading depression and the consequent biochemical cascade and hemodynamic changes are assumed to play an important role. Migraine Infarctions are most common in the posterior circulation and occur in young women with a history of migraine with aura.

The incidence of migraine infarction is extremely rare, estimated at 3.36 per 100,000 person-years, according to the strict criteria of the International Headache Society. If a patient experiences an atypical aura even with pre-existing migraine, ruling out cerebral infarction is essential. Migrainous Infarction are most common in the posterior circulation and occur in young women with a history of migraine with aura. Most patients have a long-term visual aura and mild stroke severity with good short-term and long-term outcomes.

Migraine with Aura


Not all strokes that occur during migraines can be called Migrainous Infarction. According to the definition of the International Headache Society, the following characteristics must be present:

  • Normally there must have been an visual aura:
  1. Flashes of light or sparks
  2. Blind spots
  3. Blurry vision or loss of vision
  4. Shapes, such as stars and zigzagging lines
  • A migraine attack should resemble a previous migraine attack.
  • At least one of the aura symptoms must last for at least 1 hour.
  • Stroke should be confirmed by computed tomography (CT) or magnetic resonance imaging (MRI) scan.
  • All other possible causes of stroke must be ruled out.

Symptoms of a migraine attack, along with typical migraine symptoms, generally begin suddenly and may include:

  • Weakness or numbness in the face, arms, or legs, often on the sides of the body
  • Confusion
  • Aphasia
  • Balance and coordination problems that cause walking difficulty

Migrainous Infarction Symptoms


Women under the age of 45 appear more likely to have a migraine attack if they have migraine with aura along with any of the following stroke risk factors:

  • High blood pressure
  • High cholesterol
  • Diabetes
  • Obesity
  • Smoking Habit


If the aura symptoms last longer than an hour, see your doctor to see if the blood supply to your brain is interrupted. You will receive the same diagnostic evaluation and treatment as age-matched ischemic stroke patients.

Rarely, a migraine aura can last more than a week without a stroke. This condition is called as persistent migraine aura without infarction and requires evaluation by a physician.

Health care providers use imaging tests, such as CT scans and MRIs, to look for bleeding in the brain and determine whether a stroke affects the same areas of the brain as a migraine. If so, your doctor will likely diagnose a migraine attack.

If the new aura persists for more than an hour, urgent medical evaluation is required. If in doubt, call 911 as it may be a medical emergency requiring immediate medical attention. In rare cases, the aura can last for many days, but this requires frequent and close monitoring by a doctor.


The treatment for Migrainous Infarction include:

  • Medications for stroke: If help is obtained within 3 hours of the first symptoms, drugs to dissolve blood clots are prescribed. Medications may be prescribed to reduce swelling in the brain.
  • Supplementary treatments: You may need intravenous (IV) fluids to keep you hydrated and oxygen to help you breathe.
  • Medication for prevention: Your doctor will prescribe medications that prevent migraines while advising you to avoid medications that can cause migraine headaches.

Migrainous Infarction Treatment


It is important to take preventative measures and make necessary lifestyle changes to reduce the risk of Migrainous Infarction.

Preventive Measures include:

  • Stop smoking habits
  • Avoid birth control pills
  • Treat diabetes, high blood pressure and dyslipidemia.
  • Treat Obesity
  • Change sedentary lifestyle

Migrainous Infarction is a dangerous condition that needs to be diagnosed immediately, for emergency services and treatment get in touch with Speciality Care Clinics, dial 469-545-9983 to book a telehealth appointment for an at-home check-up.

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