How a Headache May Be a Sign of a Stroke

A stroke is a medical emergency that may also be associated with a headache. Let's read about the types of stroke and how a stroke-related headache may be distinguished from a benign primary headache.

What is a Stroke?

Strokes, or "brain attacks," occur when blood flow to the brain is interrupted. There are two types of strokes. An ischemic stroke occurs when an artery that supplies oxygen-rich blood to the brain becomes blocked — this causes brain cell death due to lack of blood flow.

A hemorrhagic stroke occurs when an artery in the brain bursts, and there is bleeding into the brain. A common example of a hemorrhagic stroke is a subarachnoid hemorrhage — and in this condition, a severe headache is the only symptom in about a third of the patients.

Both types of strokes are medical emergencies, and both may be associated with a headache.

What is the Most Common Type of Headache in Stroke?

According to an older study in Stroke, the most common type of headache is a tension-type headache.

The location of a headache may depend on where the stroke is occurring. For instance, strokes that arise within the carotid artery — a major artery in the neck that brings blood to the brain —may produce a forehead headache. Strokes in the vertebrobasilar system, which supplies blood to the back of the brain, may produce a headache at the back of the head.

Distinguishing Strokes from “Normal” Headaches

It depends on which type of stroke a patient is experiencing, but according to a 2010 study in the Handbook of Clinical Neurology, between 7 to 65 percent of stroke victims report some sort of headache.

If you experience any of the following symptoms with your headache, you may be having a stroke:

• You feel you are having “the worst headache of your life”
• A “thunderclap headache” (an abrupt, severe headache without warning)
• Weakness of the face, arm, and/or leg on one side of body
• Numbness in the face, arm, and/or leg one side of body

• Inability to understand spoken language
• Inability to speak
• Inability to write
• Vertigo and/or gait imbalance
• Double vision

What Should You Do?

If you believe you are having a stroke you should call 911. Early treatment is the key to preventing any long-term effects from a stroke. If your headache symptoms change from your “usual” symptoms or you develop headache warning signs, you should also seek medical attention.

Sources:

Carolei A & Sacco S. Headache Attributed to Stroke, TIA, Intracerebral Haemorrhage or Vascular Malformation. Handb Clin Neurol. 2010;97:517-28.

"Headache: Hope Through Research.” From the National Institute of Neurologic Disorders and Stroke website.

Vestergaard K, Andersen G, Nielsen MI, & Jensen TS. Headache in Stroke. Stroke. 1993 Nov;24(11):1621-4.