Migraine is a complex neurological condition that causes waves of painful headaches and other symptoms.

One type of migraine, migraine with aura, may lead to an increased risk of stroke. Even though stroke and migraine symptoms share similarities, they are not the same. People who live with this type of migraine can take measures to reduce their risk of stroke.

In this article, we explore the link between migraine with aura and stroke, possible reasons why this risk applies, and what people who live with this type of migraine can do to reduce their risk.

A note about sex and gender

Sex and gender exist on spectrums. This article will use the terms “male,” “female,” or both to refer to sex assigned at birth. Click here to learn more.

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There are many types of migraine, two of which cause visual disturbances and were previously grouped under the term “ocular migraine.” These include the following:

  • Migraine with aura: This type causes visual disturbances, patterns, blind spots, or light flashes that occur for a short period. According to the American Migraine Foundation (AMF), migraine with aura accounts for around 30% of all types of migraine, although less than 20% of people who experience migraine auras do so during every episode.
  • Retinal migraine: This type causes short-term vision loss and is accompanied by a headache. These tend to disturb vision more than migraine with aura but can be hard to distinguish from the other type of ocular migraine.

Migraine with aura is the type most directly linked to stroke risk. Migraine with aura episodes can also cause tingling and numbness in the hands and fingers, the body, and the face. Slurring and speech difficulties might also occur.

Some people experience auras before head pain, while others have both at the same time. Others experience acephalgic migraine episodes, which do not cause any pain at all.

What is a stroke?

A stroke occurs every 40 seconds in the United States. There are two types of strokes, both of which affect blood flow in the brain:

  • Ischemic stroke: This occurs when a blockage stops blood flow from reaching the brain. This is the most common type, accounting for around 90% of stroke incidents. It is also the type most closely linked to increased risk of migraine with aura.
  • Hemorrhagic stroke: This occurs due to sudden bleeding in the brain, which damages brain cells.

Stroke causes sudden symptoms that include:

  • speech issues
  • difficulty understanding speech
  • confusion
  • severe headache
  • vision loss in one or both eyes
  • paralysis, often on one side of the body

The following conditions may increase a person’s risk of stroke:

Some lifestyle factors can also increase a person’s risk of stroke, including:

Learn more about stroke.

A 2016 study that took place over 20 years found that people who lived with ocular migraine had a significantly higher ischemic stroke risk than those who had migraine without aura.

In addition, research from 2019 concluded that in young females, having a history of migraine doubles their risk of a stroke. The research found that the risk is higher for people with migraine with aura.

More recently, a 2020 research review looked at further factors that might make stroke risk worse in people with migraine. These included:

  • migraine presenting with aura
  • oral contraceptive use
  • female sex
  • smoking

However, the study authors maintain that the causes of the increase in stroke risk are unclear for those who have migraine with aura. Both stroke and migraine with aura may affect how the blood vessels expand and contract.

The AMF also suggests that women who have migraine with aura might have an increase in risk. They estimate that around 2,000–3,000 of the 800,000 strokes that occur each year are in women with migraine. While this risk is not specific to ocular migraine, it is another factor to consider for women whose migraine attacks present with auras.

Retinal migraine and migraine with aura attacks share some symptoms, such as slurred speech, headaches, and vision issues. These can lead people with migraine to think they may be experiencing a stroke or cause people experiencing a stroke to miss symptoms if they regularly have migraine attacks.

However, there are differences between migraine attacks with aura and strokes that can help people identify which symptoms they are experiencing. The key difference is that migraine tends to add sensations, but strokes remove them.

For example:

  • Migraine aura episodes may cause lights, dots, zigzags, and shapes that may obscure vision, but a stroke can cause vision loss in one eye.
  • Migraine episode symptoms expand, gradually getting worse, but stroke symptoms are sudden.

If a migraine aura episode feels different than usual or comes on more suddenly, it is important to speak with a doctor. Not only can these symptoms be difficult to separate, but people who have migraine with aura can develop a migrainous stroke. Prompt medical attention is necessary if aura symptoms last for more than an hour to rule out a migraine-triggered stroke.

Learn more about migraine and stroke.

Treatment for migraine involves managing symptoms such as headache pain, nausea, and vomiting. This normally requires medication, including:

  • nonsteroidal anti-inflammatory drugs to manage mild to moderate headaches
  • triptans for severe head pain
  • antiemetics for nausea and vomiting
  • ergots, which can help when taken shortly after the start of symptoms, although these may increase the risk of cerebrovascular complications such as ischemic stroke
  • calcitonin-gene-related peptide antagonists
  • antidepressants, which can reduce headache pain

Migraine treatment is as much about preventing future episodes as it is treating an ongoing one. Medications to prevent migraine include:

Getting regular exercise, practicing good sleep hygiene habits, and managing migraine triggers in the diet and everyday life can also help reduce the number of attacks.

However, there is no evidence that taking preventive measures against ocular migraine episodes will reduce a person’s risk of stroke in the future, according to research from 2020. Doing so may still provide additional comfort and reduce disabling migraine attacks.

Stroke treatment requires emergency care, which can begin in the ambulance. However, it is vital to spot stroke symptoms as soon as possible using F-A-S-T as a guide:

Stroke symptoms warning signs

  • F: face drooping or numbness
  • A: arm weakness
  • S: speech problems
  • T: time to contact emergency services
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One-third of people experiencing a stroke do not call 911 or local emergency services. People who usually have migraine attacks with aura should note any attacks that feel different or go on for longer than usual. It could save valuable minutes when dealing with a stroke.

Treatment for ischemic stroke involves medications to break down clots. This improves recovery and reduces disability after a stroke.

Lifestyle choices may prevent stroke, even for those with an increased risk due to migraine with aura. These might include:

  • maintaining a healthy body weight
  • getting at least 2 hours and 30 minutes of moderate cardiovascular exercise every week
  • not smoking, or quitting smoking for those who already do
  • managing medical conditions that increase stroke risk, like high cholesterol, high blood pressure, and diabetes
  • treating heart disease and taking medications as prescribed

Migraine with aura is a type of ocular migraine that can increase a person’s risk of stroke. More research is necessary to figure out why. Females with this type of migraine who use oral contraception and people with migraine aura who smoke also have a higher risk of stroke.

Migraine symptoms can resemble those of stroke, and effective stroke treatment relies on spotting symptoms quickly. Migraine can also directly trigger strokes for some people. For this reason, it is important for people to consult a physician about any changes to the way they usually experience migraine symptoms.