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Can A Migraine Mimic A Stroke

What Does A Stroke

Serene Branson Update: Migraine Can Mimic Stroke 2/18/2011

Everyone gets the occasional headache, and some people may have more frequent headaches than others. While the majority of headaches are not serious and will eventually resolve themselves, there are certain cases where a headache can be a symptom of something more serious, like a stroke. However, it can be hard to distinguish a benign headache from a stroke-related headache. In order to help you know the difference, here is more information about strokes, stroke-related headaches, and what a stroke-related headache feels like.

Which Migraine Types Can Resemble Stroke

Migraine with aura is the type of migraine most commonly mistaken for stroke. The aura in migraine with aura is a set of visual, sensory, or other nervous system symptoms that usually last between a few minutes and an hour, and usually precede the headache phase of an attack. Its possible to have aura symptoms with no headache.

About 25 percent of people with migraine experience auras, according to the Migraine Research Foundation.

The most common aura symptoms are visual effects such as bright flashing lights or spots or zigzags in a persons field of vision. Other possible aura symptoms include losing sight for short periods having tingling and numbness in the face, hands, or other areas of the body hearing sounds such as buzzing or music and having speech and language problems such as being unable to say words, slurring, or mumbling, according to the American Migraine Foundation. Any of those could easily be assumed to be signs of a stroke.

Another migraine type that can cause stroke-like symptoms is a very rare inherited condition called familial hemiplegic migraine, or sporadic hemiplegic migraine if it occurs in only one person in a family. Symptoms of a hemiplegic migraine attack are the same as migraine with aura but also include motor, or muscle, weakness on one side of the body that may persist for days or even weeks. Rarely, hemiplegic migraine can cause fever, confusion, loss of consciousness, or even profound coma.

Name Two Common Conditions That Mimic Stroke Symptoms

Seizure and complicated migraine. Although at times difficult to distinguish, the clinician can often differentiate between these conditions on the basis of the temporal nature of symptom onset. Strokes generally produce a deficit that is sudden and maximal at onset. Seizures progress rapidly over a few seconds and may be associated with stereotyped motor movements and often impairment or loss of consciousness. Migraines can produce stereotypical visual, sensory, motor, or language symptoms in a predictable fashion because of the presumed mechanism of cortical spreading depression occurring over minutes. Spreading depression is an extracellular wave of neuronal depolarization thought to be related to rising levels of potassium concentration in the extracellular space that produces migratory symptoms as it spreads across the surface of the cortex.

Joanna C. Jen, Jijun Wan, in, 2018

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Migraine And Stroke Share A Common Cause

Several vascular disorders can cause stroke and are associated with a high risk of migraine, mostly MA. Arteriovenous malformations are the classical cause of symptomatic migraine. A causal relationship is supported by the side of the aura being contralateral and the headache being ipsilateral to the MAV. Other MA potentially associated conditions include leptomeningeal angiomatosis and hereditary haemorrhagic teleangectasia.

Ischemic stroke and migraine are also major clinical features of some specific syndromes: cerebral autosomal-dominant arteriopathy with subcortical infarcts and leukoencephalopathy , mitochondrial myopathy, encephalopathy, lactic acidosis, and stroke-like episodes , cerebroretinal vasculopathy, and hereditary endotheliopathy with retinopathy, nephropathy, and stroke . Coexistence of ischemic stroke and migraine in a syndrome with a peculiar phenotype, a confirmed inheritance and chronic alterations of the wall of cerebral small-vessel arteries, highlights a common pathogenic mechanism between these two conditions .

How Can You Tell The Difference Between A Migraine And A Tia

Migraine Stroke Symptoms: What to Watch For

Evolution of symptoms and positivity are typical for migraine. TIA appears more abruptly and is usually of shorter duration. Negativity is typical for it, i.e. part of the visual field, speech, eye movement, ability to swallow, sensation or muscle strength disappear without the above mentioned features of migraine.

