Headache Headache Basics

Distinguishing a Severe Headache from the Warning Signs of Stroke

A rapid, severe headache has long been considered an early warning sign of stroke. Along with other clues, such as a sudden numbness on one side of your face or body, an extremely painful headache that seems to come out of nowhere may require an immediate trip to the emergency room. Strokes are more common as you get older, but these so-called "brain attacks" can strike at any age. The faster you get to the hospital, the better your chances of preventing serious damage to the brain.

But new research suggests that migraines and other headaches are not just an early sign of stroke, they may even put you at risk for one. Looking at some 12,700 men and women who were involved in the Atherosclerosis Risk in Communities Study, published in May in Neurology, investigators found that people who have a history of severe migraines were more likely to suffer an ischemic attack, the type of stroke that is caused by blocked blood vessels. Compared to those who reported few serious headaches over their lifetime, migraine sufferers also showed greater symptoms of having a stroke or mini-stroke, known as a transient ischemic attack.

This connection appeared strongest in men and women who suffer from aural migraines, which are associated with blurry vision and strange smells, in addition to pain. Intuitively, a link between migraines and stroke would seem to make sense. Severe headaches are believed to cause a disturbance in blood vessels, and there is an unusually high prevalence of strokes in younger migraine sufferers.

How to Tell the Difference
But these recent findings also cause some confusion. For those who frequently get serious headaches, how can one tell regular pain from a possible stroke?

"There is a great overlap in symptoms between migraine and stroke," says Philip Stang, MD, lead author of the study and an associate of the department of epidemiology at the University of North Carolina. "And there are types of migraine that include stroke features and vice-versa."

Keeping that in mind, experts say there are some potential differences as well. For one, most migraines will clear up relatively quickly, whereas stroke symptoms are constant.

The presence of certain risk factors may also make one more suspicious that a headache could be a sign of stroke. For example, younger women with migraines, especially if they smoke or take oral contraceptives, are more likely to suffer a stroke than others, says Stang. In older patients, hypertension is a more serious risk factor for stroke than severe headaches.

It may turn out that the link between migraines and stroke risk is not a serious concern. In an editorial that accompanied the study, the authors argue that there are more questions than answers at this point. Stang is cautious as well. "Since there is no laboratory test to confirm migraine, it is difficult to be so precise and assured," he says.

Still, there is little question about the importance of seeking medical help at the first signs of a stroke, including severe headaches. Specially trained hospital staff can determine if you are having a stroke and initiate treatment, which can prevent significant harm if started early. Experts recommend that you seek help immediately if you experience the following, sudden symptoms:

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