Stroke And Headaches: Understanding The Link

A stroke is a life-threatening medical emergency that occurs when there is an interruption to blood flow to the brain. This can be caused by a blockage or bleeding in the brain, resulting in brain cell death due to a lack of oxygen. Strokes can cause severe headaches, which are often sudden in onset and can be accompanied by other classic stroke symptoms such as weakness, numbness, dizziness, and slurred speech. The location of the headache pain depends on where the stroke is occurring. While strokes are a leading cause of disability and death worldwide, early diagnosis and treatment are critical for preventing long-term effects and permanent brain damage.

Can a stroke cause a sudden, severe headache?

A sudden, severe headache can be a symptom of a stroke, although it is not always the case. Strokes are a medical emergency that occurs when blood flow to the brain is interrupted, which is what causes a headache. There are two types of strokes: ischemic strokes and hemorrhagic strokes, both of which can cause this symptom.

Ischemic Strokes

Ischemic strokes occur when the artery that supplies blood to the brain gets blocked, leading to brain cell death due to a lack of oxygen. Ischemic strokes are the most common type, accounting for about 80% of all strokes. They can be caused by a clot in the brain (thrombosis) or a fragment of a clot that formed elsewhere in the body that travels to the brain (embolism). Small vessel blockages (lacunar strokes) can also cause ischemic strokes, often as a result of long-term untreated high blood pressure, high cholesterol, or high blood sugar.

Hemorrhagic Strokes

Hemorrhagic strokes happen when an artery in the brain bursts, leading to bleeding into the brain. An example of a hemorrhagic stroke is a subarachnoid hemorrhage, which is common in patients with sudden and severe headaches. Hemorrhagic strokes can be caused by high blood pressure, brain aneurysms, brain tumors, or diseases that weaken or cause unusual changes in blood vessels in the brain.

Transient Ischemic Attacks (TIAs)

TIAs, or "mini-strokes," are temporary interruptions of blood flow in the brain that come on suddenly and resolve fairly quickly. While the symptoms of a TIA may be mild, it should still be treated as a medical emergency and can be a warning sign of an impending full stroke.

Stroke Headache Characteristics

People often describe a stroke-related headache as a very severe headache that comes on within seconds or minutes, often referred to as a "thunderclap headache." The location of the headache depends on where the stroke is occurring. For example, a blocked carotid artery can cause a headache in the forehead, while a blockage towards the back of the brain can lead to a headache at the back of the head. It is important to note that there is no specific location for a stroke headache, as they can occur anywhere on the head.

Stroke headaches are typically described as having severe and steady pain that starts without warning. In contrast, migraine headaches usually involve throbbing pain that comes on gradually and may be accompanied by sensory symptoms such as tingling skin or seeing flashes of light.

Other Stroke Symptoms

When a headache is caused by a stroke, it is often accompanied by other stroke symptoms, including:

• Weakness or numbness on one side of the body
• Dizziness or loss of balance
• Difficulty with fine hand movements
• Trouble understanding others
• Double vision or blurred vision

Treatment for Stroke

It is crucial to seek immediate medical attention if you experience a severe headache that comes on suddenly, as strokes can be fatal and early diagnosis and treatment are key to preventing long-term effects. Stroke treatment depends on the type of stroke and the time since the onset of symptoms. For ischemic strokes, the priority is to restore circulation to the affected areas of the brain, usually through the use of thrombolytic drugs or a catheterization procedure called mechanical thrombectomy. For hemorrhagic strokes, reducing blood pressure and improving clotting to stop the bleeding are the main treatment goals.

What are the different types of strokes?

Strokes are categorised into two main types: ischemic strokes and hemorrhagic strokes.

Ischemic strokes

Ischemic strokes are the most common type of stroke, accounting for about 87% of all stroke cases. They occur when a blood vessel supplying blood to the brain is blocked, causing brain cell death. This can be due to a blood clot or a buildup of fatty substances known as plaque. Ischemic strokes can be further divided into two subtypes:

• Thrombotic strokes: caused by a blood clot that develops in the blood vessels inside the brain.
• Embolic strokes: caused by a blood clot or plaque debris that forms elsewhere in the body and travels to the blood vessels in the brain through the bloodstream.

Hemorrhagic strokes

Hemorrhagic strokes, on the other hand, are less common and account for about 13% of all strokes. They occur when a weakened blood vessel in the brain bursts or leaks, resulting in bleeding in the brain. The two main subtypes of hemorrhagic strokes are:

• Intraparenchymal or intracerebral hemorrhage: bleeding occurs directly in the brain tissue, often due to high blood pressure.
• Subarachnoid hemorrhage: bleeding occurs in the subarachnoid space, which is the area between the brain and the surrounding membrane. This type of hemorrhage is often caused by an aneurysm or an arteriovenous malformation (AVM).

Transient ischemic attack (TIA)

Transient ischemic attack (TIA), also known as a "mini stroke," is another type of stroke that resembles an ischemic stroke but lasts for a shorter duration, often only a few minutes. It is caused by a temporary clot and can serve as a warning sign of a full ischemic stroke.

Cryptogenic stroke

A cryptogenic stroke is a type of stroke where the cause cannot be determined.

