F28 Migraine and Stroke

8/12/2019 F28 Migraine and Stroke

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Migraine and stroke

Migraine is a complex condition, which can impact on your workand social life. It is characterised by a severe headache, whichusually occurs with a range of other symptoms. It is thought thatmigraine can slightly increase the risk of stroke, particularly inyounger women. This factsheet explains more about migraine, itslink with stroke, and lists some useful organisations that can offerfurther information.

What is migraine?A migraine can have a wide range of symptoms. For manypeople the key symptom is a severe headache. sually this is feltas a throbbing or pulsating pain at the front or on one side of yourhead. This is often accompanied by other symptoms such asnausea and/or vomiting, and sensitivity to light, sound orsmell.

Migraine affects around !" per cent of the population. #omen areabout three times as likely to experience migraine as men. $eopleof all ages are affected by migraine, but the condition usuallybegins in young adulthood. %ome people have several migraines aweek& others may have years between migraine attacks.

What are the different types of migraine?

There are two main types of migraine'

Migraine without aura(also known as common migraine)' thema*ority of people with migraine have this type. It consists of aheadache with nausea and+or sensitivity. The other symptomsusually begin at the same time as the headache and disappearonce the headache goes. eadaches usually last between fourand - hours.

Migraine with aura(also known as classical migraine). It affectsbetween !/ and 0/ per cent of people who have migraines. Many

people who have this type of migraine also get migraine attackswithout aura. Attacks usually begin with an auraconsisting of

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some of the following symptoms which develop gradually over "1/ minutes and last less than one hour.

2isual changes. This is the most common aura symptom andthe changes can include flashing lights, 3ig13ags, sparks ordark patches. These can appear on one side or centrally andcommonly expand and move across your field of vision.

%ensations such as pins and needles and heaviness, whichspread from one body part to another.

4ess commonly, you may have difficulty speaking.

If you experience more than one aura symptom they usually followone another, so that you may experience visual changes first, thenchanges in sensation, then sometimes loss of speech.

ypical migraine symptoms of headache and nausea usuallythen follow, although they may happen at the same time or evenbefore. 5ccasionally someone may experience the aura without aheadache.

#hether or not you have a migraine aura, you may experiencesome different symptoms hours or days before a migraine attack.These can include changes in mood and energy levels, aches andpains and sensitivity to light or sound . These are called prodromalor premonitory symptoms.

!are types of migraine

There are also some rare types of migraine. They are also classedas migraine with aura'

"asilar#type migraine

This is named after the basilar artery, a blood vessel in the back ofyour head, although it is unclear whether this blood vessel isactually involved. This type of migraine usually involves aheadache at the back of your head rather than on one side. This

follows, or is accompanied by, an aura which may involveproblems with vision or hearing, speaking difficulties, tingling in



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your hands and feet (on both sides) and di33iness or problemswith co1ordination .

$emiplegic migraine

emiplegia means paralysis on one side of the body andweakness or paralysis on one sideis a key symptom of thistype of migraine. 5ther symptoms might include numbness orpins and needles, visual problems, confusion and speechproblems. These problems usually go within 6 hours, but theymay last a few days. A headache usually follows. This type of

migraine can be particularly frightening as the symptoms aresimilar to a stroke but in hemiplegic migraine they usuallydevelop more slowly, whereas a stroke is usually a sudden event.

If you have a parent who has hemiplegic migraines then you haveabout a "/ per cent chance of having this type of migraineyourself. This is called familial hemiplegic migraine %&$M'. Insome families with FM, problems have been found with particulargenes which affect how the brain cells communicate with eachother. If no one else in your family has hemiplegic migraines this iscalled sporadic hemiplegic migraine (%M).

What causes a migraine?

Migraine involves several complex changes in the brain and theexact cause is not well understood.

5ne factor, which experts think is important, is a reduction in achemical called serotoninin the brain during the migraine attack.

This can cause blood vessels to suddenly contract (narrow). Theblood vessels then relax (widen), which may cause the headache.It used to be thought that migraine was mainly caused by changesin blood vessels. owever, this is unlikely to be the whole story.

Another important cause of aura symptoms may be 7corticalspreading depression8 (9%:) which is a reduction in the normalelectrical activity in the brain. It is unclear what causes changesin serotonin or 9%:.


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(hanges in hormones; particularly oestrogen ; probably play animportant role in migraine. :uring puberty, when oestrogen levels

rise, migraine becomes much more common in girls. %ome womenhave migraines *ust before, during or after their periods 1 this iscalled menstrual migraine. Migraines can also be difficult to controlas menopause is approaching and contraceptives that containoestrogen or oestrogen replacement therapy often makes themworse.

