Headache And Stroke: Understanding The Potential Link

Headaches are a common occurrence, with several factors contributing to their onset, including tension, stress, lack of sleep, caffeine withdrawal, and medication overuse. While most headaches are benign and tend to resolve on their own, certain instances of prolonged headaches may signal a more serious underlying condition, such as a stroke.

A stroke is a medical emergency that occurs when there is an interruption in blood flow to the brain, leading to brain cell death. It can be of two types: ischemic stroke, resulting from a blocked artery, and hemorrhagic stroke, caused by the bursting of an artery in the brain.

Headaches associated with strokes are often sudden, intense, and severe, described as the worst headache of one's life. The pain is abrupt, intense, and cannot be ignored. It is crucial to distinguish stroke-related headaches from migraine headaches, as both share some overlapping symptoms. While migraine headaches may be preceded by warning signs like auras, flashing lights, or tingling skin, stroke-related headaches typically cause a loss of sensations, such as loss of vision or feeling.

Additionally, the location of the headache pain can provide valuable information, as it often corresponds to the area of the brain affected by the stroke. For instance, a blocked carotid artery may result in a headache on the forehead, while a blockage at the back of the brain can lead to a headache at the back of the head.

If you experience a severe and sudden headache, especially if it is unlike any pain you have felt before, it is imperative to seek immediate medical attention, as it could be a sign of a stroke or other serious medical condition.

Can a headache be a symptom of a stroke?

A sudden, severe headache can be a symptom of a stroke, although there are often other accompanying symptoms. A stroke occurs when blood flow to the brain is interrupted, and this interruption can cause a headache. However, it can be difficult to distinguish a benign headache from a stroke-related one, as they share some similar symptoms.

Types of Stroke

There are two types of strokes:

• Ischemic stroke: when an artery supplying blood to the brain becomes blocked, causing brain cell death.
• Hemorrhagic stroke: when an artery in the brain bursts, causing bleeding in the brain.

Stroke-Related Headaches

Around 7-65% of people having a stroke will experience some form of a headache. A stroke-related headache is often described as a very severe headache that comes on within seconds or minutes. The location of the headache depends on where the stroke is occurring. 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.

Differentiating a Stroke-Related Headache from a Migraine

It can be challenging to differentiate a migraine from a stroke-related headache as they share some overlapping symptoms such as disorientation, a general feeling of being unwell, changes in vision, and vertigo. However, there are some key differences:

• Migraines often have warning signs like auras, flashing lights, or tingling skin, while a stroke-related headache will cause a loss of sensation, such as a loss of vision or feeling.
• Migraines are usually caused by recognisable triggers, and the pain is described as a throbbing that gets worse over time, while strokes can happen randomly and cause sudden, severe pain.

Mini Strokes

A "mini stroke," or transient ischemic attack (TIA), is a temporary interruption of blood flow in the brain. While the symptoms of a TIA can be short-lived, it should still be treated as seriously as a stroke as it can be a warning sign of an impending full-blown stroke.

When to Seek Help

If you experience a severe headache that comes on suddenly and is unlike any pain you've had before, or you have other stroke symptoms, it is crucial to seek emergency medical attention. A stroke is a medical emergency, and every minute counts in preventing long-term effects or permanent brain damage.

Headaches After a Stroke

It is also common to experience headaches after a stroke, which can be a side effect of medication or the result of various factors such as stress, lack of sleep, or migraine. These headaches typically lessen over time and can be managed with painkillers and adequate hydration. However, if you experience persistent or severe headaches after a stroke, it is important to seek medical attention.

What are the different types of strokes?

There are two main types of stroke: ischemic strokes and hemorrhagic strokes.

Ischemic Strokes

Ischemic strokes are caused by a blocked blood vessel that impairs blood flow to the brain. They are the most common type of stroke, accounting for about 87% of all stroke cases. Ischemic strokes are further divided into two groups:

• 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 develops elsewhere in the body and then travels to one of the blood vessels in the brain through the bloodstream.

Hemorrhagic Strokes

Hemorrhagic strokes are caused by a ruptured or leaking blood vessel that disrupts blood flow to the brain. They are rarer than ischemic strokes but progress more quickly and are usually more severe. About 13% of all strokes are hemorrhagic. Hemorrhagic strokes are divided into two main categories:

• Intracerebral hemorrhage: bleeding is from the blood vessels within the brain.
• Subarachnoid hemorrhage: bleeding is in the subarachnoid space (the space between the brain and the membranes that cover the brain).

Transient Ischemic Attack (TIA)

Transient ischemic attacks (TIAs) are often called "mini strokes". They resemble ischemic strokes but last a short time, often only a few minutes. They are a warning sign of a full ischemic stroke in the future.

What are the symptoms of a stroke-related headache?

While most headaches are benign and non-serious, in certain cases, a headache can be a symptom of a stroke. A stroke occurs when blood flow to the brain is interrupted, and this interruption is what causes the headache.

