But some migraine attacks also cause numbness, weakness, trouble speaking, confusion, visual changes, and vertigo. And some strokes cause a sudden, severe headache. Given the sometimes overlapping symptoms of migraine and stroke, it can be difficult to tell which you’re having and whether you should go lie down in a dark, quiet room or go immediately to the emergency room. To complicate matters further, it’s possible for a person to have both a migraine attack and a stroke at the same time. So how should you respond to symptoms that could be one or the other disease? And beyond common symptoms, is there really a relationship between migraine and stroke?
How Do I Know if It’s a Stroke or Migraine Attack?
Migraine is a neurological disorder characterized by repeated episodes of symptoms, called attacks, that usually include head pain accompanied by nausea, vomiting, and sensitivity to light, touch, smell, or sound. The chain of events that occurs in the brain as a migraine attack unfolds is complicated and not fully understood. One theory, described in April 2015 in the Journal of Neuroscience, is that it involves hyperexcitable neuronal (nerve) networks in the brain that, when triggered, cause the release of a variety of chemicals known as neuropeptides. Neuropeptides, in turn, cause the dilation and contraction (widening and narrowing) of blood vessels that leads to the symptoms associated with migraine. A stroke is an episode of decreased blood flow in part of the brain. A stroke can be caused by a blockage in a blood vessel — called an ischemic stroke — or by bleeding from a blood vessel — called a hemorrhagic stroke. In either case, the part of the brain normally served by that blood vessel is starved of oxygen and nutrients, causing tissue injury or death of that portion of the brain. Stroke can also be fatal, particularly if it affects the part of the brain that controls breathing and other major organs, such as the heart. Both migraine and stroke can cause focal neurological deficits, or abnormal function in specific locations in the body, says Ava Liberman, MD, an assistant professor of neurology at the Montefiore Medical Center Albert Einstein College of Medicine in New York City. Focal neurological deficits can include weakness or loss of muscle control, numbness and tingling in an area of the body, and problems with speech, vision, or hearing caused by a problem in the brain or nervous system, according to MedlinePlus. As a result, a small number of people who arrive at the emergency department with migraine are treated with clot-busting drugs when doctors believe the person is having a stroke, since how quickly doctors are able to stop a stroke is crucial to the person’s recovery and prognosis, says Dr. Liberman. Usually, this does not harm the person, and once the dust settles, the person is correctly diagnosed with migraine, she says.
Which Migraine Types Can Resemble Stroke?
Migraine with aura is the type of migraine most commonly mistaken for stroke. The “aura” in migraine with aura is a set of visual, sensory, or other nervous system symptoms that usually last between a few minutes and an hour, and usually precede the headache phase of an attack. It’s possible to have aura symptoms with no headache. About 25 percent of people with migraine experience auras, according to the Migraine Research Foundation. The most common aura symptoms are visual effects such as bright flashing lights or spots or zigzags in a person’s field of vision. Other possible aura symptoms include losing sight for short periods; having tingling and numbness in the face, hands, or other areas of the body; hearing sounds such as buzzing or music; and having speech and language problems such as being unable to say words, slurring, or mumbling, according to the American Migraine Foundation. Any of those could easily be assumed to be signs of a stroke. Another migraine type that can cause stroke-like symptoms is a very rare inherited condition called familial hemiplegic migraine, or sporadic hemiplegic migraine if it occurs in only one person in a family. Symptoms of a hemiplegic migraine attack are the same as migraine with aura but also include motor, or muscle, weakness on one side of the body that may persist for days or even weeks. Rarely, hemiplegic migraine can cause fever, confusion, loss of consciousness, or even profound coma.
What if I’m Not Sure Whether It’s Migraine or Stroke?
“If you have a first-time migraine, and you have abnormal symptoms with it, the experience can be very scary,” says Anum Riaz, MD, an assistant professor of neurology at the University of Toledo in Ohio. Dr. Riaz notes that it’s always a good idea to be evaluated for stroke if you experience symptoms that could indicate either a stroke or migraine, including confusion, suddenly being unable to move your face, arm, or leg, especially on one side, or if you’re having trouble speaking. Liberman concurs, saying, “People with migraine headaches usually know their symptoms, and they should always act on the red flag warning signs of stroke, which include sudden numbness, vision loss, and weakness.” As a general rule of thumb, migraine typically causes positive sensations — feeling tingly, prickly, seeing spots — while stroke is linked with the absence of sensations, that is, feeling numb or weak, and having vision loss rather than seeing spots, says Riaz. Another difference worth noting is that stroke symptoms tend to occur suddenly, while migraine symptoms typically develop gradually over the course of hours.
Migraine With Aura Raises Stroke Risk Slightly
While migraine typically does not cause stroke, having migraine with aura can put people at a slightly higher risk of stroke. Liberman stresses that the increased risk is generally small, and people who have migraine should get to know their symptoms and not live in fear of having a stroke. When stroke occurs as a complication of migraine with aura, it’s called migrainous stroke or migrainous infarction. Migrainous stroke is an uncommon occurrence. According to an article published in 2017 in Current Neurology and Neuroscience Reports, it accounts for only 0.2 to 0.5 percent of all ischemic strokes. In the United States, that would mean about 2,000 to 4,000 out of the nearly 800,000 strokes that occur each year, according to Centers for Disease Control and Prevention (CDC) statistics. While many theories have been put forth about why migraine with aura raises the risk of stroke, some of which are discussed in the Current Neurology and Neuroscience Reports article, ultimately, migraine researchers don’t know why this association exists.
How Can I Lower My Stroke Risk?
“Given that migraine with aura is a vascular risk factor, the best thing people with migraine can do is be extra-engaged in reducing the risk factors for stroke that everyone should pay attention to,” says Liberman. According to the CDC, the leading causes of stroke are high blood pressure, high cholesterol, smoking, obesity, and diabetes. You can lower your risk of stroke by following a healthy diet, maintaining a healthy weight, being physically active, quitting smoking if you smoke, and avoiding drinking too much alcohol if you drink. Working with your doctor to control any medical conditions you may have — such as high blood pressure, high cholesterol, obesity, diabetes, or heart disease — will also help to lower your risk of stroke. And your doctor can help you quit smoking. Women of childbearing age who have migraine will want to discuss their stroke risk with their doctor when choosing a method of contraception. While older formulations of birth control pills, with higher amounts of estrogen, were known to raise stroke risk — particularly among women who smoke — the use of low-dose hormonal contraceptives in otherwise healthy women with migraine does not appear to pose additional risk, according to a review in Current Headache and Pain Reports.
