Migraines have not been shown to cause stroke, but if you have migraine with aura, you have a very slightly higher risk of stroke

What is migraine?

A migraine attack can have a wide range of symptoms. For many people, the key symptom is a moderate or severe headache. Typically, this is felt as a throbbing pain which gets worse with movement or physical activity. The pain is usually on one side of the head, but it can be all over the head, often with one side worse than the other. The headache is often accompanied by other symptoms such as nausea or vomiting and sensitivity to light, sound or smells.

Symptoms in adults can last from around four hours to several days. You may also feel very tired before and after an attack.

Migraine attacks tend to start gradually. Many people feel unwell before the onset of the migraine attack, sometimes a few hours or days before the headache itself. Symptoms ahead of a migraine can include changes in mood and energy levels, excessive yawning and aches and pains. These are called prodromal or premonitory symptoms.

Some people have several migraines a week. Others may have years between migraine attacks.

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On this page:
The main types of migraine
What is the link between migraine and stroke?
What causes a migraine?
Migraine diagnosis and treatment
Where to get help and information
Accessible resources

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Who is affected by migraine?

Migraine affects around 12% of men, and up to 33% of women. People of all ages are affected by migraine, but the condition often begins in young adulthood and sometimes improves as you get older.

The main types of migraine

There are three main subtypes of migraine: migraine without aura, migraine with aura and migraine aura without headache.

Symptoms like paralysis, sudden sight loss, difficulty with speech and vertigo (a feeling of the room spinning around you) can be signs of a stroke. If you have any of these symptoms and you have not been diagnosed with migraine, or are unsure if migraine is causing your symptoms, you should call 999.

Migraine without aura

Up to 80% of people with migraine have this type, which is sometimes called common migraine. It consists of a moderate or severe, throbbing headache with other symptoms, such as nausea and sensitivity to light, sound or smell. The other symptoms usually begin at the same time as the headache and disappear once the headache goes. Many people feel irritable and need to rest in a quiet, dark room or sleep.

Migraine with aura

Up to a third of people with migraine have migraine with aura (sometimes called classical migraine).

Some people have both migraine with aura and without aura at different times. Attacks typically begin with an ‘aura’ consisting of one or more of the following symptoms which develop gradually over about five minutes and last up to an hour. The headache can occur with or after the aura.

Types of aura

• Visual changes. This is the most common aura symptom. The changes can include flashing lights, zig-zags, sparks or blank spots. These can appear on one side or centrally and commonly expand and move across your field of vision. Visual changes such as flashing lights can also be signs of acute eye disease, so if you get any of these symptoms and migraine has not been diagnosed as the cause, contact your optician or GP urgently.
• Sensations such as pins and needles, tingling or numbness, weakness or a spinning sensation (vertigo).
• Difficulty speaking.

Migraine aura without headache

Also known as a silent migraine, this is an aura without the headache.

Rare types of migraine

There are some rare types of migraine, which are also classed as migraine with aura.

What is the link between migraine and stroke?

The relationship between migraine and stroke is complex. Stroke and migraine both happen in the brain. Sometimes the symptoms of a migraine can mimic a stroke, and they may share some underlying risk factors.

However, the causes of the symptoms are different. A stroke is due to damage to the blood supply inside the brain, but migraine is thought to be due to problems with brain activity affecting nerves, chemicals and blood vessels in the brain. In a stroke, the blood supply to part of the brain is cut off, killing brain cells. This causes permanent damage to the brain, and can have long-lasting physical, cognitive and emotional effects. A migraine causes pain and sensory disturbances, but these are temporary.

Migrainous infarction

Occasionally migraine and stroke can happen together, but there is no evidence to suggest that one causes the other. Migrainous infarction is the term given to an ischaemic stroke (a stroke due to a clot) that happens during a migraine. This tends to happen alongside prolonged aura symptoms. Migrainous infarction is extremely rare.

Stroke risk and migraine

If you have migraine with aura, you are about twice as likely to have an ischaemic stroke in your lifetime compared to those without migraine. However, the overall risk linked to migraine is still very low, and you are far more likely to have a stroke because of other risk factors like smoking and high blood pressure.

The risk of stroke associated with migraine without aura is uncertain, but is likely even lower than the very small risk of stroke associated with migraine with aura.

If you have migraine, your GP or nurse can give advice on reducing your risk of a stroke from any other health conditions you may have, like high blood pressure, diabetes, atrial fibrillation or high cholesterol. They can also support you with making lifestyle changes such as stopping smoking, losing weight, healthy eating and exercise.