Symptoms of a stroke-related headache

People describe a stroke-related headache as a very severe headache that comes on within seconds or minutes. The location of the pain depends on where the stroke is occurring. 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. This means that there is not one headache location that signals a stroke, as they can occur anywhere on the head.

How to differentiate a stroke-related headache from a migraine

It can be difficult to distinguish a migraine from a stroke-related headache as there are some overlapping symptoms such as disorientation, a general feeling of being unwell, changes in vision, and vertigo. However, a migraine headache produces sensations like auras, flashing lights, or tingling skin, while a stroke-related headache causes sensations to be lost, such as a loss of vision or feeling. Additionally, migraine headaches are caused by recognisable triggers and the pain is described as a throbbing that gets gradually worse, while strokes can happen at random and cause pain that is sudden and severe.

Transient ischemic attacks (TIAs)

A "mini stroke", or transient ischemic attack (TIA), can also cause a stroke-related headache. Unlike a stroke, with a TIA, the brain tissue is only temporarily damaged and recovers once blood flow has been restored. TIAs produce identical symptoms to a stroke, however, the symptoms can last anywhere from 5 minutes to 24 hours. Although the symptoms can be short-lived, a TIA should be treated like a stroke, as they are often a warning sign of an impending full-blown stroke.

What to do if you experience symptoms

If you experience a severe headache that comes on suddenly, with or without other stroke symptoms, seek emergency medical attention immediately. A stroke can be fatal, and early diagnosis and treatment are key for preventing the long-term effects of the condition.

How can you differentiate a migraine from a stroke-related headache?

While it can be challenging to distinguish a migraine from a stroke-related headache, there are some key differences to look out for.

Firstly, let's understand what a stroke is. A stroke occurs when the blood flow to the brain is interrupted, leading to brain cell death and potentially permanent brain damage. There are two types of strokes: Ischemic stroke, which is caused by a blocked artery, and Hemorrhagic stroke, which occurs when an artery in the brain bursts, resulting in bleeding in the brain.

Now, let's explore the differences between a migraine and a stroke-related headache:

Onset and Pain Development:

• Migraine headaches typically develop gradually and are described as a throbbing pain that gets worse over time. There are often warning signs, such as an aura phase, before the headache begins.
• On the other hand, stroke-related headaches come on suddenly and intensely, with pain that is severe, steady, and fast-hitting. There are usually no warning signs, and the pain can be described as a "thunderclap."

Sensations:

• Migraines often produce sensations like auras, flashing lights, or tingling skin.
• In contrast, a stroke-related headache causes a loss of sensations, such as a loss of vision or feeling.

Triggers:

• Migraines are often triggered by specific factors, such as stress, anxiety, physical tension, hormonal changes, dietary triggers, or environmental factors.
• Strokes, on the other hand, can happen at random and are not typically associated with specific triggers.

Additional Symptoms:

• Migraines can be accompanied by nausea, vomiting, and sensitivity to light, sound, or smell.
• Stroke-related headaches often occur alongside other classic stroke symptoms, including facial drooping, slurred speech, weakness or numbness on one side of the body, dizziness, and difficulty understanding speech or balance.

Age of Onset:

• Migraines usually develop at a younger age and rarely begin later in life.
• Stroke-related headaches can occur at any age but may be more concerning when they start later in life without a previous history of headaches.

It's important to note that while these are general guidelines, every individual may experience migraines and stroke-related headaches differently. If you are experiencing any concerning symptoms, it is always best to seek medical advice promptly.

What should you do if you experience a sudden, severe headache?

If you experience a sudden, severe headache, it is important to take it seriously and act promptly as it could be a symptom of something more serious, such as a stroke. Here are the steps you should take:

Recognize the Severity and Seek Immediate Medical Attention:

• A sudden and severe headache can be a warning sign of a stroke or other serious medical conditions. Do not delay and call the emergency services (911 in the US or 999 in the UK) or go to your nearest emergency room/A&E immediately.
• A stroke is a medical emergency that occurs when there is an interruption in blood flow to the brain. It can be an ischemic stroke (blocked artery) or a hemorrhagic stroke (burst artery), both of which can cause severe headaches.
• Even if it turns out not to be a stroke, a sudden and intense headache can indicate other serious issues, such as bleeding or infection in the brain, so prompt medical attention is crucial.

Identify Accompanying Symptoms:

• Be aware of other stroke symptoms that often accompany stroke-related headaches, such as weakness or numbness on one side of the body, dizziness or loss of balance, difficulty speaking or understanding speech, blurred or double vision, and sudden numbness or weakness in the face, arm, or leg.
• Other warning signs that may accompany a severe headache and require urgent medical attention include a painful red eye, pain and tenderness near the temples, a blow to the head, and impairment of normal daily activities.

Take Preventative Measures:

• While most headaches are not dangerous and can be managed with over-the-counter pain relievers, rest, and hydration, it is important to recognize when a headache may be a symptom of something more serious.
• If you experience frequent, severe, or lingering headaches, consult a medical professional to identify any underlying causes and receive appropriate treatment.
• Keep a headache diary to help identify triggers and patterns. This information can be valuable for diagnosis and management.

Frequently asked questions