There is also a tendency for migraine to run in familiesso there isprobably a genetic link.

Migraine triggers

There are various triggersthat can lead to a migraine attack.

These vary and can be'

emotional)such as stress, anxiety or depression

physical)such as tiredness or tension, particularly in theneck and shoulders

dietary)particularly lack of food, alcohol or certain foodssuch chocolate or cheese

environmental)such as bright lights or a stuffy atmosphere

medicines)including some sleeping tablets, and thecontraceptive pill.

5ne trigger may not always cause a migraine to occur. 5ften ittakes more than one trigger to lead to an attack, for example beingunder emotional stress and missing a meal.

What is the link between migraine and stroke?

A stroke happens when the blood supply to the brain is interrupted.This could be due to a blockage (called an ischaemic stroke) or

due to bleeding in or around the brain (called a haemorrhagicstroke).


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The relationship between migraine and stroke is complex.*ou

have a slightly higher risk of stroke if you have some types ofmigraine. %ome of the symptoms of migraine and stroke can beconfused with each other.

he risk of stroke


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The most common effect of a migrainous stroke most is a visualproblem called homonymous hemianopia; where you can only

see the right or the left side of the world out of each eye. This typeof stroke rarely seems to cause other lasting severe disabilitiesand does not often happen again.

t is not clear why migrainous stroke happens,but there areseveral changes during a migraine, which may be important. At thebeginning of a migraine attack the blood vessels constrict (narrow)leading to reduced blood flow. This process can also causechanges in the blood, which cause clots to form. These, in turn,

could cause a blockage in a narrowed blood vessel. :ehydrationand vomiting during migraine can cause low blood volume, whichalso makes blood clots more likely to form. If you have other riskfactors for stroke such as atherosclerosis (furring up of bloodvessels) this could happen more easily.

%trokes will not necessarily occur during a migraine attack. Thereare several possible reasons why having the condition migrainemay increase the risk of stroke. These include migrainescontributing to damaging the blood vessels, and migrainesincreasing the risk of fluid building up in the blood vessel walls(oedema) which can lead to the layers of the walls separating(dissection). This can lead to bleeding or clots forming in damagedblood vessels.

There could also be underlying causes, whichcontribute to bothstroke and migraine. 9onditions which make your blood more likelyto clot, such as systemic lupus erythematosus (%4=), ughes8syndrome and 9A:A%I4 are associated with migraine and with

stroke. Migraine sufferers are also more likely than people whodon8t experience migraines to have a patent foramen ovale%-&.'1 a hole in the wall dividing the two sides of the heart. Thismay contribute to both stroke and migraine.

$ow do tell the difference between migraine andstroke?

%ome of the symptoms of migraine can be confused with stroke.

$emiplegic migraine in particular shares many of the signs ofstroke.


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Migraine auras can be confused with transient ischemic attack

(TIA) ; where someone experiences the symptoms of stroke butthey are temporary. %ome people who have had migraine withaura get identical auras but without the headache. This can easilybe mistaken for TIA.

Migraine aura symptoms develop relatively slowlyand thenspread and intensify, whereas the symptoms of a A aresudden. Migraine symptoms also tend to be 7positive8. ?ou willprobably ac@uire symptoms (such as seeing flashing lights or

having a headache), rather than losing abilities (such as losingmuscle strength, vision or speech). In addition, a lack of other riskfactorsfor stroke or TIA, a family history of migraine and previous,similar attacks would suggest migraine.

Migraine can sometimes be mistaken for a type of haemorrhagicstroke called a subarachnoid haemorrhage (%A) which is oftencharacterised by a sudden, very severe headache. A migraine cansometimes be sudden (called a 7crash migraine8) and can lead tomild confusion or fever like %A. owever, unlike with %A,migraine headache is usually one1sided and throbbing, slower tocome on and lasts for a shorter period of time. Also, vomitingusually starts well into a migraine attack unlike %A.

If you experience sudden weakness, numbness, speech or visualproblems always seek urgent medical attentionas these can besigns of a stroke.

$ow is migraine treated?

iagnosing migraine

Migraine is diagnosed by piecing together information about yoursymptoms and identifying patterns over time. Migraines can beunpredictable, so getting a diagnosis may take some time.

It is a good idea to keep a diaryof your migraine symptoms andfactors such as what you ate and how you slept leading up to

them. This may help you identify and avoid your triggers.


