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Migraine versus Stroke

A migraine and stroke may share some symptoms in common, which may lead someone with a migraine to wonder if they are having a stroke. With exception of certain cases of complicated migraines, most of the time the two present very differently and are distinguishable. That distinction may be based on finding a repetitive pattern over time (for example recurrent numbness that accompanies a headache and completely resolves in time, suggesting a migraine). Ultimately, is best to consult with a physician who would make that differentiation based on a careful neurological examination and brain imaging, if necessary.

A migraine is a type of a severe headache, comprised of a constellation of symptoms including nausea/vomiting, sensitivity to lights/sounds/smells. Sometimes a migraine is accompanied by an “aura”, which is a set of symptoms typically occurring prior to or alongside the head pain such as changes in vision, numbness or speech disturbances. Rarely, auras may be experienced without the headache itself. Often migraines begin in a young, otherwise healthy, individuals with a a href=”/migraines-and-family-history/”>family history of headaches, which are exacerbated by stress, dehydration, poor sleep and skipping meals. A migraine is likely to be recurrent and stereotypical – a similar type of pain coming with similar accompanying features that one has for years. If a person experiences his/her typical migraine, and if a home treatment is established, then it does not require a visit to the emergency room.

A stroke, in contrary, is most often due to a blood clot in the brain, and may cause sudden changes in vision, speech and weakness on one side of the body (depending on the location of the blood clot). Strokes usually occur in middle-aged and older people with predisposition for it, like due to certain heart problems or blood vessel problems, uncontrolled blood pressure or a blood clotting disorder. On rare occasions a stroke may be accompanied by a headache.

A stroke always needs immediate medical attention. Therefore, if the cause of the symptoms isn’t clear and a stroke is suspected, or if a new severe headache starts or if there are new neurological symptoms (with or without a headache) or if there is a change to the usual migraine headache, it is important to seek medical care immediately.

This article represents the opinions, thoughts, and experiences of the author; none of this content has been paid for by any advertiser. The Migraine.com team does not recommend or endorse any products or treatments discussed herein. Learn more about how we maintain editorial integrity here.

Comments

  • Teri-Robert
    6 years ago

    Dr. Syrow,

    You make some statements here with which I must disagree or at least add a different point of view…

    You wrote “A migraine and stroke may share some symptoms in common, which may lead someone with a migraine to wonder if they are having a stroke. With exception of certain cases of complicated migraines, most of the time the two present very differently and are distinguishable.”
    ****This is a question I’ve discussed with several Migraine specialists and researchers during American Headache Society continuing education conferences. Without exception, they told me that “most of the time” is not accurate; that times when patients and even some doctors can’t tell with any level of certainty if symptoms are Migraine or stroke – without imaging – are not uncommon.****

    You wrote, “A migraine is a type of a severe headache,”
    ****Calling a Migraine a “headache” is akin to calling a heart attack “chest pain.” Under ICHD criteria, headache alone is not sufficient for a diagnosis of Migraine, is only one possible symptom of a Migraine attack, and indeed need not occur at all during a Migraine attack.****

    You wrote “Rarely, auras may be experienced without the headache itself.”
    ****The literature would suggest that aura without headache is not rare. One continuing medical education module by Dr. Janet C. Rucker states, “Aura accompanies migraine headaches in up to 30% of migraineurs and, in patients with migraine headache with aura, between 13% and 47% experience episodes of aura without headache.”****

    You wrote, “A stroke, in contrary, is most often due to a blood clot in the brain, and may cause sudden changes in vision, speech and weakness on one side of the body (depending on the location of the blood clot).
    **** According to the National Stroke Association, although only about 13% of strokes are the second type, hemorrhagic stroke (which occurs when a blood vessel inside the brain ruptures and leaks blood into surrounding brain tissue), they account for more than 30% of all stroke deaths. Until a patient who could be having a stroke is seen by a physician, no assumption should be made regarding the type of stroke, and aspirin and other NSAIDs should be avoided because they could significantly exacerbate the hemorrhaging.****

    You wrote, “On rare occasions a stroke may be accompanied by a headache.”
    **** Again, the literature suggests that stroke being accompanied by headache is not rare. Tentschert et. al, in “headache at Stroke Onset in 2196 Patients with Ischemic Stroke or Transient Ischemic Attack,” report, “Five hundred eighty-eight (27%) patients experienced headache at stroke onset.” I wouldn’t call that 27% rare. They also state, “We could confirm previously described associations of headache at stroke onset with younger age and a history of migraine, implicating a careful evaluation of young patients with a focal neurological deficit and a history of migraine to avoid misclassification as;complicated migraine’.” and “Headache is a common symptom in acute ischemic and hemorrhagic stroke, but many aspects of its association with clinical parameters have been controversial in previous studies. The reported frequency of stroke-related headache ranges from 7% to 65%. Previous studies provide differing results as to whether lateralized headache is related to the side of the lesion, whether headache frequency is different in anterior versus posterior lesion localization, whether it is more common in women than in men or whether headache in stroke is related to several factors, such as blood pressure (BP), history of hypertension, or history of migraine.”

    In addition, the National Stroke Association lists “Sudden severe headache with no known cause” as one of their top five stroke symptoms.****

    Thank you,
    Teri

  • Denise Whitehead
    6 years ago

    Earlier this year, my mother had a severe migraine for several days. On about the 3rd day I noticed she was mixing her words a little bit. This was a Saturday. By Sunday she had full blown aphasia. The migraine and aphasia were her only symptoms. Since I have suffered severe migraine for over 30 years I knew something was wrong. I told her to be prepared because I was calling 911. She started screaming at me but I called anyways. At the emergency room the doctor checked her out. He told me that she was having a series of mini strokes and it was good that I called 911 when I did. She stayed in the hospital for 3 days and had physical therapy. We also found out that she is diabetic. The doctors said to get our blood sugar checked whenever we have the migraines that they may be related. Luckily my mother suffered no permanent injury due to all of this. For her migraine they gave her Magnesium in an i.v. It knocked her migraine out in about 15-20 minutes. I asked a doctor at the emergency room, for my visit, if they could use Magnesium. They had never even heard of this as a treatment. Why is that? If it helps should it not be known to emergency rooms? I have also been hearing talk of Botox for migraines. Can you provide me with some information in regards to the Magnesium and the Botox? Thanks a bunch. Mom is still symptom free in regards to the strokes.

  • Dr. Larisa Syrow author
    6 years ago

    Hi Denise, thank you for sharing your story and I’m glad to hear that your mom is doing better now.
    Magnesium is a natural supplement that can help with migraine headaches both as an abortive medication, when used IV in the emergency room, as well as a prophylactic medication, when used on a daily basis at home. It can be purchased in vitamin stores (over the counter). Usually the only side effect is loose stool. For dosing recommendation I suggest you talk to your doctor.

    “Botox” is a brand name for Botulinum Toxin, which is an FDA approved treatment for chronic migraine. It is a set of injections, performed every 3 months, recommended for people who have migraine headaches at least 15 days/month, lasting at least 4 hours each time, who did not have success with other medications.

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