What is the relationship between migraine and stroke?

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A migrainous stroke, or a migrainous infarction, is a stroke that happens during a migraine attack.

Although migraine does not cause stroke, people who have migraine with aura have an increased risk of stroke.

If a migrainous infarction happens, it usually occurs during prolonged aura symptoms, although this is very rare.

Stroke and migraine symptoms can overlap. Migraine with aura can also appear similar to a transient ischemic attack (TIA). During a TIA, a blockage temporarily stops blood flow to the brain and causes stroke-like symptoms.

Symptoms of migraine with aura include:

• usually last 60 minutes or less
• visual disturbances, such as a bright crescent-shaped light with jagged edges that obscures some vision
• tingling on one side of the body, from fingertips to the side of the face, that may last for around 5 minutes or longer

Symptoms of TIA or stroke start suddenly and include:

• loss of vision in one or both eyes
• numbness or weakness in the body, usually on one side
• confusion
• dizziness or difficulty walking
• severe headache

People can use the acronym FAST to identify and respond to signs of a stroke:

• Face drooping on one side
• Arm weakness on one side
• Speech unclear or slurred
• Time to call 911 if people have any of the above symptoms

Some types of migraine, such as hemiplegic migraine, can mimic stroke symptoms.

Symptoms of a hemiplegic migraine include:

• weakness or paralysis on one side of the body
• feelings of numbness or pins and needles
• visual problems
• confusion
• difficulties with speech
• headache

Symptoms of hemiplegic migraine usually come on gradually compared to stroke or TIA, which happen suddenly.

According to the American Migraine Foundation, migraine with aura increases the risk of stroke. This may be due to a temporary narrowing of blood vessels. This can lead to the formation of blood clots which can cause a stroke.

Among people who have migraine with aura, females have a higher risk of stroke.

Around 25–30% of people with migraine experience aura. Aura is a set of sensations or sensory disturbances that happen just before a migraine attack. Aura may last between 20-60 minutes, and may include:

• tingling sensation on one side of the body
• seeing sparks, bright spots, or zig-zags in vision
• being unable to speak clearly

People may not have aura with every migraine attack.

According to a 2020 review, other risk factors for ischemic stroke in people with migraine include:

• female sex
• being younger than 45 years old
• use of oral contraceptives
• smoking

Males are three times less likely to have migraine than females, so risk factors are less clear. Stroke risk may increase if people:

• have active migraine (a migraine attack took place within the previous 12 months)
• have a high frequency of migraine attacks
• are older adults who smoke
• experience migraine onset later life

There is currently no clear evidence that the severity of a migraine attack relates to the risk of an ischemic stroke.

There is currently no clear connection between migraine and stroke.

A 2020 review suggests that migraine increases the risk of diseases that affect the brain and blood vessels, such as stroke.

Brain imaging has also shown a higher occurrence of brain lesions in people with migraine. People with migraine may also have more risk factors related to blood vessels.

The review also suggests that the risk of stroke is higher in people with migraine who do not have any traditional risk factors for stroke.

Stroke symptoms come on very suddenly, while migraine with aura usually develops more slowly.

Although symptoms can overlap, migraine symptoms usually add sensations, while stroke takes them away.

For example, migraine with aura symptoms can include tingling or seeing bright lights or shapes in line of vision. Stroke symptoms include weakness on one side of the body, difficulty speaking clearly, or droopy face.

Hemiplegic migraine is a rare type of migraine that can also cause weakness on one side of the body.

If people experience any new symptoms with migraine, they should seek immediate medical attention in case it is a stroke.

To diagnose migraine, a doctor carries out a number of tests to check vision, reflexes, sensation, and coordination.

It can also be helpful for people to keep a record of any symptoms they experience, lifestyle factors such as diet and sleep, and frequency of migraine attacks. A doctor will also assess any medication people are taking.

To diagnose a stroke or TIA, doctors carry out a range of tests including:

• MRI or CT scans to provide imaging of the brain
• electrical impulse tests to show electrical activity in the brain
• blood flow tests to look for any issues with blood flow to the brain

According to a 2017 article, there are currently no clear guidelines for preventing stroke in people with migraine.

People can take steps to help reduce the risk of stroke through lifestyle changes, such as:

• controlling high blood pressure and high cholesterol
• quitting smoking
• maintain a healthy weight
• for females who have migraine with aura, avoid using estrogen supplements or contraceptives containing ethinylestradiol

People who have migraine with aura should get regular check-ups with a healthcare professional to evaluate their risk for stroke.

Aiming to prevent migraine headaches may help.

Certain medications may also help to reduce the severity and frequency of migraine attacks, such as:

• beta blockers
• candesartan, an angiotensin II receptor blocker
• tricyclic antidepressants
• CGRP monoclonal antibodies
• topiramate and divalproex, which are anti-seizure medications
• onabotulinum toxin A

It is also important for people who have migraine with aura to recognize any warning signs. Changes to their aura, such as longer duration, increased frequency, or weakness in one side of the body, require medical attention.

According to research, there is usually a good outcome for functionality in people who have an ischemic stroke that relates to migraine with aura.