The Difference Between Strokes vs Migraine Headaches

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A migraine headache is a type of headache that can, surprisingly, be mistaken for a stroke. The sensations that are caused by some of the most severe migraine headaches can cause migraine sufferers to feel as if they are having a stroke. Sometimes a migraine headache may be so similar to a stroke that it can even be misdiagnosed as a stroke in the medical setting. Rarely, a stroke can have some unusual features that cause it to be misdiagnosed as a migraine headache.

Some of the characteristics of strokes and migraine headaches overlap, and these features are the reasons for the confusion. However, there are also several important distinctions between strokes and migraine headaches that can help differentiate the two conditions.

Similarities Between Strokes vs Migraine Headaches

A stroke and a migraine headache are both events that may cause a variety of symptoms. That means that there is not one defined trademark symptom that is a guaranteed indication of either a stroke of a migraine. Each condition is characterized by a number of features, and usually not all of these features are present with every stroke or every migraine headache.

Both conditions can cause a sense of disorientation, although the disorientation of a stroke is generally characterized by confusion, while the disorientation of a migraine headache is generally caused by the disturbance of the extreme pain.

Both conditions may cause vision changes or vision loss. The vision loss of a stroke is usually described as an area of blindness from one or both eyes, while the vision changes of a migraine headache are typically described as lights flashing or squiggly lines. Nevertheless, a severe migraine headache can indeed cause true vision loss.

Both conditions are associated with dizziness or a spinning sensation. A stroke is far more likely to produce physical balance and coordination problems than a migraine headache.

Generally, both conditions produce an overall sense of feeling vaguely terrible. People who have migraine headaches are normally able to describe their symptoms in great detail, while people who have a stroke are often unable to describe their symptoms and are sometimes unable to communicate.

Both conditions may cause you to feel and act like you are not yourself. And both conditions can feel as if they are continuing to get worse with no end in sight. 

Migraines are usually associated with pain, while strokes are not typically associated with pain. However, sometimes strokes, particularly strokes caused by bleeding in the brain (hemorrhagic strokes) or tearing of the arteries (arterial dissection) do cause pain. The severe pain of a migraine can make it difficult to determine whether the overwhelming head pain is indeed a stroke or a migraine.

 Often, the head pain of a stroke is sudden and overwhelming, while the pain of a migraine headache is typically more gradual.

Strokes typically cause one-sided weakness, one-sided numbness, partial vision loss, speech difficulties, or a combination of these symptoms. Migraine headaches are usually not associated with weakness, numbness, vision loss or speech difficulties. However, on rare occasions, migraines can cause these physical symptoms. 

Hypertension, which is chronic high blood pressure, is one of the risk factors that is known to lead to stroke. Sudden bouts of extremely high blood pressure can trigger a stroke or a migraine headache if a person is already predisposed to these conditions. 

The reason that there is such a strong overlap between the symptoms of migraine headaches and the symptoms of stroke is that they both are caused by changes in the brain. But, the differences between a migraine and a stroke are much more significant than the similarities are.

Differences Between Stroke and Migraine Headaches

A stroke and a migraine headache may overlap when it comes to some symptoms, but there are other symptoms that do not typically overlap, and more importantly, the results of a medical evaluation of these conditions are quite different, as is the treatment. 

A migraine headache is often a recurrent event. Most of the time, a person's first migraine headache does not produce neurological deficits such as weakness, loss of sensation or vision loss. Unfortunately, however, there are exceptions to this rule and sometimes a person's first ever migraine can be associated with neurological deficits. 

Migraine headaches tend to be associated with triggers. There are well-known food triggers that elicit migraine headaches, and these triggers do not affect everyone who experiences migraines in the same way. There are not known food triggers that cause a sudden stroke, although poor eating habits contribute to hypertension and cholesterol levels that lead to stroke in the long term. 

Other things that can induce a migraine headache besides food include hormonal changes, such as those induced by the menstrual cycle, stress, lack of sleep, loud noises and chemical smells.

