There are several ways to think about migraine and its relationship to stroke. Migraine is a disease that affects the nerves in our body, as well as the blood vessels. More specifically, it affects the arteries or the blood vessels that carry blood from the heart to the rest of our body. There are two important relationships between migraine and stroke. The first is that some people can present with stroke-like symptoms when they are having a migraine. Second, migraine is now known to be a risk factor for having a stroke. These are both important topics to be aware of if you are someone who lives with migraine.
Migraine and stroke
Migraine and stroke are both common conditions. Stroke is the second most common cause of death and causes a lot of disability. Migraine is also very common; it affects about one in 7 people (1,2). Traditionally, stroke occurs mostly in the older population, although recently it has been increasing in young people as well. Migraine is much more common in women than in men. Many studies show that for those that have migraine, the highest risk of developing a stroke is in young pre-menopausal women. In most studies, this risk is higher in women who have a sub-type of migraine known as migraine with aura (3). This risk is further increased with smoking, uncontrolled high blood pressure and also possibly if women are using estrogen-containing medications like birth control (3).
Migraine with Aura
There are two main types of migraine, migraine with aura and migraine without aura. In migraine with aura, the migraine is accompanied by focal neurological symptoms; in addition to a headache, which can come with nausea, sensitivity to light, sounds and even smells at times. Dizziness or vertigo, trouble speaking or thinking are also symptoms that can be a part of a migraine attack. The most common type of aura is visual, in which someone will notice visual symptoms in one portion of their visual field, either prior to or during the headache portion of their migraine. Most commonly, this can be bright lines or colors that grow gradually over 20-30 minutes which can obstruct someone’s vision. Other aura symptoms can also be numbness or tingling on one side of a person’s body, including their face, arm and/or leg. Weakness on one side of the body can also be an aura symptom.
Is it a migraine or a stroke?
Some of the symptoms of a migraine can look very similar to a stroke, so how can you know if it is another migraine or something more worrisome? A good rule of thumb is; if you are having a symptom for the first time, like weakness, numbness, dizziness or a severe headache that is not similar to your other headaches you should see a doctor immediately. If you have a history of migraine, you will have a sense of what the usual pattern is for your migraine attacks. Anything different from your usual pattern should also be a cause for alarm. There are also some other helpful patterns to determine if this could be a stroke. Strokes tend to come on suddenly, while a migraine aura tends to occur more gradually. If you are having visual symptoms, a migraine aura tends to come with zig-zag lines or colors, while in a stroke; it will more likely be a decrease in vision or blurry vision.
Although this may sound scary for women with migraine, the good news is that the overall rate of strokes in this population is low. It is also important to work with your doctor if your migraine attacks are frequent or very severe, as adequate treatment may help decrease the risk of a stroke. There are many ways to treat or prevent migraine attacks including new treatments that have recently been approved by the FDA, as well as many natural options. In addition, living a healthy lifestyle with regular exercise and controlling other risk factors for stroke are important. This includes regular check-ups to make sure that your blood pressure is controlled. It is always a good idea to not smoke or work on stopping if you are currently smoking, as well.
1-Feigin VL, Forouzanfar MH, Krishnamurthi R, Mensah GA, Connor M,
Bennett DA, et al. Global and regional burden of stroke during
1990–2010: findings from the Global Burden of Disease Study 2010.
2-Victor TW, Hu X, Campbell JC, Buse DC, Lipton RB. Migraine
prevalence by age and sex in the United States: a life-span study.
3-Schurks M, Rist PM, Bigal ME, Buring JE, Lipton RB, Kurth T. Migraine
and cardiovascular disease: systematic review and meta-analysis. BMJ.
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MEET THE AUTHOR
Huma U. Sheikh, MD, is an assistant professor at Mount Sinai Beth Israel and was previously a clinical instructor of neurology at Brigham and Women’s Hospital-Harvard Medical School. She completed her neurology residency at Montefiore Medical Center, where she also completed a Stroke Fellowship before going on to Brigham and Women’s Hospital for a fellowship in Headache Medicine. She was the previous co-chair of the Migraine and Vascular Disease special interest section at the American Headache Society (AHS) and on the AHS committee to develop “Guidelines for Vascular Issues and Headache.” Her main research interest is in investigating the role of low dose oral contraceptives in stroke for women with migraine with a grant from the International Headache Society.
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