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AWARENESS CENTER

Migraine and Stroke Risk: What You Need To Know

Posted on April 06, 2022
Medically reviewed by
Evelyn O. Berman, M.D.
Article written by
Elizabeth Wartella, M.P.H.

Compared to those who don’t experience migraine at all, those who have migraine with aura have an increased risk of having a stroke. (The risk is most prevalent in females under 45 years old.) Still, while the risk of a person who has migraine with aura experiencing a stroke may be more than double than that of those without migraine, their overall risk remains small.

The American Migraine Foundation notes that of the 800,000 strokes that occur in the United States each year, between 2,000 to 3,000 can be associated with migraine. Published research gets even more specific, and reports this increased risk of stroke has only been found in people with migraine with aura. (In migraine, aura is the sensory experience that can precede a migraine headache. Auras can be visual, physical, or audio in nature. Hazy patches of light that don’t exist might appear, a person’s body might tingle, they could hear sounds when there are none, or their speech might slur.) The stroke connection has not been observed in people with migraine without aura.

According to current research, migraine itself does not cause a stroke. And only in extremely rare cases will a migraine attack and stroke happen at the same time. While migraine with aura may increase a person’s risk of having a stroke, a stroke is more likely to be caused by other risk factors. Those factors include smoking, high blood pressure, and a family history of heart disease.

To be clear: Having migraine with aura in no way means you will definitely have a stroke. And there are ways to manage your risk factors for stroke and your migraine symptoms. You can also learn the warning signs of a stroke — indicators that something more serious than a migraine is happening. Armed with that knowledge, you can better know when you should seek medical attention.

What Is a Stroke?

A stroke is a medical emergency. When someone has a stroke, blood and oxygen cannot reach their brain because an artery is blocked or has burst. If your brain doesn’t receive blood and oxygen, brain cells start to die.

Cell death can lead to neurological symptoms such as:

  • Slurred speech
  • Weakness or numbness in the arm
  • Drooping on one side of the face

The two main types of stroke are called ischemic or hemorrhagic. A third type is called a transient ischemic attack (TIA). A blood clot or clots cause an ischemic stroke. A hemorrhagic stroke happens when blood vessels become weak and burst. A TIA occurs when the blood supply to the brain gets interrupted. (People sometimes call TIAs “mini-strokes.”)

Generally, experiencing an ischemic or hemorrhagic stroke is rare. But a person’s risk for these strokes may be higher, depending on their age, health, and lifestyle.

Differences Between Strokes and Migraine

Symptoms of stroke and migraine can be similar. And it is often particularly difficult to tell a migraine headache from a TIA. The main point of distinction between any stroke and a migraine is the speed you experience the symptoms of either. Strokes and TIA symptoms usually come on suddenly, whereas migraine symptoms develop gradually.

A hemiplegic migraine leads to temporary weakness on one side of the body. That kind of physical reaction can be mistaken for a TIA or stroke. The symptoms of migraine with aura can also be confused for those of TIAs or strokes.

The Migraine Trust shares helpful ways to differentiate between a stroke and a migraine. The group notes that strokes have “negative” symptoms. In a negative symptom, a person’s normal ability to function decreases. For example, losing feeling on one side of your body or losing vision in one eye are negative symptoms. Migraine symptoms, The Migraine Trust counters, are “positive.” Seeing or hearing things that don’t exist or feeling unprovoked tingling would be considered positive symptoms. These sensations are added rather than taken away.

If you are unsure if you’re experiencing a migraine attack, stroke, or TIA, seek emergency medical help. Any stroke needs to be treated as soon as possible to increase your chance for a good recovery.

How Are Migraine and Stroke Connected?

People with migraine with aura have a higher risk of having a stroke, specifically an ischemic stroke. Migraine with aura does not have a clear effect on the risk of hemorrhagic stroke.

Researchers have observed an increased risk of ischemic stroke particularly in young women with migraine with aura. This increased risk is not generally seen in older people with migraines unless they are smokers or didn’t start having migraines until later in life.

