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Migraine Headaches Can Mimic a Stroke
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Richard C Senelick, MD posted:
Ellen's migraine headaches started shortly after her 16th birthday and they really hadn't slowed down now that she was 35 years old. But, one Saturday morning was different. She first noted numbness and tingling in her right hand that slowly spread up her arm and then to the corner of her mouth. After about 10 minutes she became alarmed and called her sister from her cell phone, but she had trouble speaking--her speech was slurred. Ellen was sure she was having a stroke. After 30 minutes the numbness and speech disturbance started to clear and she noticed the beginning of her typical migraine headache. Ellen was experiencing a "complicated" migraine- not a stroke.

Migraine headaches are common, affecting over 50 million people in the United States and one billion people worldwide. When migraine presents in its usual manner with a headache ranging from annoying to disabling, it can be easy to recognize and diagnose. However, there are times when migraine can be associated with "stroke-like" symptoms and it can cause significant anxiety and concern. We call these types of headaches, complicated migraines.

Approximately 15-20% of migraine headaches are preceded by an "aura" that precedes the headache and may mimic stroke symptoms. Typical auras develop over 5-20 minutes and last less than an hour. The majority of the time they are followed by a headache, but they can also occur without a headache.

? Ophthalmic aura — These may be the typical aura of sparkling, shimmering lights that precede the headache, blurred vision or the loss of vision in one half of the person's visual field.

? Hemiparetic aura- Like Ellen, one half of the body may become numb or weak. On rare occasions there may be temporary paralysis.

? Aphasic aura- The person may have slurred speech or true aphasia with the inability to speak that precedes the headache and then clears as the headache increases in intensity.

When an aura is atypical or prolonged, it can be difficult to distinguish from an actual stroke. Either way the symptoms are alarming the first time they occur and it is important to see a physician familiar with the evaluation and treatment of migraine headaches. I have had physicians experiencing complicated migraine for the first time race into my office to be reassured that they are not having a stroke.

It is not clear how migraine causes these symptoms, but the current theory is that the blood vessels in the brain narrow by going into spasm and decrease the blood flow to the brain. On rare occasions, if this lasts long enough, there have been reports of stroke. The association of migraine and stroke is a bit difficult to sort out. Women with migraine and an aura are at a slightly increased risk of having a stroke. The risk of stroke is only 19/100,000 persons but increases significantly in women with migraine who smoke or take birth control pills after the age of 35. Women over the age of 35years with migraine headaches should avoid birth control pills, control their blood pressure and stop smoking. As always, controlling risk factors is critical in preventing a stroke.

Complicated migraine can be frightening, but it is NOT a stroke and it is only the rare patient that has any lasting effects. If they occur frequently, there are medicines that the person can take to prevent these episodes. If you have had a stroke, there are also certain migraine medicines, like triptans, that you should not take.

As always, check with you own physician.
After your stroke you may be experiencing a new normal, but remember what George Eliot said- It is never too late to be what you might have been.  You still can achieve new goals.
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Richard C. Senelick M.D. is a physician specializing in both neurology and the subspecialty of neurorehabilitation. He did his undergraduate and medic...More

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