MIGRAINOUS INFARCTION: A CLINICAL REVIEW OF PATHOPHYSIOLOGY, DIAGNOSIS, AND MODERN THERAPEUTIC STRATEGIES

Abstract

Migraine represents one of the most prevalent neurological disorders globally and is increasingly recognized as a complex brain disease with significant cerebrovascular implications. Among its rare but severe complications, migrainous infarction constitutes a critical entity that bridges primary headache disorders and ischemic stroke. This narrative review examines the current understanding of migrainous infarction, with particular emphasis on epidemiological data from Central Asia, underlying pathophysiological mechanisms, diagnostic challenges, and emerging therapeutic approaches. The analysis reveals that Central Asian countries demonstrate a disproportionately high burden of both migraine and stroke, with Uzbekistan ranking among the top nations globally for age-standardized stroke incidence. The pathophysiology of migrainous infarction involves cortical spreading depression, neurovascular dysfunction, and prothrombotic changes, predominantly affecting young women with migraine with aura in the posterior circulation territory. Diagnosis remains challenging due to the necessity of excluding alternative stroke etiologies, particularly in young patients without traditional vascular risk factors. The advent of calcitonin gene-related peptide (CGRP)-targeted therapies represents a paradigm shift in migraine management, offering effective prevention without vasoconstrictive effects and demonstrating favorable cardiovascular safety profiles in recent large-scale studies. However, caution is warranted in patients with established cerebrovascular disease. The review underscores the importance of individualized risk assessment, comprehensive diagnostic evaluation, and integration of modern preventive strategies in clinical practice across Central Asia and globally.