Brainstem stroke

A brainstem stroke describes the location of the stroke rather than its cause. It occurs in the brainstem, which controls essential functions like breathing, heartbeat, and consciousness.

Recurrent stroke

Recurrent strokes refer to the condition of having multiple strokes. The risk of having a second stroke increases after the first one, and the likelihood of severe disability and death also increases with each recurrent stroke.

What are the symptoms of a stroke?

The symptoms of a stroke often occur quickly but can also develop over hours or even days. The type of symptoms depends on the type of stroke and the area of the brain that is affected.

The acronym FAST is used by the American Stroke Association to help identify the early signs of a stroke:

• F = Face Drooping: Does one side of the face droop or is it numb? Ask the person to smile. Is the person's smile uneven?
• A = Arm Weakness: Is one arm weak or numb? Ask the person to raise both arms. Does one arm drift downward?
• S = Speech Difficulty: Is speech slurred or are they having trouble understanding speech?
• T = Time to call 911: Stroke is an emergency. Every minute counts. Call 911 immediately. Note the time when any symptoms first appear.

Other symptoms of a stroke include:

• Numbness or weakness of the face, arm, or leg, especially on one side of the body
• Confusion, trouble speaking or understanding speech
• Trouble seeing in one or both eyes
• Trouble walking, dizziness, loss of balance or coordination
• A severe headache with no known cause

It's important to note that a "mini stroke" or transient ischemic attack (TIA) can also be a warning sign of a stroke. TIA symptoms are the same as those of a stroke but usually only last a few minutes up to 24 hours.

It can be hard to distinguish a benign headache from a stroke-related one. A stroke-related headache is described as a very severe headache that comes on within seconds or minutes. The location of the headache is often directly related to where the stroke occurs. For example, a blocked carotid artery can cause a headache on the forehead, while a blockage towards the back of the brain can cause a headache at the back of the head.

Some overlapping symptoms between a migraine and a stroke-related headache include disorientation, a general feeling of being unwell, changes in vision, and vertigo. However, migraine headaches are usually triggered by recognisable triggers and the pain is described as a throbbing that gets worse over time, while strokes can happen randomly and cause sudden and severe pain.

What causes a stroke?

A stroke is a life-threatening medical emergency that occurs when there is an interruption to the blood flow to the brain. This can happen when blood vessels are blocked (known as an ischemic stroke) or due to bleeding in the brain (known as a hemorrhagic stroke).

Ischemic Strokes

Ischemic strokes are the most common type of stroke, accounting for about 80% of all strokes. They are usually caused by a blockage in the blood vessels in the brain, which can be due to a clot forming in the brain (thrombosis) or a fragment of a clot that has travelled from elsewhere in the body becoming stuck in the brain (embolism). Ischemic strokes can also be caused by small vessel blockages (lacunar strokes), which are often the result of long-term untreated high blood pressure, high cholesterol, or high blood sugar.

Hemorrhagic Strokes

Hemorrhagic strokes are caused by bleeding in or around the brain. This can be due to a blood vessel inside the brain tearing or breaking open (intracerebral hemorrhage), or bleeding into the subarachnoid space, which is the area between the brain and its outer covering (subarachnoid hemorrhage). Hemorrhagic strokes are often the result of high blood pressure, brain aneurysms, brain tumours, or diseases that weaken or cause changes in blood vessels in the brain, such as moyamoya disease.

Risk Factors

While anyone can have a stroke, certain factors can increase the risk. These include:

• High blood pressure
• High cholesterol
• Type 2 diabetes
• History of stroke, heart attack, or irregular heart rhythms
• Alcohol use disorder
• Migraine headaches
• Smoking and other forms of tobacco use
• Drug misuse
• Obesity
• Abnormal heart rhythms
• Sleep apnea
• Age (risk increases for babies under 1 and adults over 65)
• Genetics and family history
• Air pollution exposure
• Viral infections or conditions such as lupus or rheumatoid arthritis

How is a stroke treated?

The treatment for a stroke depends on the type of stroke you've had. In the first 24 hours after a stroke, treatment may include:

• Medicine to get rid of blood clots in the brain (thrombolysis)
• Surgery to remove a blood clot (thrombectomy) or drain fluid from the brain
• A procedure to stop pressure building up inside the skull or brain

While in hospital, a team of doctors, specialists, and therapists will help start your recovery. Treatments are often long-term and include:

• Anticoagulants to stop blood clots from forming
• Medicine to lower blood pressure
• Statins to lower cholesterol

If you get to the hospital within three hours of the first symptoms of an ischemic stroke, you may be given a thrombolytic (a "clot-busting" drug) to break up blood clots. Tissue plasminogen activator (tPA) is a thrombolytic that improves the chances of recovering from a stroke. Studies show that patients with ischemic strokes who receive tPA are more likely to recover fully or experience less disability than those who do not receive the drug.

Hemorrhagic strokes may be treated with:

• Endovascular procedures to repair a weak spot or break in a blood vessel
• Surgery to put a metal clip in place and stop blood loss if the bleeding is caused by a ruptured aneurysm

Frequently asked questions