Headache disorders, particularly migraine, exhibit a complex and still incompletely understood relationship with cerebrovascular disease. Epidemiological studies have shown that migraine with aura is associated with an elevated risk of ischemic stroke, especially in young women, while acute or thunderclap headache may act as a sentinel symptom of vascular pathologies such as cervical artery dissection, cerebral venous thrombosis, or reversible cerebral vasoconstriction syndrome. Underlying mechanisms under investigation include endothelial dysfunction, cortical spreading depression, platelet activation, and hypercoagulable states, though causal pathways remain debated. Critical knowledge gaps persist in determining which patients with headache are at increased risk of stroke, how specific vascular or imaging markers should be interpreted, and how treatment strategies can be optimized to prevent cerebrovascular complications. Neuroimaging advances increasingly reveal subclinical vascular changes, such as white matter hyperintensities and subcortical lesions, in individuals with migraine and other chronic headache disorders. These observations raise key questions regarding long-term cerebrovascular outcomes and underscore the need for better integration between headache medicine and vascular neurology.

This Research Topic explores the link between migraine, stroke, and other vascular conditions, with the goal of improving patient assessment, prevention, and outcomes. By gathering multidisciplinary contributions from clinical, imaging, and translational research, this Research Topic seeks to refine current risk models, including factors such as cryptogenic stroke, patent foramen ovale, thrombophilia, arterial dissection, or hormonal factors, and improve the identification of secondary headaches indicative of an underlying vascular cause. The overarching goal is to support clinicians in distinguishing benign primary headaches from high-risk vascular presentations, while promoting precision approaches to prevention and long-term care.

To gather further insights into the interplay between headache and cerebrovascular disease, we welcome submissions across a diverse range of manuscript types supported by the journal - including Original Research, Brief Research Reports, Perspectives, Protocols, Mini-Reviews, and more - exploring, but not limited to, the following themes:
- Common mechanisms of headache and cerebrovascular diseases
- Shared genetic factors between migraine and cerebrovascular diseases
- Diagnostic biomarkers, risk stratification tools, and management models for overlapping headache–vascular profiles
- Young stroke in patients with migraine with aura
- Patent foramen ovale and cryptogenic stroke in headache populations
- Thrombophilia, migraine with aura, and young stroke
- Cervical artery dissection and headache characteristics
- Cerebral venous thrombosis and headache characteristics
- Sex-specific and hormonal risk factors, including contraception and pregnancy-related vascular events associated with headache
- Subcortical vascular lesions and white matter hyperintensities in patients with headache
- Longitudinal cohort or follow-up studies on headache and vascular outcomes
- Treatment strategies in the headache-vascular disease population

Authors are encouraged to submit contributions that bridge clinical and mechanistic perspectives, enhance early recognition of vascular complications, and promote improved cerebrovascular outcomes for patients with headache disorders.

Articles will be published online as soon as they are accepted after peer review and approved for publication.

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Topic Editor Fabrizio Vernieri leads investigator-initiated trial collaborations and principal investigator clinical trial projects with AbbVie, Angelini, Eli Lilly, Lundbeck, Pfizer, and Teva.

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Headache and Cerebrovascular Disease: Stroke Risk, Vascular Mechanisms and Outcomes