How Migraine Increases Risk of Stroke

Scientists and doctors are still sorting out the root of the connection between migraine and stroke, both neurological conditions. A popular theory highlights the effect migraine has on a person’s arteries (the blood vessels that carry blood to the brain).

Here’s how the theory unfolds: A migraine attack causes spasms — narrowing of arteries in a person’s head and neck. Temporarily narrowed and less-flexible arteries can increase the chance of someone’s blood cells clumping together to form blood clots. If one of these blood clots block an artery, and that clot prevents oxygen-rich blood from flowing to the brain, a stroke can occur.

When narrowed arteries exist alongside factors known to increase a person’s chance of developing blood clots, they risk having a stroke. Factors that increase the chance of blood clots can include:

  • Smoking
  • Having high cholesterol
  • Being obese
  • Taking certain contraceptive pills

Contraceptive Pills, Migraine, and Strokes

A woman who has migraine with aura and takes a combined oral contraceptive pill increases her risk of an ischemic stroke. (A combined oral contraceptive pill is a birth control pill that includes synthetic versions of the hormones progesterone and estrogen.) However, her stroke risk overall remains small. Nonetheless, these medications are generally not advised for anyone with migraine with aura, especially those with other risk factors, like a family history of cardiovascular (heart) disease, or a condition like high blood pressure.

If you have migraines with aura and are considering your birth control options, tell your doctor so they can suggest one that is most likely safe for you, like a progesterone-only option.

Migrainous Infarction

Sometimes a migraine and a stroke can happen at the same time. When an ischemic stroke happens during a migraine attack, it’s called a migrainous infarction. There is no evidence that a migraine causes a stroke, and migrainous infarctions are very rare.

How To Manage Your Risk of Stroke When You Have Migraine With Aura

If you have migraine with aura, it is important to manage other risk factors for a stroke. It’s also essential to continue seeing your doctor or neurologist — especially if your symptoms change. And it’s crucial to know the warning signs of a stroke.

Manage Risk Factors

If you have migraine with aura, let each of your health care providers know. Knowing your condition will direct their health care plans for you. Beyond that, if you have migraine with aura, take steps to manage your risk of a stroke.

Some of the ways to manage your stroke risk if you have migraine with aura include:

  • Avoiding your migraine triggers
  • Taking your migraine-preventive medication
  • Following your doctor’s treatment if you have high blood pressure (hypertension)
  • Adhering to your doctor’s treatment plan if you have high cholesterol
  • Avoiding contraceptives with estrogen
  • Quitting smoking
  • Avoiding exposure to secondhand smoke
  • Moderating your alcohol consumption (or abstaining altogether)
  • Eating a healthy, balanced diet
  • Exercising regularly
  • Updating your doctor when your migraine symptoms suddenly grow severe or occur more often
  • Visiting your general health care practitioner annually to address health issues like high blood pressure, high cholesterol, obesity, or diabetes

Know the Warning Signs of a Stroke in People With Migraine With Aura

In addition to managing your general stroke risk factors, be aware of the stroke warning signs specifically related to those who have migraine with aura. Such warnings can include:

  • A history of TIAs
  • Changes in aura symptoms (severity, duration)
  • A sudden onset of symptoms (as opposed to the gradual onset typical of migraine attacks)

Talk With Others Who Understand

MyMigraineTeam is the social network for people living with migraine. On MyMigraineTeam, more than 75,000 members come together to ask questions, give advice, and share their stories with others who understand life with migraine.

Do you have migraine with aura and have you had a TIA or stroke? Share your experience in the comments below, or start a conversation by posting on your Activities page.

All updates must be accompanied by text or a picture.
Evelyn O. Berman, M.D. is a neurology and pediatric specialist and treats disorders of the brain in children. Review provided by VeriMed Healthcare Network. Learn more about her here.
Elizabeth Wartella, M.P.H. is an Associate Editor at MyHealthTeam. She holds a Master's in Public Health from Columbia University and is passionate about spreading accurate, evidence-based health information. Learn more about her here.

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