Abstract
Migraine, particularly with aura, has been consistently associated with an increased risk of cardiovascular disease, including ischemic stroke and myocardial infarction. Shared pathophysiological mechanisms such as endothelial dysfunction, platelet aggregation, systemic inflammation, and autonomic imbalance suggest that migraine may act as an early clinical marker of systemic vascular vulnerability. Psychiatric comorbidities, frequently present in chronic migraine, further compound disability and may contribute to long-term cardiovascular risk. This narrative review discusses the evolving understanding of migraine as a multisystem disorder, emphasizing its vascular and neuropsychiatric dimensions. Emerging data on calcitonin gene-related peptide (CGRP)-targeting monoclonal antibodies highlight their efficacy not only in reducing headache burden but also their favorable cardiovascular safety profile. Moreover, preliminary evidence suggests these agents may have a positive effect on mood symptoms in patients with comorbid depression and anxiety. Recognizing migraine as a condition that intersects neurological, cardiovascular, and psychiatric pathways may support earlier risk stratification and guide integrated treatment approaches in complex patient populations.