Complex Migraines: Stroke Risk And Complications

While migraines typically do not cause strokes, there is a link between the two. Migraine with aura can put people at a slightly higher risk of stroke, although the exact reason for this is unknown. This type of migraine is accompanied by visual, sensory, or other nervous system symptoms that usually precede a headache. It is important to note that the increased risk is generally small. In the context of stroke, when a migraine with aura occurs simultaneously, it is referred to as a migrainous stroke or migrainous infarction, which is considered a rare occurrence.

Migraines and strokes: similarities and differences

Overview

Migraines and strokes are two distinct conditions that affect the brain. While they share some overlapping symptoms, the underlying causes are different. Understanding these similarities and differences is crucial for prompt diagnosis and treatment, especially in the case of strokes, where immediate medical attention can be life-saving.

Similarities

Symptoms

Both migraines and strokes can exhibit similar symptoms, including:

• Blurred vision
• Sudden confusion
• Numbness or weakness on one side of the body
• Trouble speaking
• Headache

Risk Factors

While the direct link between migraines and strokes is unclear, certain risk factors are associated with both conditions:

• Age: Older individuals tend to have a higher risk of stroke, while migraines are more prevalent in younger people. However, the onset of migraine later in life may increase stroke risk.
• Vascular Issues: Conditions such as high blood pressure and arterial hypertension are risk factors for both migraines and strokes.
• Hormonal Factors: Hormonal changes, particularly in women, can influence both migraines and stroke risk.
• Smoking: Smoking is a risk factor for both conditions.

Differences

Definition and Cause

Migraines: Migraines are a neurological disease characterised by painful, recurring headaches. They are believed to be caused by problems with brain activity affecting nerves, chemicals, and blood vessels in the brain.

Strokes: Strokes occur when the blood supply to the brain is interrupted, leading to brain cell death and permanent brain damage. The two main types of strokes are ischaemic (caused by blood clots) and haemorrhagic (caused by weakened blood vessels bursting).

Onset and Duration

Migraines: Migraines typically develop gradually and can last from a few hours to several days. They may also be preceded by prodromal symptoms, such as mood changes, excessive yawning, and sensitivity to light or sound. Chronic migraines occur at least 15 times a month.

Strokes: Strokes have a sudden onset without any advanced signs. Three-quarters of strokes occur in individuals with no prior history of the condition.

Pain

Migraines: Migraines usually involve pain, often described as a throbbing headache, which may affect one side of the head or occur behind the eye.

Strokes: Most strokes are not accompanied by pain. However, haemorrhagic strokes involving bleeding in the brain or arterial tears can be painful.

Frequency

Migraines: Migraines can vary in frequency, ranging from several times a month to months or years between attacks.

Strokes: Strokes typically occur once, and there is no expectation of recurrence.

Diagnosis and Treatment

Migraines: Migraines are diagnosed by analysing symptom patterns over time, and treatment focuses on managing triggers and reducing pain.

Strokes: Strokes require immediate medical attention, and treatment aims to dissolve clots, reduce swelling, and prevent future strokes.

Migraines and strokes: risk factors

Migraines and strokes are both neurologic disorders that affect the brain. While migraines are not known to cause strokes, there is a link between the two, and people with migraines may have a slightly higher risk of stroke. This is especially true for women under 45 with migraines with aura, who are twice as likely to have an ischemic stroke in their lifetime compared to those without migraines. However, the overall risk is still very low, and other factors like smoking and high blood pressure are more significant contributors to stroke risk.

Migraines are a type of neurological disorder characterized by repeated episodes of symptoms, called attacks, that usually include head pain accompanied by nausea, vomiting, and sensitivity to light, touch, smell, or sound. Strokes, on the other hand, are caused by decreased blood flow in the brain due to a blockage or bleeding in a blood vessel. This can lead to tissue injury or death in the affected area of the brain, resulting in permanent damage and long-lasting physical, cognitive, and emotional effects.

The link between migraines and strokes

The exact cause of the link between migraines and strokes is not yet fully understood. However, it is known that people with migraines with aura, a type of migraine that involves sensory disturbances like seeing flashes of light or feeling tingling sensations, have a slightly higher risk of stroke. This is especially true for women under 45, with an increased risk of blood clots due to hormonal changes and the use of hormonal birth control. Overall, the risk of a migrainous stroke, or a stroke occurring during a migraine, is rare, accounting for only 0.2% to 0.5% of all ischemic strokes.

Reducing stroke risk

While having migraines with aura may slightly increase the risk of stroke, there are other risk factors that contribute more significantly. These include high blood pressure, high cholesterol, smoking, obesity, and diabetes. To lower the risk of stroke, it is recommended to maintain a healthy lifestyle by following a healthy diet, staying physically active, quitting smoking, and avoiding excessive alcohol consumption. Additionally, it is important to work with a doctor to control any existing medical conditions and discuss the use of oral contraceptives, especially for women with other risk factors.

Migraines with aura and strokes: what's the link?

Migraines and strokes are both serious neurologic disorders that affect the brain. While they share some symptoms, they are distinct conditions. A migraine is a neurological disorder characterised by repeated episodes of symptoms, known as attacks, that usually include head pain accompanied by nausea, vomiting, and sensitivity to light, touch, smell, or sound. A stroke, on the other hand, is an episode of decreased blood flow in part of the brain, caused by a blockage or bleeding in a blood vessel. While migraines typically do not cause strokes, there is a link between the two, particularly in people with migraines with aura.

