Migraine and Stroke

Severe headache is a symptom of migraines and strokes.

• A migraine headache is a type of headache that causes severe, intense, and throbbing pain on one side of the head.
• A stroke occurs when a blood vessel in the brain is blocked, leaks, or bursts, which deprives brain cells of oxygen and they begin to die. The part of the body controlled by the damaged area of the brain loses function.
• Stroke and migraine symptoms that may be similar include:
  • Severe headache
  • Facial numbness
  • Numbness in the extremities or face
  • Dizziness
• A main difference between the symptoms of migraine and stroke is that stroke symptoms come on suddenly while migraine symptoms tend to come on gradually.
• Stroke symptoms that are different from migraine include:
  • Face drooping
  • Uneven or lopsided smile
  • Difficulty speaking or slurred speech
  • Sudden confusion or difficulty understanding speech
  • Sudden trouble seeing in one or both eyes
  • Sudden loss of balance or coordination, or trouble walking
• Migraine symptoms that are different from stroke include:
  • Visual disturbances
  • Nausea or vomiting
  • Extreme sensitivity to sound/light/touch/smell
  • Tingling in the extremities

A migraine is a group of neurological symptoms that typically include a severe throbbing headache, usually on one side of the head. Researchers and doctors do fully understand the causes of migraine headaches; however, most think that they may be caused by changes in the chemicals in the brain, which causes inflammation, or the condition may be genetic (inherited).

A migraine “aura” describes neurological symptoms that occur prior to a migraine attack. Symptoms of a migraine aura can include problems with:

• Vision (wavy lines, spots in vision, or flashing lights)
• Sensations (skin crawling or tingling or even strange smells)
• Speech (stuttering)
• Motor functions (twitching or weakness of arm or leg)

Migraine aura symptoms last just a few minutes and should not leave any lasting effects. It is common for aura symptoms to occur only on one side of the body (unilaterally) or one side of the visual field. After migraine aura symptoms resolve, usually a migraine attack or headache will occur.

Migraine aura symptoms and signs are very similar to stroke or transient ischemic attack (TIA, mini-stroke). If you think you or someone you know is having a stroke, remember “FAST.”

A stroke or "brain attack" occurs when a blood vessel in the brain is blocked, leaks, or bursts. This deprives brain cells of oxygen and they begin to die. The part of the body controlled by the damaged area of the brain loses function. A small stroke may only cause minor problems or temporary weakness or memory loss. A larger stroke can cause permanent paralysis or loss of ability to speak or in some individuals, death.

There are two main types of stroke:

• Hemorrhagic stroke happens when a blood vessel leaks or bursts and there is bleeding into the brain tissue.
• Ischemic stroke occurs when a blood vessel is blocked by a blood clot in the brain.
  • A “mini-stroke” (transient ischemic attack, TIA) is a type of ischemic stroke in which there is only temporary blockage of a blood vessel in the brain. Mini-stroke symptoms and signs only last a few minutes; however, it is still a medical emergency and 911 should be called.

It is possible for a headache that feels like a migraine to occur during a stroke. A migraine aura may resemble a transient ischemic attack (TIA), also called a “mini-stroke” (a temporary stroke that resolves symptoms quickly without residual or long-term disability).

Migraine headache symptoms and signs

Migraine attacks can last between 4 to 72 hours and can be incapacitating. Migraine is more than other types of headaches. It is a cluster of neurological symptoms that include:

• Severe throbbing pain on one or both sides of the head
• Visual disturbances
• Nausea or vomiting
• Dizziness
• Extreme sensitivity to sound, light, touch, and smell
• Tingling or numbness in the extremities or face

It also is possible for a migraine aura to resemble a transient ischemic attack (TIA).