Women and migraine

Taking the combined oral contraceptive pill (combi pill) increases the risk of a stroke in women who have migraine with aura. Because of this, women who have migraine with aura are not usually given the combi pill. If you have migraine without aura, you should be able to take the combi pill, unless you have other risk factors like smoking or being overweight. Your doctor can discuss your contraception options with you.

Other health conditions

Some health conditions are linked to both stroke and migraine. For example, CADASIL (a rare genetic disorder), and auto-immune conditions such as antiphospholipid syndrome and lupus, are linked to a higher risk of stroke, and people with these conditions are also more likely to have migraine.

When migraine mimics stroke

This information is a guide to some of the stroke-like symptoms of migraine, but it is not intended as a way of diagnosing migraine or stroke. You should get individual advice from a medical professional if you have migraine symptoms. If you have any stroke symptoms, you must call 999.

Similarities

• Like a stroke, a migraine can be sudden and can lead to mild confusion.
• Migraine can sometimes be mistaken for a stroke caused by bleeding on the brain, called a subarachnoid haemorrhage (SAH), which is often characterised by a sudden, very severe headache.
• Hemiplegic migraine, where there is weakness down one side, can mimic stroke.
• Migraine auras can be confused with TIA, where someone has stroke symptoms that pass in a short time. For instance, a migraine with only a visual aura but no headache may be mistaken for TIA.

Differences

• Migraine aura symptoms tend to develop relatively slowly and then spread and intensify, while the symptoms of a transient ischaemic attack (TIA) or stroke are sudden.
• Unlike SAH, migraine headache is typically one-sided and throbbing, slow to come on and lasts for a shorter period of time. Vomiting usually starts after a migraine headache starts, but is likely to happen at the same time as headache during an SAH. Patients with an SAH also commonly develop neck stiffness and may have other stroke symptoms.

What causes a migraine?

Migraine often runs in families. If one or more close relatives experience migraine, it is more likely that you will too.

Migraine triggers

Some people report various triggers that might lead to a migraine attack, including:

• Emotional: such as stress, anxiety or depression.
• Physical: tiredness, too much or too little sleep, or tension, particularly in the neck and shoulders.
• Hormonal: some women experience migraine around the time of their period or during the menopause.
• Dietary: missing a meal, drinking alcohol or caffeinated drinks, or eating certain foods.
• Environmental: such as bright or flashing lights or a stuffy atmosphere.
• Medicines: including some sleeping tablets, the combined contraceptive pill and some types of hormone replacement therapy.

Sometimes, it takes more than one trigger to lead to an attack, for example, being under emotional stress and missing a meal.

Migraine diagnosis and treatment

Diagnosing migraine

Migraine is diagnosed by piecing together information about your symptoms and identifying patterns over time. This includes understanding any history of headaches in your family.

Your GP may do some tests checking your vision, reflexes, coordination and sensations. They may ask you to keep a diary of your migraine symptoms and factors leading up to them, such as what you ate and how you slept. This may help you identify and avoid your triggers. You should also record any medicines you are already taking.

Managing migraine

Some people are able to avoid their triggers and reduce how often they have migraines. Many people find that ordinary painkillers such as paracetamol or ibuprofen reduce the pain of their migraine headache. Do not take painkillers every day for a migraine, as over-use can cause headaches. Your pharmacist can give you individual advice on non-prescription medication for migraines, as some may not be suitable if you’ve had a stroke.

Prescription medicines

Your GP or a specialist can prescribe other treatments for nausea. There are also medications taken at the start of an attack to stop it developing, and others that you take regularly to make attacks less frequent or less intense (prophylactic medication).

Triptan medications, such as sumatriptan, are not given to people who have had a stroke or TIA. A newer type of medication called a gepant to treat or prevent frequent migraines is available, especially for those who have tried several other treatments which have not worked. Gepant medications have not been widely used in stroke survivors. If you’ve had a stroke, you may need specialist advice on medication suitable for you.

Botulinum toxin type A treatment (often known as Botox) is available for some cases of chronic migraine. Chronic migraine is when you have 15 days or more of headache a month, with at least eight of them migraines, for at least three months.

The Migraine Trust, listed under 'Other sources of help and information', has more information about managing migraine.

Where to get help and information

Resources available

The information on this page can be accessed in the following formats:

• Download the Migraine and stroke guide (PDF) or large print large print Word document.
• Order a printed copy from our Shop.
• To request a braille copy, email feedback@stroke.org.uk

To view all of our resources, visit our resources area.