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Polygenic Forms Of Migraine

New powerful technologies of gene analysis along with the possibility to use informatics resources providing genome-wide sequence and variant data has fostered an effective and challenging approach to complex diseases. On the basis of the results of such analysis, several specific genetic variants have been implicated in migraine susceptibility and it can be gathered from three main streams.

  • The first group includes genes involved in neurotransmitter-related pathway, such as genes encoding for dopamine D2 receptor , human serotonin transporter , catechol-O-methyltransferase , and dopamine b-hydroxylase .

  • The second group includes genes involved in vascular function, such as 5,10-methylenetetrahydrofolate reductase , angiotensin I-converting enzyme , and endothelin type A receptor.

  • The third group includes genes involved in hormonal function, such as estrogen receptor 1 , progesterone receptor and androgen receptor .

Find Out Your Stroke Risk

Most strokes involve a clot that blocks blood flow to your brain . Sometimes, a weakened blood vessel breaks, causing bleeding . A temporary clot can cause a mini stroke or TIA . The smallest stroke can damage your brain or warn of a bigger stroke to come. It can limit your ability to think, talk or move. If you see symptoms, call 911 right away.

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Stroke And Migraine With Aura Overlapping Symptoms

  • Visual changes
  • Stroke: Sudden trouble seeing in one or both eyes
  • Migraine with aura: Flashing lights spots or zigzag lines temporary, partial loss of vision
  • Speech changes
  • Stroke: Sudden confusion, trouble speaking or understanding speech
  • Migraine with aura: Speech difficulties and disturbances, confusion
  • Physical changes
  • Stroke: Sudden numbness or weakness of face, arm or leg, especially on one side of the body sudden trouble walking, dizziness, loss obalance or coordination
  • Migraine with aura: Weakness in arm or leg numbness or tingling in the face or hands lightheadedness
  • As you can see, it can be very difficult to tell whether someones having a stroke or migraine with aura because the symptoms can be nearly identical. As if to complicate matters even more, people who suffer from seizure disorders can also experience aura symptoms. This is why its so important to have any of these symptoms checked out by a medical professional, especially in the case of a stroke where time is brain.

    Recognizing a stroke is key, according to Albert Yoo, MD, a neurologist at Medical City Plano. Dr. Yoo says that because treatment is time dependent, every minute that passes without medical care means more brain cells are dying.

    Stroke Or Migraine The Migraine

    Migraines Can Mimic Like A Stroke! Dr. Kuti Sheds More Lights On Migraine

    Migraine is the most common neurological disorder, affecting 10% to 15% of adults in the U.S. According to a study published in the Journal of Stroke, people who suffer from migraine headaches have increased risks for a variety of vascular diseases, including ischemic stroke and hemorrhagic stroke.

    TheNational Headache Foundation reported that people who have migraine with aura are more than twice as likely to have an ischemic stroke as people who have migraine without aura. In addition to a severe headache, it is these aura symptoms that can mimic some of the signs of a stroke or transient ischemic stroke .

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    Facial Weakness Or Pain

    Facial weakness can be a very concerning symptom, as it is one of the hallmark signs of a stroke. If you have facial weakness, or see that someone else has facial weakness, it is important to get urgent medical attention right away.

    While it is often associated with stroke, sudden facial weakness can be the sign of a fairly common condition called Bell’s Palsy. This condition often improves on its own, but you might need some medication to help you as you recover if you are diagnosed with Bell’s Palsy. Another condition, trigeminal neuralgia, characterized by excruciating facial pain, may also mimic a stroke.

    Treatment For Hemiplegic Migraine

    Treatment of hemiplegic migraine can be challenging. The care of a headache specialist is often required, as many other doctors may never have treated a case of hemiplegic migraine.

    Acute Hemiplegic Migraine Treatment

    Triptans and ergotamines are currently contraindicated in the treatment of hemiplegic migraine because of their vasoconstrictive properties and concerns about stroke. One small study was conducted, safely using triptans with patients with hemiplegic migraine, but more trials are needed before theyre considered a safe option. Other treatments such as NSAIDs, antiemetics, and sometimes narcotic analgesics are used for symptomatic relief of hemiplegic migraine. Intranasal ketamine has been shown to shorten the duration of aura symptoms in patients with hemiplegic migraine.

