Throbbing pain. Sensitivity to light. Nausea. Auras. For the 30 million people in the United States who experience migraines on a regular basis, they aren’t just a nuisance. They can interfere with your life and keep you from doing the things you love.
They also could be a sign that you’re at an increased risk for stroke.
Although research is inconclusive, there has been some associated risk of stroke—from 7.4 to 34% depending on the study—found among people who experience migraines.
Why do headaches often accompany a stroke?
Thomas Olmsted, DO, stroke director and emergency medical physician on the medical staff at Baylor Scott & White Medical Center – Centennial, said that headaches three days before and up to three days after a stroke have been tied to the event.
Headaches can be related to the type of stroke (ischemic vs. hemorrhagic), the severity and the location of the stroke in the brain. For example, people with posterior circulation strokes, which occur in the back of the brain, often experience headache, dizziness and vision changes, as opposed to the more classic stroke symptoms such as weakness on one side of the body. Those with a hemorrhagic, or bleeding, stroke often have a very severe, sudden-onset headache caused by the building inner cerebral pressure.
The association between headache and stroke also may be related to the inflammatory markers that are released when a stroke occurs. There are no pain receptors in the brain itself. But the inflammation can be perceived as pain by two places in your brain—the meninges, which cover the brain, and the periosteum, the coverings of the bones.
Related: Are you at risk for stroke?
The migraine and stroke link
A rare type of stroke, called a migrainous stroke or migrainous infarction, is when an ischemic stroke occurs along with migraine aura symptoms and resulting in neurological deficits such as:
- Numbness or weakness on one side of the body
- Trouble speaking or understanding speech
- Balance or coordination problems
- Vison changes
According to Dr. Olmsted, this type of stroke can be difficult to diagnose because some patients will present with a complicated or complex migraine that causes neurological deficits that mimic stroke symptoms.
When patients present with a headache in combination with stroke symptoms, nurses in the emergency room activate Code Stroke protocol to immediately assemble a team of specialists. The protocol helps provide immediate stroke treatment, if necessary, to limit any long-term effects.
If you have a history of migraines, you may want to talk to your physician about lowering your risk for stroke. That could include taking aspirin to keep platelets from sticking together, taking a statin to decrease your cholesterol and focusing on a healthy diet and regular exercise.
When a migraine becomes an emergency
While migraines are a painful disruption to your day-to-day life, they are not always an emergency. Dr. Olmsted said that a few factors should trigger you to seek emergency care.
”If the headache that you normally have changes, you should come in and be seen,” he said.
Call 911 if you experience:
- Changes in the severity, frequency or location of the headache or the other symptoms you experience with the headache
- Any neurological deficit (such as weakness or problems with coordination, balance or speech)
- Changes in your vision
The onset of your headache is also significant. If you experience a very sudden onset headache—often called a thunderclap headache—that goes from 0 to 10 in an instant, that could be a sign of a hemorrhagic or bleeding stroke.
In these cases, a trip to the emergency room is in order, and don’t plan to drive yourself. Call 911. That not only ensures that the EMS team can evaluate your symptoms and transport you to the appropriate level of care—for example, a Primary or Comprehensive Stroke Center—but also keeps you (and others) safe.
“If you have worsening symptoms and you’re driving a car down the interstate at 70 miles an hour, and all of a sudden, you can’t move part of your body, bad things can happen,” Dr. Olmsted said.
Once in the emergency room, you’ll go directly to the CT scanner for imaging of the brain, as well as undergo a neurological assessment to determine if there are any neurological deficits.
Other headache red flags
Other headache red flags that might not be a sign of stroke, but that necessitate immediate emergent care include:
- If you are over 50 with no history of migraine headaches and you get a new onset headache.
- If you have a headache accompanied by neck pain or neck stiffness.
- If you have changes in your vision.
- If you have fever and headache.
- If you’re in an immunocompromised state, such as taking medications for an autoimmune disorder or undergoing chemotherapy, and you get a sudden onset headache.
- If you’re pregnant or postpartum and you get a severe headache, it could be a sign of eclampsia or preeclampsia.
- If you have a headache and you faint.
- If you have a headache accompanied by a first-time seizure.
“If you have a headache with any of these other symptoms, you need to call 911 and get in to be evaluated,” Dr. Olmsted said.
Bottom line on severe headaches and migraines: When in doubt, seek care.
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About the author
Thomas Olmsted, DO, is an emergency medical physician and stroke director at Baylor Scott & White Medical Center – Centennial.