Israeli Neurologist Identifies Migraine Patients at Higher Stroke Risk

In 2016, neurologist Dr. Piotr Melikov and his wife Ela immigrated from Russia to Israel. A year later, Ela, who had suffered from severe migraines since childhood, experienced a stroke. Melikov, then working at Ichilov Hospital, quickly recognized the symptoms and ensured she received prompt treatment. This personal experience motivated him to research the link between migraines and stroke risk.

Melikov explains that large studies have shown migraines double the risk of stroke, especially migraines with aura, which include visual disturbances. Collaborating with American neurologist Prof. Subik Sun from the University of South Carolina, who maintains a database of 15,000 patients over a decade, they analyzed 1,500 migraine sufferers to identify who might be at higher stroke risk. Their multidisciplinary team found specific migraine characteristics that increase stroke risk.

Migraines affect about 14% of the global population, with 1-2% experiencing chronic migraines, and women are two to three times more likely to suffer from them than men. Identifying high-risk migraine patients could enable targeted preventive care, including more frequent vascular screenings and possibly blood thinners, as well as raising patient awareness to ensure timely treatment if a stroke occurs.

The research also revealed that use of steroids, opioids, and SSRI antidepressants in migraine patients is associated with an increased stroke risk. Melikov warns that while opioids and SSRIs are sometimes prescribed for migraines, they may cause cognitive issues or other harm. Although the study did not find a causal link between antidepressants and stroke, it urges caution among physicians. No increased stroke risk was found related to contraceptive pills or menstrual cycles.

To improve migraine care, Melikov is founding a new association for migraine and headache physicians in Israel, aiming to raise awareness, provide specialized training, and promote patient-centered treatment approaches. He hopes their research, published as a lead article in a top migraine journal, will advance understanding and management of migraines and their serious complications like stroke.