    Preventive Hemiplegic Migraine Treatment

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    What Is A Stroke

    During a stroke, blood flow to part of your brain is cut off. Cells there don’t get enough oxygen and start to die.

    There can be two causes. Either a blood vessel is blocked, for instance with a blood clot, or a blood vessel tears or bursts and causes bleeding in or around the brain.

    A sudden severe headache can be a sign of a stroke. Other common symptoms are:

    • Numbness or weakness, especially on one side of your body
    • Trouble speaking or trouble understanding others
    • Vision problems in one or both eyes
    • Sudden dizziness or loss of balance or coordination
    • Confusion

    The kind of stroke that tends to be mistaken for a migraine is called a transient ischemic attack, or TIA. It’s also known as a “mini stroke” because blood flow to your brain is cut off only for a short time. Symptoms are less severe than with a regular stroke and may last less than an hour.

    Classification Of Migraine Related Stroke

    Can a migraine mimic a stroke ?

    One of the most relevant drawbacks in unrevealing the complex relation between migraine and cerebral ischemia is the lack of consistency while defining migraine-related stroke.

    Attempting a categorization, four major issues should be considered:

    • cerebral ischemia can occur during an attack of MA, causing true migraine induced infarction

    • migraine and stroke share a common underlying disorder increasing the risk for both diseases

    • migraine might cause stroke only as far as other risk stroke factors are present interacting with the migraine induced pathogenesis

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    Conditions People With Migraine Were Misdiagnosed With

    Although the symptoms of migraine, a neurological disorder that affects nerve pathways and brain chemicals, feel anything but invisible when youre experiencing them, they can be tough to see and understand from the outside. Migraine symptoms can also mimic the symptoms of other conditions. Those two challenges put together are the perfect recipe for misdiagnosis. While many doctors may have good intentions when they investigate your symptoms and offer their diagnosis, the fact remains that mistakes are made in fact, one study found only one in 20 get the correct headache or migraine diagnosis. As neurologist R. Allan Purdy said, Bad diagnosis can lead to the wrong treatment, which may cause a bad outcome.

    Here, weve made a list of some conditions that migraine is often misdiagnosed as. These conditions have similar symptoms, so you or your doctor may believe they are the cause rather than migraine. But migraine is a serious chronic illness in its own right, and should be considered a possibility when the symptoms fit. Let us know in the comments below what your migraine diagnosis experience was like.

    Its also important to note that migraine misdiagnosis can go both ways, and perhaps youve been told you have migraine but actually you have one of the following conditions. See your doctor if you are concerned you may have the wrong diagnosis. You deserve to find your true diagnosis.

    Coexisting Ischemic Stroke And Migraine

    Despite the apparent increased risk of stroke in migraineurs, the high frequency of migraine in young adults underlines its possible coexistence with ischemic stroke without contributing to its development.

    Being the etiology of these strokes probably multifactorial, identification and management of other established risk factors should be pursued with particular vigilance in all migraine sufferers .

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    Stroke Or Migraine How To Recognize The Differences In Symptoms

    While its always advisable to seek emergency medical treatment by calling 911 for any signs of stroke, even if youre not sure, there are subtle differences in symptoms that may give you a clue as to whether its a stroke or migraine.

    Here are some questions to ask that may help you identify:

    • Abrupt or gradual? A stroke typically comes on suddenly, without warning. Symptoms are immediately at peak intensity. A migraine aura usually occurs gradually, with symptoms evolving over several minutes and any accompanying headache building to a peak over time.
    • Increased or decreased vision changes? With migraine you see it, with stroke you dont. Someone having a migraine with aura will experience added visual stimuli, such as flashing lights or zigzagging lines. A stroke, on the other hand, typically diminishes vision bumping into something may be the first clue that vision has been impaired.
    • Past history of migraine? Although its possible to have a first migraine at any age, its more typical to begin having them as a child. Most migraine sufferers will also recognize their aura, as it tends to be the same every time. If you have never had a migraine or your migraine symptoms differ from their normal course, get to the closest ER or urgent care center. With stroke, its also possible to have one at any age or in any physical shape, so dont ever rule it out. Call 911 immediately, because its better to be safe than sorry.

