Migraines have not been shown to cause stroke, but if you have migraine with aura you have a very slightly higher risk of stroke.
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Understanding migraine and stroke
Stroke and migraine both happen in the brain, and sometimes the symptoms of a migraine can mimic a stroke. However, the causes of the symptoms are different. A stroke is due to damage to the blood supply inside the brain, but migraine is thought to be due to problems with the way brain cells work.
In a stroke, the blood supply to part of the brain is cut off, killing brain cells. This causes permanent damage to the brain, and can have long-lasting physical, cognitive and emotional effects.
A migraine causes pain and sensory disturbances, but the changes inside the brain are usually temporary.
The relationship between migraine and stroke is complex. The symptoms can sometimes seem similar, and they may share some underlying risk factors.
Occasionally migraine and stroke can happen together, but there is no evidence to suggest that one causes the other. Migrainous infarction is the term given to an ischaemic stroke (a stroke due to a clot) that happens during a migraine. This tends to happen alongside prolonged aura symptoms, but is extremely rare.
Stroke risk and migraine
If you have migraine with aura, you're about twice as likely to have an ischaemic stroke in your lifetime, compared to those without migraine. However, the overall risk linked to migraine is still very low, and you're far more likely to have a stroke because of other risk factors like smoking and high blood pressure.
If you have migraine, your GP or nurse can give advice on reducing your risk of a stroke from any other health conditions you may have, like high blood pressure, diabetes, atrial fibrillation or high cholesterol. They can also support you with making lifestyle changes such as stopping smoking, losing weight, healthy eating and exercise.
Women and migraine
Taking the combined oral contraceptive pill (combi pill) increases the risk of a stroke in women who have migraine with aura. Because of this, women who have migraine with aura are not usually given the combi pill. If you have migraine without aura you should be able to take the combi pill, unless you have other risk factors like smoking or being overweight.
Other health conditions
Some health conditions are linked to migraine. For example, CADASIL (a rare genetic disorder), and the auto-immune conditions antiphospholipid syndrome and Lupus, are linked to a higher risk of stroke, and people with these conditions are also more likely to have migraine.
What is migraine?
A migraine attack can have a wide range of symptoms. For many people the key symptom is a moderate or severe headache. Usually this is felt as a throbbing pain on one side of your head. This is often accompanied by other symptoms such as nausea and vomiting, and sensitivity to light or sound.
Migraine affects around one in every 15 men, and one in five women. People of all ages are affected by migraine, but the condition often begins in young adulthood. It often runs in families, and many people with migraine have a close relative with the condition. Some people have several migraines a week; others may have years between migraine attacks. Symptoms can last from a few hours to several days, and you may also feel very tired for up to a week after an attack.
Migraine without aura
Between 70% and 90% of the population with migraine have this type, which is sometimes called common migraine. It consists of a headache with other symptoms such as nausea and sensitivity to light, sound or smell. The other symptoms usually begin at the same time as the headache, and disappear once the headache goes. Many people feel irritable and need to rest in a dark room or sleep afterwards.
Migraine with aura
About 30% of people with migraine have migraine with aura (sometimes called classical migraine). Some people have both types. Attacks typically begin with an 'aura' consisting of one or more of the following symptoms which develop gradually over five to 30 minutes and last less than one hour. The headache can occur with or after the aura.
Types of aura
- Visual changes. This is the most common aura symptom, and the changes can include flashing lights, zig-zags, sparks or blank spots. These can appear on one side or centrally and commonly expand and move across your field of vision. Visual changes such as flashing lights can also be signs of acute eye disease, so if you get any of these symptoms and have not been diagnosed with migraine, contact your optician or GP urgently.
- Sensations such as pins and needles, tingling or numbness, weakness or a spinning sensation (vertigo).
- Less commonly, you may have difficulty speaking or hearing, and feel fear or confusion and even have paralysis.
Whether or not you have a migraine aura, you may experience some different symptoms hours or days before a migraine attack. These can include changes in mood and energy levels, aches and pains and sensitivity to light or sound. These are called prodromal or premonitory symptoms.
Migraine aura without headache
Also known as a silent migraine, this is an aura without the headache.
Rare types of migraine
There are some rare types of migraine, which are also classed as migraine with aura.
Migraine with brainstem aura
Previously known as basilar-type migraine, people with this condition experience two or more of the following symptoms before a migraine:
- Visual disturbances, including double vision.
- Speaking difficulties.
- Hearing problems, including ringing in the ears.
- Tingling in the hands and feet.
- Vertigo (spinning sensation).
People may experience these symptoms either ahead of or alongside typical migraine symptoms.
Hemiplegia means paralysis on one side of the body, and weakness or paralysis on one side is a key symptom of this type of migraine. Other symptoms might include numbness or pins and needles, visual problems, confusion and speech problems. These problems usually go away within 24 hours, but they may last a few days. A headache usually follows.
If you have a parent with hemiplegic migraines then you have about a 50% chance of having this type of migraine yourself, known as familial hemiplegic migraine (FHM). In some families with FHM, problems have been found with particular genes which affect how the brain cells communicate with each other.
What causes a migraine?
Migraine often runs in families, and if one or more close relatives experience migraine, it is more likely that you will too.
There are various triggers that can lead to a migraine attack, including:
- Emotional: such as stress, anxiety or depression.
- Physical: such as tiredness or tension, particularly in the neck and shoulders.
- Hormonal: some women experience migraine around the time of their period.
- Dietary: missing a meal, drinking alcohol or caffeinated drinks, and eating certain foods such chocolate or cheese.
- Environmental: such as bright lights or a stuffy atmosphere.
- Medicines: including some sleeping tablets, the combined contraceptive pill and hormone replacement therapy.
When migraine mimics stroke
The symptoms of some types of migraine can mimic stroke, such as hemiplegic migraine where there is weakness down one side.
Migraine auras can be confused with transient ischaemic attack (TIA), where someone has stroke symptoms that pass in a short time. For instance, a migraine with only a visual aura but no headache may be mistaken for TIA.
Like a stroke, a migraine can be sudden and can lead to mild confusion. However, migraine aura symptoms tend to develop relatively slowly and then spread and intensify, while the symptoms of a TIA or stroke are sudden.
Migraine can sometimes be mistaken for a stroke caused by bleeding on the brain, called a subarachnoid haemorrhage (SAH), which is often characterised by a sudden, very severe headache. Unlike SAH, migraine headache is usually one-sided and throbbing, slow to come on and lasts for a shorter period of time. Vomiting usually starts after a migraine headache starts, but is likely to happen at the same time as headache during a SAH. Patients with a SAH also develop neck stiffness, which is uncommon during a migraine attack.
Migraine diagnosis and treatment
Migraine is diagnosed by piecing together information about your symptoms and identifying patterns over time.
Your GP will do a number of tests checking your vision, reflexes, coordination and sensations. They will ask you to keep a diary of your migraine symptoms and factors such as what you ate and how you slept leading up to them. This may help you identify and avoid your triggers. You should also record any medicines you are already taking. Painkiller over-use makes migraines difficult to treat.
Some people are able to avoid their triggers and so eliminate migraine that way. Many people find that ordinary painkillers such as paracetamol, ibuprofen and aspirin reduce the pain of their migraine headache. Do not take painkillers every day for a migraine, as painkiller over-use can cause headaches. Your GP or a specialist can prescribe other treatments for nausea.
There are medications you can take at the start of an attack to stop it developing, and others that you take regularly to make attacks less frequent or less intense (prophylactic medication). Botulinum toxin type A treatment (often known as Botox) is available for some cases of chronic migraine.
For more information about managing migraine, visit migrainetrust.org.