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Managing migraine

There are things you can do to manage your migraines. Manypeople find that ordinary over1the1counter painkillerssuch asparacetamol, ibuprofen and aspirin reduce the pain of theirmigraine headache. If these are not effective, your $ or aspecialist can prescribe a stronger pain killer. Medications are alsoavailable to reduce nausea, sometimes in a single tablet with apainkiller.

Anti1sickness medications and painkillers are most effective if they

are taken as soon as your symptoms start. ?our digestive systemslows down during an attack which can mean that the medicationsare not absorbed into your body soon enough to have an effect.%ome medications come in forms that you can dissolve in waterand these will have a faster effect. Medications that can beabsorbed through the gums or rectum are also available if youhave difficulty swallowing. %ome over1the1counter medicines arenot suitable for everyone. Always read the instructions on thepackaging.

Many people find sleeping or lying in a 0uiet, darkened roomhelps to ease the symptoms at the time of a migraine, or at leastshorten the duration of the migraine.

Applying pressure, an ice packor a hot water bottleto the painfularea can also be helpful. ?ou may need to experiment to find outwhat works for you.

1topping migraines once they have started

If painkillers do not help, there is a type of drug called a triptan,which can stop an attack once the headache is beginning todevelop. Triptans work by causing blood vessels to narrow.Therefore, they stop the dilation of blood vessels, which probablycontributes to migraine headache. #hilst it might seem that thiswould put you at risk of stroke, there is no evidence that this is thecase . owever, it is generally recommend that you should havean evaluation of your risk of blood vessel problems if you are over

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-reventing migraines

If you have very severe or fre@uent migraines, your doctor mayprescribe preventative medication. This is usually dailymedication, which you may have to take for three to !B months. Itmay be a few months before you notice an effect. owever,preventative treatment generally leads to a big improvement,which continues even after you have stopped taking themedication.

Many of the drugs used to prevent migraine are used for other

conditions such as high blood pressure, epilepsy or depression. Ifyou have had a stroke you may already have been prescribedsome of these. If you are prescribed these drugs for migraine, youwill usually be given a lower dose than if they are prescribedspecifically for the other condition.

.ther treatments

There are a wide range of alternative or natural treatmentsavailable for migraine. There is some evidence that certain herbsand supplements are effective in reducing the fre@uency orseverity of migraines, including magnesium, feverfew, coen3ymeC!/, riboflavin and butterbur.

These may interact with medications you are already taking andcan have unwanted side effects so talk to your doctor beforetrying them.


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information on preventing stroke including specific factsheets onhealthy eating and stroke, high blood pressure, and smoking.

he Migraine rust$elpline)// ->0! >-/3#mail) infoEmigrainetrust.orgWebsite) www.migrainetrust.org4eading patient support and research charity for migraine. 9anprovide details of specialist migraine clinics.

Migraine Action

el)/!!> -" B0!-Website)www.migraine.org.ukMembership organisation providing information and advice aboutall aspects of migraine.

isclaimer)The %troke Association provides the details of otherorganisations for information only. Inclusion in this factsheet doesnot constitute a recommendation or endorsement.

4lossary of terms

AuraG a range of symptoms that start before a migraineheadache, often including a visual disturbance

"asilar#type migraineG migraine involving pain at the back of thehead with a number of other symptoms such as visual or hearingproblems and pins and needles

(lassical migraineG migraine with aura

(ommon migraineG migraine without aura

$aemorrhagic strokeG a stroke caused by bleeding in or aroundthe brain

$emiplegic migraineG a type of migraine that involves weaknessor paralysis on one side of the body as well as other symptoms

$omonymous hemianopiaG a type of visual problem where youcan only see the left or right half of the world out of both eyes.


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mailto:[email protected]://www.migrainetrust.org/http://www.migraine.org.uk/http://www.stroke.org.uk/mailto:[email protected]://www.migrainetrust.org/http://www.migraine.org.uk/http://www.stroke.org.uk/


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schaemic strokeG a stroke caused by a blockage

1ubarachnoid haemorrhage %1A$'G bleeding on the surface ofthe brain

ransient ischaemic attack %A'G also called a mini stroke,stroke like symptoms than are temporary and always disappearwithin 6 hours

riptanG a type of medicine that aims to stop a migraine attack

once it has started

$roduced by the %troke Association8sInformation %ervice. For sources used,visit stroke.org.uk

H %troke AssociationFactsheet B, version !, published April /!(next review due une /!6).

%troke Association is a 9ompany 4imited by uarantee, registered in =ngland and #ales (Jo >!-6).

F28 Migraine and Stroke

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