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Migraine vs. Stroke: Differences and Warning Signs

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When you live with migraine, you’re familiar with the nuances of your migraine episodes — the warning signs, the throbbing pain, the aftereffects. But what happens when new, alarming symptoms surface? Could it be a stroke? It’s crucial to distinguish between a migraine episode and a stroke because while both can share similar symptoms, a stroke demands immediate medical action.

Migraine and Stroke: An Overview

Migraine and strokes are distinct medical conditions that, despite having some symptom overlap, differ significantly in their implications and required responses.

Migraine Characteristics

Episodes of debilitating symptoms characterize migraine. These symptoms commonly include:

  • Headaches with a throbbing or pulsating quality, often unilateral (affecting one side of the head), which may not present in some subtypes of migraine
  • Sensory sensitivities like photophobia and phonophobia
  • Nausea or vomiting
  • Potential for aura, which can include visual disturbances, sensory changes, or speech difficulties

There are specific types of migraine that can mimic stroke symptoms, including:

  • Hemiplegic migraine: This rare form of migraine involves temporary paralysis (hemiplegia) or neurological or motor symptoms on one side of the body, which can be similar to stroke symptoms.
  • Migraine with brainstem aura: Formerly known as basilar-type migraine, this subtype can cause symptoms such as vertigo, slurred speech, and tinnitus, which also resemble stroke signs.
  • Migraine with unilateral motor symptoms (MUMS): This can involve muscle weakness on one side of the body.

Stroke Is a Medical Emergency

Strokes, on the other hand, are life-threatening emergencies requiring immediate medical intervention. Symptoms of a stroke are abrupt and can cause permanent neurological damage.

Stroke identifiers include:

  • Ischemic stroke: Caused by a blockage, often a blood clot, in a blood vessel supplying blood to the brain and is the most common type of stroke.
  • Hemorrhagic stroke: Where a blood vessel ruptures (aneurysm) and bleeds into the surrounding brain.

Urgent Stroke Indicators

Prompt recognition of stroke is crucial. Here are some symptoms to watch for:

  • Sudden numbness, especially on one side of the body
  • Sudden loss of balance, difficulty with walking, dizziness, or lack of coordination
  • Confusion, trouble speaking, or difficulty understanding speech
  • Sudden blurred or loss of vision
  • Severe headache with no known cause

Stroke and FAST Intervention

It can be easier to remember the symptoms of stroke with the FAST acronym:

  • Face drooping
  • Arm weakness
  • Speech difficulty
  • Time to call emergency services

Immediate medical intervention is crucial to minimize brain damage and potential disability.

The complexity arises when you experience migraine attacks with stroke-like symptoms. It’s essential to be aware that migraine, even those with severe neurological symptoms like hemiplegic migraine, do not involve the death of brain tissue or carry the immediate risk of death and severe long-term disability that strokes do.

However, because the symptoms can be so similar, any sudden onset of these symptoms or a significant deviation from someone’s typical migraine pattern should prompt immediate medical evaluation to rule out a stroke.

Migraine and Risk of Stroke

When you’re living with migraine, especially if you’re familiar with its disruptive impact on your daily life, understanding the relationship between migraine and stroke risk is crucial.

Increased Risk of Stroke

Research has shown that there is a connection between migraine, particularly migraine with aura, and an increased risk of stroke. The reasons behind this heightened risk aren’t fully understood, but it’s believed to involve changes in blood vessel function and blood flow to the brain during a migraine episode.

Risk Factors at Play

There are specific factors that can elevate this risk even further:

  • Gender and age: Young women with migraine with aura are at a particularly higher risk, especially if they smoke or use oral contraceptives
  • Cardiovascular health: Having a personal or family history of cardiovascular diseases can also increase the likelihood of stroke in those with migraine.
  • Frequency of episodes: More frequent migraine episodes may correlate with a higher stroke risk.