Understanding Migraines and Strokes

Migraines are characterised by intense head pain that can be debilitating and are often accompanied by nausea, weakness, and sensitivity to light and sound. They are believed to be caused by problems with brain activity that affect nerves, chemicals, and blood vessels in the brain. Strokes, on the other hand, occur when there is a disruption in the blood supply to the brain, leading to brain cell death and permanent damage. This can have long-lasting physical, cognitive, and emotional effects.

The Link Between Migraines with Aura and Strokes

While migraines themselves have not been shown to cause strokes, there is a slight increase in the risk of stroke for people who experience migraines with aura. Migraines with aura are characterised by sensory disturbances such as seeing flashes of light, tingling sensations, and difficulty speaking. This type of migraine is often mistaken for a stroke due to the similar symptoms. The risk of stroke is about twice as high for people with migraines with aura compared to those without migraines. However, it is important to note that the overall risk is still very low, and other factors such as smoking and high blood pressure contribute more significantly to stroke risk.

Understanding the Underlying Mechanisms

The exact mechanisms underlying the link between migraines with aura and strokes are not yet fully understood. However, several theories have been proposed, including cortical spreading depression, endovascular dysfunction, vasoconstriction, and neurogenic inflammation. Cortical spreading depression is an electrophysiological mechanism that underlies migraine aura and plays a role in the pathogenesis of ischemic stroke. It involves a wave of depolarization that moves across the cortex, leading to changes in the blood-brain barrier and increased energy metabolism. Endothelial activation and dysfunction, as well as inflammatory cytokines released during the aura phase, may also contribute to the increased risk of stroke in people with migraines with aura.

Managing Risk

For people with migraines with aura, it is important to be aware of the slightly increased risk of stroke and take steps to manage other risk factors. This includes controlling high blood pressure and cholesterol, maintaining a healthy weight, quitting smoking, and managing conditions such as diabetes and high blood pressure. Women with migraines with aura should also carefully consider their contraceptive options and discuss them with their doctor. While older formulations of birth control pills with higher amounts of estrogen were known to increase stroke risk, newer formulations with lower doses of estrogen have a lower risk.

Migraines and strokes: diagnosis and treatment

Diagnosis

The symptoms of a migraine and a stroke can sometimes be similar, and it can be difficult to tell the difference between the two. However, it is important to seek medical help as soon as possible if you are experiencing symptoms of either a migraine or a stroke.

The symptoms of a migraine attack are usually characterised by repeated episodes of head pain accompanied by nausea, vomiting, and sensitivity to light, touch, smell, or sound. About a quarter of people with migraines also experience an "aura", which involves visual, sensory, or other nervous system symptoms such as flashing lights or tingling sensations, that usually precede the headache phase of the attack.

On the other hand, the symptoms of a stroke typically include numbness and weakness on one side of the body, as well as slurred speech, confusion, decreased or double vision, dizziness, and loss of balance and coordination. A stroke occurs when there is decreased blood flow in part of the brain, caused by either a blockage in a blood vessel (ischaemic stroke) or bleeding from a blood vessel (haemorrhagic stroke).

Treatment

If you are experiencing symptoms of a stroke, it is important to seek emergency medical care as soon as possible. Prompt medical attention may prevent life-threatening complications and is critical for recovery. For example, if treatment is sought within the first three hours of an ischaemic stroke, medication can be administered to dissolve the clot and increase the chances of a full recovery.

Migraines and strokes: related?

While migraines have not been shown to cause strokes, people who experience migraines with auras do have a slightly higher risk of stroke. This risk is still considered low, and there is no evidence to suggest that migraines cause strokes or vice versa. However, the complex relationship between the two conditions is not yet fully understood.

Risk factors and prevention

To reduce the risk of stroke, it is important to manage other risk factors such as high blood pressure, high cholesterol, smoking, obesity, and diabetes. Women with migraines who are taking oral contraceptives may also have a higher risk of stroke, especially if they are over the age of 45 or have other risk factors.

Migraines and strokes: prevention and lifestyle changes

While migraines have not been shown to cause strokes, people who experience migraines with auras are twice as likely to have an ischemic stroke in their lifetime compared to those without migraines. This is because people with auras may have a higher tendency to form blood clots due to narrowed blood vessels. However, the overall risk of stroke linked to migraines is still very low, and other factors like smoking and high blood pressure are more likely to cause a stroke.

Prevention and lifestyle changes

If you experience migraines, here are some ways to lower your risk of stroke:

• Control high blood pressure
• Lower high cholesterol
• Avoid smoking
• Maintain a healthy weight
• Control hypertension and hyperlipidemia
• Avoid contraceptives with ethinylestradiol or estrogen supplements, as these can increase the formation of small blood clots
• Get regular evaluations and use preventive medication and cognitive behavioural therapy
• Identify and avoid migraine triggers

Warning signs of stroke

It is important to know the warning signs of stroke, especially if you experience auras. A transient ischemic attack can serve as a warning and may include:

• Loss of vision in one eye
• Slurred speech
• Weakness or numbness on one side

If you notice any changes in your aura, such as increased frequency or duration, seek medical attention.

Frequently asked questions