Call the Stroke Helpline: 0303 3033 100 or email: [email protected] Migraine and stroke Migraines have not been shown to cause stroke, but if you have migraine with aura you have a very slightly higher risk of stroke. This guide explains more about migraine, and lists some useful organisations. Understanding migraine and Migrainous infarction stroke Occasionally migraine and stroke can occur Stroke and migraine both happen in the at the same time, but there is no evidence to brain, and sometimes the symptoms of suggest that one causes the other. Migrainous a migraine can mimic a stroke. However, infarction is the term given to an ischaemic the causes of the symptoms are different. stroke (clot) that happens during a migraine. A stroke is due to damage to the blood This tends to happen alongside prolonged supply inside the brain, but migraine is aura symptoms, but is extremely rare. thought to be due to problems with the way brain cells work. Stroke risk and migraine In a stroke, the blood supply to part of If you have migraine with aura, you are about the brain is cut off, killing brain cells. twice as likely to have an ischaemic stroke This causes permanent damage to the in your lifetime compared to those without brain, and can have long-lasting physical, migraine. However, the overall risk linked cognitive and emotional effects. A migraine to migraine is still very low, and you are far causes pain and sensory disturbances, but more likely to have a stroke because of other the changes inside the brain are usually risk factors like smoking and high blood temporary. pressure. The relationship between migraine and If you have migraine, your GP or nurse stroke is complex. The symptoms can can give advice on reducing your risk of a sometimes seem similar (see How do I tell stroke from any other health conditions the difference between migraine and stroke you may have, like high blood pressure, later in this guide), and they may share some diabetes, atrial fibrillatrion or high underlying risk factors. cholesterol. They can also support you with making lifestyle changes such as stopping smoking, losing weight, healthy eating and exercise. For more information visit stroke.org.uk 1 Migraine and stroke Women and migraine The main types of migraine Taking the combined oral contraceptive pill (combi pill) increases the risk of a stroke Symptoms like paralysis, sudden in women who have migraine with aura. sight loss and confusion can be signs Because of this, women who have migraine of a stroke. If you have any of these with aura are not usually given the combi pill. symptoms and you have not been If you have migraine without aura you should diagnosed with migraine, you should be able to take the combi pill, unless you call 999. have other risk factors like smoking or being overweight. Migraine without aura Other health conditions Between 70% and 90% of the population Some health conditions are linked to with migraine have this type, which is migraine. For example, CADASIL (a rare sometimes called common migraine. It genetic disorder), and the auto-immune consists of a headache with other symptoms conditions antiphospholipid syndrome and such as nausea and sensitivity to light, sound Lupus, are linked to a higher risk of stroke, or smell. The other symptoms usually begin and people with these conditions are also at the same time as the headache, and more likely to have migraine. disappear once the headache goes. Many people feel irritable and need to rest in a dark What is migraine? room or sleep. A migraine attack can have a wide range Migraine with aura of symptoms. For many people the key symptom is a moderate or severe headache. About 30% of people with migraine have Usually this is felt as a throbbing pain on one migraine with aura (sometimes called side of your head. This is often accompanied classical migraine). Some people have both by other symptoms such as nausea and types. Attacks typically begin with an ‘aura’ vomiting, and sensitivity to light or sound. consisting of one or more of the following symptoms which develop gradually over Migraine affects around one in every 15 men, five to 30 minutes and last less than one and one in five women. People of all ages are hour. The headache can occur with or after affected by migraine, but the condition often the aura. begins in young adulthood. It often runs in families, and many people with migraine Types of aura have a close relative with the condition. Some people have several migraines a week; • Visual changes. This is the most others may have years between migraine common aura symptom, and the attacks. Symptoms can last from a few hours changes can include flashing lights, to several days, but you could also feel very zig-zags, sparks or blank spots. These tired for up to a week after an attack. can appear on one side or centrally, and commonly expand and move across 2 Call the Stroke Helpline on 0303 3033 100 Migraine and stroke your field of vision. Visual changes such • hearing problems, including ringing in as flashing lights can also be signs of the ears acute eye disease, so if you get any of these symptoms and have not been • tingling in the hands and feet diagnosed with migraine, visit your optician or GP urgently. • dizziness • Sensations such as pins and needles, • vertigo. tingling or numbness, weakness or a spinning sensation or vertigo. People may experience these symptoms either ahead of or alongside typical migraine • Less commonly, you may have difficulty symptoms. speaking or hearing, and feel fear or confusion and even have paralysis. Hemiplegic migraine Hemiplegia means paralysis on one side of the Whether or not you have a migraine body, and weakness or paralysis on one side is aura, you may experience some different a key symptom of this type of migraine. Other symptoms hours or days before a migraine symptoms might include numbness or pins attack. These can include changes in mood and needles, visual problems, confusion and and energy levels, aches and pains and speech problems. These problems usually go sensitivity to light or sound. These are called away within 24 hours, but they may last a few prodromal or premonitory symptoms. days. A headache usually follows. Migraine aura without headache If you have a parent with hemiplegic migraines then you have about a 50% chance of having Also known as a silent migraine, this is an this type of migraine yourself, known as aura without the headache. familial hemiplegic migraine (FHM). In some families with FHM, problems have been found Rare types of migraine with particular genes which affect how the brain cells communicate with each other. 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 For more information visit stroke.org.uk 3 Migraine and stroke What causes a migraine? When migraine mimics stroke Migraine often runs in families, and if one or more close relatives experience migraine, it This information is a guide to some is more likely that you will too. of the stroke-like symptoms of migraine, but it is not intended as a Migraine triggers way of diagnosing migraine or stroke. You should get individual advice from There are various triggers that can lead to a a medical professional if you have migraine attack, including: migraine symptoms. • emotional: such as stress, anxiety or If you have any stroke symptoms you depression must call 999. • physical: such as tiredness or tension, particularly in the neck and shoulders The symptoms of some types of migraine can mimic stroke, such as hemiplegic migraine, • hormonal: some women experience which can cause weakness down one side. migraine around the time of their period Migraine auras can be confused with transient ischaemic attack (TIA), where someone has • dietary: missing a meal, drinking stroke symptoms that pass in a short time. alcohol or caffeinated drinks, and For instance, a migraine with only a visual aura eating certain foods such chocolate or but no headache may be mistaken for TIA. cheese Like a stroke, a migraine can be sudden • environmental: such as bright lights or and can lead to mild confusion. However, a stuffy atmosphere migraine aura symptoms tend to develop relatively slowly and then spread and • medicines: including some intensify, while the symptoms of a TIA or sleeping tablets, and the combined stroke are sudden. contraceptive pill Migraine can sometimes be mistaken for a Often it takes more than one trigger to stroke caused by bleeding on the brain, called lead to an attack, for example being under a subarachnoid haemorrhage (SAH), which is emotional stress and missing a meal. 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. 4 Call the Stroke Helpline on 0303 3033 100 Migraine and stroke Migraine diagnosis and Spotting the signs of a stroke treatment Diagnosing migraine FAST test Migraine is diagnosed by piecing together Face Can the person smile? Has information about your symptoms and their face fallen on one side? identifying patterns over time.