Migraine and Stroke

What is a migraine?

A migraine is an intense headache that may be accompanied by nausea, vomiting, fatigue, sensitivity to light and sound, and mild to severe throbbing pain, usually worse on one side of the head. Women are more likely than men to have migraines, especially between the ages of 20 and 44. There are an estimated 28 million migraine sufferers in the US, and 70% of them are women.

The two most common types of migraine are defined by their warning symptoms:

  • Migraine with aura: Known as the “classical” migraine, it affects about 20% of migraine sufferers. This type of migraine has warning symptoms, called auras, that usually affect vision—such as bright flashing lights or spots and occur 10 to 30 minutes before the migraine. There are other types of auras that affect other senses, such as a ringing in the ear or changes in smell or taste. Migraines with aura may also include other symptoms such as difficulty speaking, weakness of an arm or leg, confusion, pain, nausea, and sensitivity to light.
  • Migraine without aura: Known as the “common” migraine because it occurs in 80% of migraine sufferers in the US, this type of migraine has no visual warning symptoms. However, symptoms such as fatigue, depression, or anxiety may appear hours before the migraine.

Does having migraines increase my risk of stroke?

Women who have migraines with aura have twice the risk of blocked-vessel (ischemic) stroke and heart disease, and are more than twice as likely to die from cardiovascular disease. It is not clear if women who have migraines with aura have an increased risk of stroke because of the migraine alone, or if it is related to other risk factors that also contribute to stroke, such as high blood pressure and smoking. Migraines without aura do not seem to increase your risk of stroke.

The longer you have migraines, the more the blood vessels in your brain are affected by the changes that occur during a migraine. One study of 300 women found that the risk of stroke increased in those who had migraines with aura more than 12 times a year or for more than 12 years. The risk may be even higher in women who smoke, use birth control pills, or have high blood pressure.

What causes migraines?

The exact cause of migraines is not fully understood. The theory is that migraines are related to abnormal activity deep in the brain brought on by internal and external cues, called triggers. This abnormal brain activity causes changes in the size of the blood vessels, which swell up. The nerves in the brain respond to these swollen blood vessels by sending pain signals a migraine. Migraines are associated with blocked-vessel stroke because of this change in blood vessel size and blood flow in the brain, especially during migraines with aura.

Most migraines are triggered by external factors. Some common external triggers include:

  • Bright lights
  • Alcohol
  • Smoking or exposure to smoke
  • Lack of sleep or too much sleep
  • Stress
  • Chocolates, dairy products, nuts, fermented or pickled foods
  • Weather changes

Internal factors can also trigger migraines, such as fluctuating hormones in women. Seven out of 10 women report that they have more migraines around their menstrual cycle, usually a couple of days before menstruation begins. This may be due to lower estrogen levels during this time.

Migraines tend to be hereditary; between 70% to 80% of migraine sufferers have a family history of migraines. This leads some to believe that the heightened sensitivity of the nerves in the brain to certain triggers may be genetic.

Diagnosis and Treatment :

How are migraines diagnosed?

It is estimated that nearly half of migraine sufferers in the US remain undiagnosed. You should see a doctor if you experience more than 2 debilitating headaches a month that are accompanied by any of the following symptoms:

  • Flashing lights or other visual disturbances (migraine with aura)
  • Sensitivity to light or sound
  • Nausea and vomiting
  • Fatigue
  • Loss of appetite

Migraine diagnosis usually consists of a medical history of migraine-related symptoms as well as a family history of migraines.

Typical questions the doctor will ask about your headache include:

  • When did your headaches start?
  • What do they feel like? Are they worse on one side of the head than the other?
  • How long do they last?
  • What are your symptoms before, during, and after a headache?
  • What medications have you tried to ease the pain?

A physical and neurological examination and imaging tests such as CT scan or MRI may be done to rule out other causes. A CT scan may be used if you have never had migraines before or if they have changed recently, because the test can rule out brain abnormalities such as bleeding. MRI and MRA may be done for a more detailed evaluation. X-rays and other tests can rule other types of headache, such as a sinus headache.

One of the most important tools in the diagnosis and treatment of migraines is the headache diary. A headache diary records the date and time of your headache, where you had the headache, potential triggers, and the intensity of the headache. Resources for links to headache diary samples.

Half of migraine sufferers are not diagnosed and do not receive treatment for their migraines. You should seek help if you think you may be suffering from migraines. For information on how you can find a headache specialist.

How are migraines treated?

Migraines cannot be cured, but the symptoms can be controlled and future attacks can be prevented with medication and by avoiding the triggers that cause a migraine. A healthy diet, exercise, and regular sleep hours can also help to reduce the incidence of migraines.

Your doctor may recommend or prescribe medication to treat the pain and other symptoms associated with migraines. Mild migraines can respond to aspirin or nonsteroidal anti-inflammatory drugs (NSAIDs) like Advil, Motrin, and Aleve. Moderate migraines may be treated with a nonprescription combination of aspirin, acetaminophen, and caffeine. If you have migraines that do not respond to nonprescription drugs or that are severe and frequent (more than 2 days a week), your doctor may prescribe medications that reduce or prevent migraines, such as beta-blockers, anticonvulsants, calcium channel blockers, and antidepressants. Other types of drugs can stop an attack once it starts, such as triptans (Imitrex, Axert, Maxalt). Triptans are not recommended for women at high risk for heart disease and blocked-vessel stroke because they can cause blood vessels to narrow.

How can I prevent a stroke if I have migraines?

Frequent migraines with aura for long periods of time increase a woman’s risk of stroke. However, it is not clear if taking medication to reduce the number of migraines also reduces the risk of blocked-vessel stroke and heart attack. Because of their increased stroke risk, women who have migraines need to manage their other risk factors for stroke and heart disease, including high blood pressure, high cholesterol, birth control pills, and smoking.

Talk to your doctor about steps you can take to control your blood pressure and cholesterol. If you smoke, you should seriously consider quitting. If birth control pills are making your migraines worse, discuss with your doctor the possibility of switching to a birth control pill with lower amounts of hormones or to another method of birth control.

A healthy diet with regular exercise and sleep will help not only your migraines but your quality of life overall.

More Information

National Headache Foundation:

Women and Migraine Learning Module  – www.headaches.org/educational_modules/medtronic
Headache Diary – www.headaches.org/educational_modules/migraine_module/diary.htm

American Headache Society

Migraine in Women – www.achenet.org/education/patients/MigraineinWomen.asp
Headache Triggers Worksheet – www.achenet.org/assets/Identifying_Headache_Triggers_Worksheet.pdf
Finding A Headache Health Care Professional – www.achenet.org/resources/physician/index.asp

National Institute for Neurological Disorders and Stroke – www.ninds.nih.gov/disorders/headache/detail_headache.htm#85743138

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