When an ischemic stroke occurs along with a migraine headache, it is known as a migrainous stroke or migrainous infarction. Ischemic strokes occur when blood vessels to the brain are blocked, restricting blood flow.
Migraine headaches usually affect only one side of the head and often occur with nausea, vomiting and extreme sensitivity to light or sound. In some patients, the pain may switch sides each time a migraine occurs.
In migrainous strokes, the migraine must occur with aura. Aura is a set of symptoms preceding the migraine, such as flashes of light or tingling in the face or hands. Migrainous strokes are rare and account for only 0.8 percent of all strokes.
For a stroke to be classified as a migrainous stroke, the episode must occur along with a migraine with aura. Most ischemic strokes occur suddenly, and time is vital. If you notice one or more of these signs in another person or in yourself, do not wait to seek help. Call 9-1-1 immediately.
Symptoms of a migraine with aura include:
- Flashes of light
- Blind spots
- Tingling in the hands or face
- Difficulty concentrating
- Neck stiffness
- Sensitivity to light or sound
- Blurred vision
Stroke symptoms include:
- Sudden numbness or weakness of the face, arm or leg, especially on one side of the body
- Sudden confusion
- Sudden trouble speaking
- Sudden trouble seeing in one or both eyes
- Sudden trouble walking
- Sudden dizziness, loss of balance or coordination
- Sudden, severe headache with no known cause
Causes and Risk Factors
Migrainous strokes are rare and the connection between migraine and stroke is not yet fully understood. However, research has shown an increased risk of stroke in patients with a history of migraines with aura.
Women aged 45 and younger appear to be at a greater risk of migrainous strokes. Some possible reasons for this are hormonal changes and increased risk of blood clots due to hormonal birth control.
Patients who have a history of migraines with aura, or who have an increased risk of ischemic stroke, can lower their risk of through lifestyle changes such as:
- Regular exercise
- Controlling high blood pressure
- Managing diabetes
- Quitting smoking
- Lowering high cholesterol
Diagnosis of migrainous stroke usually begins with a physical exam and a detailed review of the event's symptom history.
Imaging tests, such as magnetic resonance imaging (MRI) and computed tomography (CT) angiography, are used to diagnose stroke and observe the affected area.
These imaging tests look at the soft tissue and blood vessels within the body and can determine if the area of the brain affected by the migraine is the same area affected by the stroke. If the same area of the brain is being affected by both events, then the physician may suspect a migrainous stroke.
For most patients who have experienced a migrainous stroke, the treatment is the same as what they would experience for an ischemic stroke without accompanying migraine with aura.
People who have symptoms of a stroke need to seek emergency medical care. Prompt medical attention may prevent life-threatening complications, more widespread brain damage, and is critical for recovery.
If emergency treatment is sought for ischemic stroke within the first three hours after symptoms begin, the patient may receive a medication to dissolve the clot, known as tissue plasminogen (tPA), which can increase the chances of a full recovery.
Medication may be given to treat brain swelling or pressure that can occur after a stroke. Many effects of a stroke require oxygen or an intravenous line to provide the patient with fluids and nourishment.
Removing blood vessel blockages after a small stroke or transient ischemic attack (TIA) may reduce the risk of future strokes. In this case, carotid artery stenting, or treating aneurysms or arteriovenous malformations, may be recommended. Additional treatments of acute ischemic strokes vary according to the underlying cause.
The goals of treatment are to prevent life-threatening complications that may occur soon after stroke symptoms develop, prevent future strokes, reduce disability, prevent long-term complications and help the patient get back as much normal functioning as possible through rehabilitation.
Cedars-Sinai has a range of comprehensive treatment options.