    Revised 4/27/2021

    How Can You Tell The Difference

    Dr. Mohammad Daaif Explains Hemiplegic Migraines on KTHV

    It can be hard to tell the difference between a migraine with aura and a TIA. Here’s what to look for:

    • With a stroke, symptoms usually come on suddenly. With a migraine, they happen gradually the headache usually starts small and gets more painful.
    • A stroke is more likely to have what are called “negative” symptoms such as you might lose sight in one eye or lose feeling in one of your hands or feet. A migraine is more likely to have “positive” symptoms. That means added sensations, like flashes in your vision or tingling in your skin.
    • If you’re young, it’s more likely to be a migraine. If you’re older, it’s more likely to be a stroke, especially if you’ve never had a migraine before or you have high blood pressure or an irregular heartbeat.

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    Stroke During A Migraine

    In rare instances, a stroke can occur during a migraine attack, usually in young women who have a history of migraine with aura. This is called a migrainous infarction, and it’s so uncommon that the vast majority of people who have migraines will never experience this rare complication. Scientists are still trying to understand why this happens and what the cause-effect relationship is.

    Some stroke survivors begin to experience headaches after having a stroke. Generally, though, these headaches aren’t described as migraines and they’re not normally associated with neurological symptoms.

    Migraine With Aura Raises Stroke Risk Slightly

    While migraine typically does not cause stroke, having migraine with aura can put people at a slightly higher risk of stroke. Liberman stresses that the increased risk is generally small, and people who have migraine should get to know their symptoms and not live in fear of having a stroke.

    When stroke occurs as a complication of migraine with aura, its called migrainous stroke or migrainous infarction. Migrainous stroke is an uncommon occurrence. According to an article published in 2017 in Current Neurology and Neuroscience Reports, it accounts for only 0.2 to 0.5 percent of all ischemic strokes. In the United States, that would mean about 2,000 to 4,000 out of the nearly 800,000 strokes that occur each year, according to Centers for Disease Control and Prevention statistics.

    While many theories have been put forth about why migraine with aura raises the risk of stroke, some of which are discussed in the Current Neurology and Neuroscience Reports article, ultimately, migraine researchers dont know why this association exists.

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    Monogenic Forms Of Migraine

    Even if many chromosomal regions were reported as possibly involved in migraine occurrence, mutations in three genes for familial hemiplegic migraine represent the only established monogenic cause of migraine so far. Familial hemiplegic migraine is a subtype of MA characterized by an autosomal-dominant pattern of inheritance and at least some degree of weakness during the aura. In spite of these clinical markers, a broad variability rules: age at onset, frequency, duration and features of attacks may differ from one patient to another, even among affected members from a family carrying the same mutation in the same gene. Less frequent features such as cerebellar ataxia, occurring in some families, minor head trauma acting as triggering factor and severe attacks with impairment of consciousness have also been reported. Moreover, even headache has been reported as the sole clinical manifestation . Furthermore, the majority of FHM patients experience attacks of typical MA and MO. It seems then reasonable to assume that migraine is composed by a spectrum of pathologic identities, starting from the common forms of migraine up to FHM. The latter is thus a valid model to study genetic factors of migraine in general as well as the relation between migraine and ischemic stroke. To date, three different genes responsible for different subtypes of FHM have been identified:

    Summary Of Hemiplegic Migraines

    Migraine Can Mimic Stroke Video

    Because symptoms of hemiplegic migraine are also symptoms of other conditions such as stroke and epilepsya hemiplegic migraine attack can be quite frightening, both to the migraineur and to those witnessing the attacks. Proper diagnosis and treatment are especially essential with this form of migraine. Imaging studies and other testing should be performed to rule out other causes of the symptoms. It is important that people with hemiplegic migraine understand their migraines as well as possible. With continuing research, especially genetic research, more is being learned about hemiplegic migraine. As this research continues, living with hemiplegic migraine will become easier.

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