How Migraine and Heart Holes Double Stroke Risk in Young Adults
Posted on April 17 2025,
A groundbreaking study reveals the surprising connection between migraine with aura, patent foramen ovale, and unexplained strokes in people under 50
Study Overview
A closer look at the groundbreaking SECRETO research
The Participants
523
Young adults with unexplained strokes
523
Healthy matched controls
Adults aged 18-49 from 19 European medical centers who experienced strokes with no clear cause despite extensive testing.
Heart Structure Focus
37.5%
Patients with PFO (heart hole)
A PFO is a small opening between the heart's upper chambers that typically closes after birth but remains open in about 25% of people.
The study focused on PFOs with high-risk features that might make them more likely to cause problems.
Key Terminology
Unexplained (Cryptogenic) Stroke
A stroke where doctors can't identify the cause, even after running many tests. These strokes are common in younger adults.
Patent Foramen Ovale (PFO)
A small hole between heart chambers that should close after birth but remains open in some people. It can potentially allow blood clots to bypass the lungs and travel to the brain.
Migraine with Aura
A type of migraine where people experience visual disturbances (flashing lights, zigzag lines) or other sensory changes before or during (less common) the headache phase.
Risk Factor Categories
The study examined two distinct groups of risk factors
Traditional Risk Factors
- High blood pressure
- Smoking
- Excess belly fat
- Lack of exercise
- Unhealthy diet
- Heavy drinking
- High cholesterol
- Diabetes
- Chronic stress
- Depression
- Sleep apnea
Nontraditional Risk Factors
- Migraine with aura
- Previous blood clots
- History of cancer
- Autoimmune diseases
- Inflammatory bowel disease
- Kidney or liver disease
- Blood disorders
- Recreational drug use
Striking Findings
Risk patterns differ dramatically based on presence of a PFO
Strokes Without PFO
+42%
Increased risk per traditional risk factor
Traditional risk factors play the dominant role:
Migraine with aura 22.7%
Smoking 21.9%
Excess belly fat 21.1%
Stress 14.6%
High blood pressure 13.8%
* Percentages represent population-attributable risk (PAR) - the proportion of strokes that might be prevented if the risk factor was eliminated
Strokes With PFO
+166%
Increased risk per nontraditional risk factor
Nontraditional risk factors are more critical:
Migraine with aura 45.8%
Excess belly fat 22.5%
Unhealthy diet 9.4%
Physical inactivity 6.3%
Stress 5.0%
* Percentages represent population-attributable risk (PAR) - the proportion of strokes that might be prevented if the risk factor was eliminated
Gender Differences
Risk patterns vary significantly between men and women
Women
55.5%
Migraine with aura contribution in women with PFO
Most significant risk factors:
- Migraine with aura: Dramatically higher effect in women with PFO
- Unhealthy diet: 22% contribution in women without PFO
- Excess belly fat: About 20% contribution across both groups
Men
37.2%
Migraine with aura contribution in men with PFO
Most significant risk factors:
- Smoking: 29.3% contribution in men without PFO
- Migraine with aura: Significant but less dramatic than in women
- Excess belly fat: ~20% contribution across groups
- Stress: ~18% contribution across groups
What This Means for Migraine with Aura Patients
This research identified migraine with aura as the single strongest risk factor for unexplained strokes in young adults, with several key implications:
- The strongest link exists in people who have both migraine with aura and a PFO
- Women face an elevated risk when both conditions are present
- Theoretically, if migraine with aura could be managed or eliminated (less likely), up to 45.8% of these types of strokes might potentially be prevented
- The connection suggests potential shared mechanisms between migraine with aura and stroke (see my video at the bottom for a detailed explanation of this)
- People with both conditions might benefit from specialized monitoring or preventive strategies
Important: While this connection is significant, the vast majority of people with migraine with aura never experience a stroke. Discuss your individual risk profile with a healthcare provider.
Key Takeaways
- So-called "unexplained" strokes in young adults actually follow clear risk patterns
- Traditional factors (smoking, high blood pressure) drive stroke risk in people without PFO
- Nontraditional factors, especially migraine with aura, are more important in people with PFO
- Women with both migraine with aura and PFO face elevated risk
- Comprehensive risk assessment should be standard for young stroke patients
- Further research is needed to understand the exact mechanisms connecting these conditions
Learn More
Educational Video
Watch this informative video explaining the connection between PFO and migraine
Watch Video
Full Research Paper
Read the complete SECRETO study with detailed findings and methodology
Read Study
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