Find Out When Headaches are a Big Deal

Headaches can be so painful and persistent. You might get worried that you could be having a stroke during an agonizing headache. There is a connection between strokes and headaches, but most of the time, headaches are not a sign of stroke. Learn more about how to know if your headache could be a stroke.

The Stroke-Headache Connection

There is a real association between headaches and strokes because they both affect the same part of the body, but a headache is usually not alarming.

About 10-15% of stroke survivors go on to experience new headaches after a stroke. In the meantime, headaches are very common in the healthy adult population. Estimates of adults who suffer from headaches range from 30-60%. Very few headache sufferers go on to experience strokes, but there is a slight increase in strokes among people who have severe headaches compared to people who do not have severe headaches.

Strokes, Headaches, and Genetics

Headaches, whether migraine headaches, tension headaches, fatigue induced headaches, or medication overuse headaches do not normally cause strokes. Numerous scientific research studies have investigated whether or not there is a relationship between headaches and strokes.

Headaches and stroke are both conditions with a hereditary component, which means that some people are at an increased risk of having them because of genetics. Some of the same genes that increase the risk of stroke may be associated with genes that increase the risk of migraine headaches.

Even when heredity plays a role in migraine headaches and strokes, a headache typically does not occur at the same time as a stroke. What does this mean for migraine sufferers? It simply means that it is important to understand the stroke risk factors and to talk to your doctor about medical management of stroke risk factors to avoid a stroke.

Should I Worry About a Stroke If I Have Headaches?

Most of the time, stroke symptoms consist of weakness, vision changes, numbness, confusion or trouble speaking. Headaches are not usually a sign of an impending stroke.

However, there is a type of stroke which results not from lack of blood flow to the brain, but from bleeding of a blood vessel in the brain. This is called a hemorrhagic stroke. A brain hemorrhage is a stroke that causes bleeding, usually stemming from an abnormally shaped blood vessel. The bleeding irritates and damages brain tissue. It also causes lack of appropriate blood delivery to the brain (because the bleeding blood vessel can't deliver blood where it needs to go if the blood is leaking where it shouldn't be).

Head pain is one of the signs of a brain hemorrhage. This leads to the more important question. How would I know if a headache is caused by a blood vessel abnormality or a brain hemorrhage?

Headaches as a Sign of Stroke

There are rare instances when a headache is the sign of the stroke.

Only about 1-3% of patients who go to the emergency room because of headaches are diagnosed with a stroke. In one study that appeared in The British Medical Journal, almost 2000 patients who went to the ER for severe headaches were evaluated for stroke. Most patients complained that the headaches that brought them to the emergency room were the worst headaches of their lives. The study went a step further to evaluate other symptoms that were present at the same time as the severe headaches. The vast majority of the headache patients who were diagnosed with a hemorrhagic stroke also complained of other symptoms.

Predictors of hemorrhagic stroke in headache patients in the emergency room include the following:

  • Worst headache of your life
  • Headaches starting over age 40 (it is unusual to start getting headaches after the age of 40, and thus headaches that start after age 40 should be medically evaluated)
  • Loss of consciousness
  • Neck pain or neck stiffness
  • Vomiting
  • Blood pressure values higher than 160/100
  • Headache triggered by physical exertion
  • Arrival to the emergency room by ambulance

Thus, a headache, even a severe one, is rarely a sign of a stroke.

While there is a weak association between headaches and stroke, most of the time it is safe to say that headaches are not an indication of a stroke. If you experience any of the symptoms above, you should obtain medical attention immediately.

Sources

Eikermann-Haerter K, Spreading depolarization may link migraine and stroke, Headache, August 2014

Jeffrey J Perry, Ian G Stiell, Marco L A Sivilotti, Michael J Bullard, Jacques S Lee, Mary Eisenhauer, Cheryl Symington,  Melodie Mortensen,  Jane Sutherland, Howard Lesiuk, George A Wells, High risk clinical characteristics for subarachnoid haemorrhage in patients with acute headache: prospective cohort study, British Medical Journal, October 2010

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