A stroke is not normally associated with such ordinary life triggers and is more likely to be precipitated by extreme alterations in blood pressure or an irregular heart beat, both of which are events that you would not expect to feel.

Strokes are far more likely to affect individuals who are older than age 60 and who have risk factors such as heart problems, hypertension, blood disorders or high cholesterol. These risk factors are not typically associated with migraines. Migraine headaches generally start in a person's 20s or 30s, and it is highly unusual for a person to begin having migraines after the age of 50.

Migraines and strokes are both conditions that are linked with a genetic tendency. A person with a family history of stroke is more likely to have strokes, while a person with a family history of migraines is highly likely to experience migraine headaches.

Can a Migraine Cause a Stroke?

In rare instances, a migraine headache can cause a stroke. This is called a migrainous infarction, and it is so uncommon that the vast majority of people who suffer from migraine headache will never experience this rare complication.

Can a Stroke Cause Migraine Headaches?

Some stroke survivors do begin to experience headaches after having a stroke. Generally, these headaches are not described as migraine headaches and they are not normally associated with neurological symptoms. Post stroke headaches are usually manageable with headache medications.

Migraine vs. Transient Ischemic Attack (TIA)

One of the important differences between a stroke and a migraine headache is how long the episode lasts. A stroke is permanent, while a migraine headache is temporary. A stroke causes permanent brain damage due to a lack of blood supply in the brain, which injures the brain tissue, leading to permanent disability. A migraine headache is a temporary event that improves and does not cause brain damage.

However, a condition called a temporary ischemic attack (TIA) is a reversible mini stroke caused by a brief interruption of blood supply in the brain that completely resolves without causing permanent brain damage. Usually, people who experience a TIA are at risk of stroke and are highly likely to experience a stroke. Most people with TIAs have stroke risk factors. If the risk factors are not medically managed, this can greatly increase the chances of having a stroke.

A migraine headache and a TIA are both temporary. But the outcome of a TIA is quite serious. And this is why it is important to seek medical attention if you experience any neurological symptoms when you have a headache. Your doctor can examine you and might order some diagnostic tests that can help sort out whether you are experiencing TIAs or migraine headaches.

Some of these tests include imaging tests such as a Brain CT, a Brain MRI, a Brain MR Angiogram, a Brain CT Angiogram or a carotid ultrasound. Other tests that can help in the evaluation of a possible TIA include an electroencephalogram (EEG), an electrocardiogram (EKG), an echocardiogram or selected blood tests. Your doctor can decide which of these tests are right for you, if any, based on your detailed description of the event and your physical examination. Most people who have had a possible TIA do not need all of these tests, but may need a few of them, depending on the individual situation.

Normally, if you have had a TIA, one or more of the tests could be abnormal, while the tests are expected to be normal if you have had a migraine headache. Of course, a person who has had a migraine headache may indeed have one or more stroke risk factors, even if the event was not a stroke or a TIA.

The Treatment for Migraine Headaches and Strokes

Migraine headaches and strokes are managed very differently from each other. Migraine headaches require treatment with headache medication that does not prevent or improve a stroke. The medications used for stroke do not prevent or improve migraine headaches. After a stroke, most people have some level of disability and need to participate in physical therapy and rehabilitation.

A Word From Verywell

It is not usual to be confused about whether you are experiencing a migraine headache or a stroke. If you can’t tell whether you are having a stroke or a migraine headache, it is important to get medical attention so that you will not experience permanent disability from a stroke.

If you suffer from migraine headaches, there are effective treatments available to prevent your migraines from happening and there are also treatments that can get rid of your migraine headaches when you get them.

If you have had a stroke or a TIA, you should know that there has been tremendous improvement in the prevention and treatment of strokes over the past years, and that you stand a very strong chance of preventing disability if you seek medical attention.

Sources:

Migrainous infarction: aspects on risk factors and therapy, Laurell K, Lundström E, Curr Pain Headache Rep. 2012 Jun;16(3):255-60

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