Stroke symptoms and signs

• Face drooping, facial numbness, uneven or lopsided smile
• Arm weakness or numbness
• Difficulty speaking or slurred speech
• Sudden confusion or difficulty understanding speech
• Sudden numbness or weakness of face or extremities, especially on one side of the body
• Sudden trouble seeing in one or both eyes
• Sudden dizziness, loss of balance or coordination, or trouble walking
• Sudden severe headache with no known cause

Stroke is a medical emergency. Immediate medical attention is necessary. The American Heart Association and the American Stroke Association recommend you know the signs of a stroke and act FAST:

• Facial drooping
• Arm weakness
• Speech difficulties
• Time to call 9-1-1

Migraine and stroke may occur at the same time, but a causal link has not been established. When an ischemic stroke occurs during a migraine attack, it is called a migrainous infarction.

Migraine and stroke risk factors

In a very small population of patients with specific symptoms, migraines may be related to a higher risk of stroke. Migraines may be a risk factor for stroke, in that strokes occur more frequently in people who have had migraines, but the strokes do not necessarily occur during migraine attacks. The specific type of migraine associated with an increased risk of ischemic stroke is migraine with aura, a type of migraine that affects about one-quarter of all migraine patients. Moreover, women who have migraine with aura are at a greater risk for stroke than women without migraine, or even men who experience migraine with aura.

People with migraines at highest risk for stroke are those who also have traditional risk factors for stroke such as high blood pressure, diabetes, high cholesterol, smoking, and obesity.

Migraine triggers and causes

The cause of migraines is not completely understood, but it is believed to be due to abnormal increases in levels of substances naturally produced in the brain, which produce inflammation that causes blood vessels in the brain to swell and press on nearby nerves resulting in migraine symptoms. There may also be a genetic link to migraines.

On a day-to-day basis, migraine triggers or factors (environmental, chemical and many others) contribute to a migraine attack, but are not triggers for stokes.

Common migraine triggers include:

• Bright lights, loud noises, or strong odors
• Stress or anxiety
• Hormonal changes
• Caffeine
• Alcohol
• Irregular sleep
• Missing a meal
• Certain foods that contain nitrates, MSG (monosodium glutamate), or tyramine
• Artificial sweetener (aspartame)
• Changes in weather

Stroke causes

A blood vessel in the brain is blocked, leaks, or bursts causes a stroke. This deprives brain cells of oxygen and they begin to die. The part of the body controlled by the damaged area of the brain loses function.

Migraine treatment

There is no cure for migraine, but the headaches can be managed with:

• Medications for acute treatment include over-the-counter (OTC) pain relievers such as aspirin, acetaminophen (Tylenol), or nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Advil, Motrin); triptans; and ergot derivatives
• Medications to prevent an attack include antidepressants, anticonvulsants, beta-blockers, calcium channel blockers (CCBs), and hormone therapy (in women whose migraines are linked to their menstrual cycle).
• Lifestyle changes include avoiding known migraine triggers, maintaining a healthy balanced diet, regular exercise, limiting caffeine and alcohol, and stress reduction techniques.
• Biofeedback, acupuncture, and counseling may also help.

Stroke treatment

Stroke is a medical emergency. If you have stroke symptoms, call 9-1-1 and get medical attention immediately.

It is important to CT scan the patient’s brain to diagnose an ischemic stroke from a hemorrhagic stroke because the emergent treatments are very different.

Blood thinners are the most common treatment for acute ischemic stroke. The “clot buster” drug used in emergency settings is called alteplase (Activase), also referred to as tPA (tissue plasminogen activator) and it must be administered within 3-4.5 hours of the onset of stroke symptoms (depending on the circumstance) for the best chance of recovery. Patients who cannot receive tPA may receive blood thinners such as aspirin and clopidogrel. Some stroke patients also may need, or benefit from, intra-arterial blood thinners or clot retrieval devices.

Patients with carotid artery disease may get a carotid endarterectomy or carotid artery angioplasty to open blocked carotid arteries.

Hemorrhagic strokes may be treated by taking patients off antiplatelet medicines and blood thinners to reduce bleeding. Patients with high blood pressure may receive antihypertensive drugs to lower blood pressure. Surgery such as aneurysm clipping, coil embolization, or arteriovenous malformation (AVM) repair may be needed to treat hemorrhagic stroke.