Migraine and Cardiovascular Risk: A Scoping Review of Vascular Outcomes, Risk Assessment, and Endothelial Dysfunction.

Migraine affects over one billion individuals worldwide and is increasingly recognized as a systemic disorder with broad cardiovascular comorbidities extending beyond its neurological profile. Despite growing epidemiological evidence, the intersections of migraine with cardiovascular risk stratification, stroke mechanisms, endothelial dysfunction, neuroimaging findings, and neurocognitive profiles remain incompletely mapped. Following the PRISMA-ScR framework, we searched PubMed/MEDLINE for recent (2015-2025) English-language human studies with large sample sizes (≥400) examining cardiovascular outcomes, vascular biomarkers, neuroimaging, or endothelial function in adult migraine populations. The protocol was preregistered on OSF. Forty-three studies encompassing more than 1,500,000 participants across seven thematic domains were included. Migraine with aura was consistently associated with increased ischemic stroke risk in a non-atherosclerotic pattern, with evidence suggesting potential cardioembolic mechanisms including patent foramen ovale and atrial fibrillation. Active episodic migraine paradoxically showed inverse associations with traditional cardiovascular risk scores, while inflammatory biomarkers such as high-sensitivity C-reactive protein and fibrinogen remained interictally elevated, and white matter hyperintensity burden was substantially higher than controls, though available evidence did not indicate increased dementia risk. Cardiovascular disease may represent a clinically relevant comorbidity of migraine, warranting integrated multidisciplinary management. Future studies should prioritize sex-stratified longitudinal designs with aura-specific risk modeling and cerebral endothelial assessment.