Understanding the Mechanism

While the exact mechanisms linking migraine to stroke aren’t clear, there are several proposed theories:

  • Vascular dysfunction: Migraine affecting the vascular system. The same blood vessel dysfunctions that cause migraine symptoms may contribute to the formation of clots or lead to blood vessel constrictions that can trigger a stroke.
  • Hypercoagulability: There is some evidence to suggest that people with migraine might have blood that’s more prone to clotting, which naturally increases stroke risk.
  • Genetic predisposition: Certain genetic factors that predispose you to migraine might also increase your susceptibility to stroke.

Important Differences Between Migraine and Stroke Symptoms

The intensity and onset of symptoms can help differentiate a migraine from a stroke. Stroke symptoms often occur suddenly, while migraine symptoms can present gradually.

Timing and Onset of Symptoms

  • Stroke: Symptoms appear abruptly, often without warning.
  • Migraine: Symptoms develop over minutes to hours, sometimes preceded by an aura.

Physical and Neurological Differences

  • Stroke: Sudden numbness or weakness, especially on one side of the body, confusion, trouble speaking, or understanding speech.
  • Migraine: Often presents with a headache that can be severe but doesn’t include sudden confusion or trouble speaking. While numbness/tingling, brain fog, and aphasia may present during a migraine attack, it is gradual as opposed to sudden.

Immediate Actions to Take

If you think you or someone else might be having a stroke, quick action can be lifesaving. Here’s what to do without delay:

  • Skip “wait and watch” and call the emergency services immediately.
  • Note the time of symptom onset and relay it to the health care team.
  • Stay with the person even if you believe their symptoms have improved.
  • Use the ambulance, and do not drive yourself or the person to the hospital.
  • Provide as much information as you can to the first responders.

Every second counts, so don’t hesitate to act.

Diagnosing Migraine vs. Stroke

When it comes to differentiating between a migraine attack and a stroke, health care professionals employ a thorough diagnostic approach to avoid misdiagnosis and ensure immediate and appropriate treatment.

  • Interview and physical exam: Questions about symptom onset and characteristics and checks for stroke-specific signs like facial drooping and speech difficulties help guide diagnosis.
  • Review of medical history: A history of similar episodes might suggest migraine, whereas new and abrupt symptoms could indicate a stroke.
  • Imaging tests: A CT scan or MRI can quickly identify a stroke and sometimes show changes related to migraine.
  • Blood tests and heart health evaluation: Assess for clotting issues and heart conditions that could lead to stroke.
  • Ultrasound: Used to examine the carotid arteries for blockages or narrowing that increase stroke risk.

In the case of complex or unusual presentations, additional testing might be required, including angiography or spinal tap, to gather further evidence for an accurate diagnosis.

Preventive Measures and Education

Preventive measures and education play pivotal roles in mitigating the risk of both stroke and migraine. For those living with migraine, particularly migraine with aura, understanding and managing risk factors becomes doubly important, as this group may have a slightly increased risk of stroke.

Preventive Measures for Stroke

  • Monitor and manage blood pressure
  • Maintain a healthy weight
  • Eat a balanced diet
  • Get 150 minutes of medium-intensity aerobic activity a week alongside muscle-strengthening exercises.
  • Quit smoking
  • Limit alcohol
  • Manage blood sugar levels
  • Treat atrial fibrillation

Education on Stroke and Migraine Risk

  • If you live with migraine, be aware of your stroke risk, especially if you experience migraine with aura.
  • Recognize and manage migraine triggers to reduce the frequency and intensity of your attacks.
  • Some migraine medications may have implications for stroke risk; discuss this with your doctor.
  • Oral contraceptives and hormone replacement therapies may slightly increase the risk of stroke.
  • Follow up regularly with your neurologist or primary care physician to stay on top of any new symptoms.

Understanding the signs of a migraine episode and stroke can save lives. Knowing when to seek immediate help can be potentially lifesaving.

Getty image by Maskot

Originally published: November 13, 2023
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