Migraine with aura linked to disease

Dear Dr. Roach: Iaman 80-year-old active male taking only thyroxine. I have no known health issues. In November 2021, I experienced a migraine with aura and have a slight vision loss in my right eye. After seeing an eye doctor, a retinal specialist and a primary care doctor, the only thing I am hearing is the term “microvascular disease.” This is based on the eye doctor’s examination. Any information you could provide would be appreciated.

R.B.

Answer: Microvascular disease refers to poor flow in the smaller arteries, called the arterioles. These branch off from the larger arteries and ultimately provide blood to the capillaries.

All organs have small blood vessels, but the term microvascular disease is most often applied to the heart and brain. Unlike macrovascular disease, where there are usually discrete cholesterol plaques, microvascular disease is a more diffuse process.

Although most cases of migraine with aura are not related to microvascular disease, there is an association between migraine and microvascular disease. Given your relatively older age when your migraine developed, I would be concerned this might be the case in you.

Microvascular disease, as seen by eye exam or by MRI, increases your risk of a stroke. When I have a patient with this diagnosis, I am substantially more aggressive about treating risk factors, especially blood pressure and cholesterol.

This may include medication treatment even if the numbers are not as elevated as would normally be treated with medicines. Of course, lifestyle changes, including a careful dietary history to identify potentially improvable habits, are critical as well. Smoking must be stopped if present, and careful control of diabetes has been proven to reduce risk. Even modest increases in regular exercise are important. Alcohol use should be no more than moderate.

Of course, people can have both microvascular disease and macrovascular disease at the same time. Fortunately, the treatments for microvascular disease tend to help macrovascular disease, if present, as well.