4 Major Differences Between Strokes and Migraines

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If you get migraines, then you’re familiar with common signs of an attack, like throbbing on one side of your head. But it’s worth knowing that sometimes a migraine and stroke can have similar symptoms, particularly if you experience migraines with aura, meaning you have sensory changes on top of your headache. About 20 percent of people with migraines experience aura, which can include issues with your vision, numbness or tingling in your face and arms, and more during a migraine, according to the Mayo Clinic. And while these symptoms could certainly be signs of a migraine attack, it’s important to be sure that you’re not experiencing neurological symptoms related to a stroke, which can include vision problems, numbness, tingling, and a very severe headache, according to the Centers for Disease Control and Prevention. Stroke and migraine are two separate conditions with very different outcomes and treatments, so it’s important for people with migraines to be able to differentiate between the two.

First, let’s talk about the causes of each condition: While it’s not clear what causes migraine headaches, they generally lead to throbbing or pulsing in your head that can last anywhere from hours to days, according to the Mayo Clinic. As for strokes, although there are various types, they all result in the brain being starved of the blood and nutrients it needs to function properly. And with strokes, it’s important to get to the hospital as quickly as you can to preserve brain tissue. (Migraines can generally be treated at home by going into a dark room and using pain medications, according to the Mayo Clinic—though severe or frequent migraines may benefit from longer-term maintenance medication.) Hopefully, you won’t be affected by a stroke, but understanding the nuances between the two conditions can help you seek the appropriate care if you’re ever confused about which one you’re experiencing. Here are four ways to differentiate between a migraine and stroke.

1. Migraines begin gradually, while strokes happen quickly.

Both conditions can cause debilitating headaches, vision disturbances, and sensory changes, so it’s important to pay attention to how quickly these all appear. Typically, migraine headaches come on slowly and become more painful with time, sometimes lasting for several days, whereas a stroke-related headache usually reaches its intensity within a few minutes. Additionally, other migraine symptoms appear in phases too, according to Carrie Oakley Dougherty, M.D., associate professor of neurology at Georgetown University Medical Center. “In the situation of migraine with aura, it’s generally a progression of symptoms over time,” she tells SELF.

You can think of the differences as being similar to turning on a dimmer switch versus turning on a light switch, she explains. First, you might notice a small spot in your visual field that makes it difficult to see, Dr. Dougherty says. Then, you may feel like there are pins and needles in your hands or around your mouth. That feeling can eventually spread to your forearms and face, Dr. Dougherty explains. “With a stroke, symptoms usually all occur at the same time,” Dr. Dougherty says. Oftentimes, your symptoms appear suddenly and you may lose sensation in your entire arm and half of your face, she says. On top of that, you may suddenly have trouble seeing clearly and walking, according to the Mayo Clinic. If you experience an onslaught of these symptoms, then it’s really important to head to the hospital as fast as possible so a doctor can evaluate your condition and provide treatment.

2. Changes to your vision will be different depending on what you’re experiencing. 

In migraines, vision problems are one noticeable aura symptom, according to the University of Michigan. You may see a geometric or zigzag pattern in your visual field or flashing lights, according to Dr. Dougherty. But vision changes are notably different during a stroke. Rather than noticing shapes, your environment will suddenly appear dark or blurry, according to Phil Stieg, Ph.D., M.D., a neurosurgeon and founder of the Weill Cornell Medicine Brain and Spine Center. One of the telltale signs of stroke is if a person’s “eyes feel like the blinds are being pulled down,” Dr. Stieg tells SELF.

“If [the feeling] lasts for a while, you need to seek medical attention immediately,” Dr. Stieg says. “If [the sensation] lasts for five minutes and goes away, it can be a transient ischemic attack and you should still seek medical care as soon as possible,” Dr. Stieg explains. A transient ischemic attack is sometimes called a “mini-stroke” because your brain is briefly deprived of blood and nutrients when this happens, and people experience the same symptoms as a stroke. Transient ischemic attacks are over quickly and generally don’t cause permanent damage in the same way that strokes do. About 30% of individuals who have a transient ischemic attack will eventually have a stroke, so it’s really important to seek immediate medical care if you think you’re experiencing one and to discuss your stroke risk factors with a doctor, according to the Mayo Clinic. Together, you can come up with a care plan, especially if you need to manage other medical conditions like diabetes and high blood pressure that may increase your chances of having a stroke.

3. Migraines are more common in people younger than 30; strokes are more common in older people.

People of any age can get migraines, but you generally get fewer and less severe attacks once you’re out of your 30s, according to the Mayo Clinic. Strokes most commonly affect people in their 60s, and at this point many individuals who experienced migraines when they were younger generally don’t get them either as frequently or at all anymore, according to Dr. Stieg. If you can’t tell whether your headache, vision changes, or other symptoms are closer to a stroke or migraine, and you haven’t had a migraine recently, then it’s safest to get emergency care as soon as you can. If you’ve never experienced a migraine and are older than your 30s, your chances of getting your first migraine are low. In that case, it’s safest to get medical care as soon as you can if you’re having symptoms.

That said, younger people can have strokes, particularly individuals with certain medical conditions, like a blood clotting disorder, sickle cell disease, or a metabolic condition, according to the Cleveland Clinic. If you’re at an increased risk of having a stroke and questioning whether you’re experiencing a stroke or migraine, then it’s a good idea to be cautious and go into the hospital if you can.

4. Migraines are usually set off by a specific trigger, but strokes are not.

Not everyone has the same migraine triggers, but stress, hormonal changes, sudden weather changes, and too much or too little sleep can cause a migraine flare-up. Even certain foods or drinks, including alcohol, chocolate, and cured meats, can lead to migraines in certain people. “Migraine brains don’t like change,” Dr. Dougherty says, which is why doctors advise people who get migraines to follow a consistent schedule as best as they can.

Unlike migraines, strokes aren’t triggered by a specific change, though there are risk factors that can increase your chances of developing a stroke, including high blood pressure, heart disease, diabetes, and history of mini-strokes. If you’re not at risk of a stroke, your symptoms occur after encountering one of your specific migraine triggers, and they are similar to symptoms during previous migraines, then migraine may be the cause of your pain. If you’re at all unsure, then it’s a good idea to reach out to your primary care physician if you have one or to contact a hospital for further advice.

Bottom line: Anytime something seems off with your headaches, you should reach out to your doctor for guidance. “If you haven’t had a migraine for a long time or something about it changes—like you have a new symptom—those are all good reasons to check-in with your doctor,” says Dr. Dougherty. “You want to make sure that you’re still on the same page and you’re still dealing with the same diagnosis of migraine.” And, if that does happen to be the case, it opens the door to a conversation about how to best treat your migraines in the future.

Related:

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  • 9 Ways People Are Getting Migraine Relief These Days
  • The Pandemic Caused My Migraines to Flare—Here’s How I Managed the Pain

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