Migraine has long been linked to a higher risk of ischemic stroke, especially in younger women. However, less research has focused on how migraine affects stroke risk in middle aged and older adults. A new study from the REGARDS cohort offers important insights into how migraine, particularly migraine with aura, may influence stroke risk later in life.
Researchers examined more than 11,000 Black and White adults across the United States and discovered that migraine with aura was associated with a higher likelihood of ischemic stroke. Surprisingly, the strongest risk appeared in men younger than 72 years old, challenging previous assumptions that women face the highest migraine related stroke risk.
Migraine is a neurological condition that causes recurring headaches and other symptoms such as nausea, light sensitivity, and dizziness. Some people experience “aura” before a migraine attack. Aura often includes visual disturbances such as flashing lights, blind spots, or zigzag lines.
Previous studies have shown that migraine with aura may increase the risk of cardiovascular problems, including ischemic stroke. An ischemic stroke occurs when blood flow to the brain becomes blocked, usually by a blood clot.
The study, titled Migraine and Ischemic Stroke Risk in Middle and Older Age: The REGARDS Cohort, analyzed data from the REasons for Geographic and Racial Differences in Stroke study.
Researchers followed 11,381 adults with an average age of 72 years over approximately 6.4 years. Participants were grouped into categories based on migraine history:
The investigators then tracked how many participants experienced ischemic stroke during the follow up period.
The study found that participants with migraine with aura had a significantly higher risk of ischemic stroke compared to those without migraine.
Researchers reported a hazard ratio of 1.73 for migraine with aura. This means participants with aura had about a 73% higher risk of ischemic stroke after adjusting for age, race, smoking, hypertension, diabetes, and other cardiovascular risk factors.
Migraine without aura did not show a significant association with stroke risk.
One of the most unexpected findings involved sex and age differences.
Men younger than 72 years old who had migraine showed the highest risk for ischemic stroke. The study found:
This finding differs from earlier research focused on younger adults, where women with migraine with aura were often considered the highest risk group.
Researchers still do not fully understand why migraine with aura is associated with stroke. Several possible explanations include:
The study also noted that migraine related stroke risk appears independent of many traditional cardiovascular risk factors.
The REGARDS study included both Black and White adults from across the United States. Researchers adjusted for many common stroke risk factors, including:
Interestingly, researchers did not find meaningful differences in migraine related stroke risk based on race.
Although the findings are important, the authors acknowledged several limitations.
Participants reported whether a healthcare professional had diagnosed them with migraine. This method may miss people who have migraine but were never formally diagnosed.
Aura status was based on self reported visual symptoms before headaches. Some participants may have misunderstood or overreported aura symptoms.
The study did not measure:
These factors could influence stroke risk.
The findings suggest that middle aged and older adults with migraine with aura may benefit from closer cardiovascular monitoring.
Doctors may consider discussing stroke prevention strategies with patients who have migraine, especially men under 72 years old. Preventive measures could include:
The study does not prove that migraine directly causes stroke. Instead, it shows a significant association between migraine with aura and increased stroke risk.
Most people with migraine will never experience a stroke. Even though the relative risk was higher in some groups, the overall number of stroke events remained relatively low.
Still, people with migraine with aura should take cardiovascular health seriously and speak with their healthcare provider about personal risk factors.
Symptoms that require urgent medical attention include:
These may be signs of stroke and should never be ignored.
The researchers emphasized the need for additional studies to better understand why migraine increases stroke risk in older adults, especially in men.
Future research may explore:
Understanding these connections could improve screening and reduce long term stroke risk.
The REGARDS cohort study adds important evidence linking migraine with aura to ischemic stroke risk in middle aged and older adults. While previous studies mainly highlighted younger women, this research found that men under 72 with migraine may face particularly elevated risk.
Although migraine without aura was not strongly linked to stroke overall, migraine with aura remained a notable risk factor even after adjusting for major cardiovascular conditions.
Patients with migraine should work closely with healthcare professionals to manage vascular risk factors and maintain long term brain health.
Sprouse Blum AS, Wilkinson KS, Sparks AD, et al. Migraine and Ischemic Stroke Risk in Middle and Older Age: The REGARDS Cohort. June 2026; 2(2): e000107. DOI: 10.1212/WN9.0000000000000107.
This article is for informational and educational purposes only and does not provide medical advice, diagnosis, or treatment. Always consult a qualified healthcare professional regarding any medical condition or concerns about stroke or migraine symptoms.
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