Aura Usually Triggers Visual Disturbances
About one in four people with migraine experience aura, which usually starts 15 minutes to an hour before a migraine headache begins. Aura is most often visual, says Salman Azhar, M.D., a neurologist at Lenox Hill Hospital in New York City. You might see zigzag lines or funny sorts of patterns, or not be able to see clearly, like seeing through a haze, he explains. But aura also can cause tingling or numbness, often spreading up one arm to one side of your face and, less commonly, speech and movement problems, he adds.
The Connection Between Migraine And Stroke
There is currently no clear connection between migraine and stroke.
A 2020 review suggests that migraine increases the risk of diseases that affect the brain and blood vessels, such as stroke.
Brain imaging has also shown a higher occurrence of brain lesions in people with migraine. People with migraine may also have more risk factors related to blood vessels.
The review also suggests that the risk of stroke is higher in people with migraine who do not have any traditional risk factors for stroke.
Stroke symptoms come on very suddenly, while migraine with aura usually develops more slowly.
Although symptoms can overlap, migraine symptoms usually add sensations, while stroke takes them away.
For example, migraine with aura symptoms can include tingling or seeing bright lights or shapes in line of vision. Stroke symptoms include weakness on one side of the body, difficulty speaking clearly, or droopy face.
Hemiplegic migraine is a rare type of migraine that can also cause weakness on one side of the body.
If people experience any new symptoms with migraine, they should seek immediate medical attention in case it is a stroke.
Benefits From A Healthy Lifestyle
People who have migraine with Aura should get regular evaluations, Tietjen said. She also recommends preventive strategies to try to stop headaches before they happen. Try to prevent the headaches, Tietjen said. I think thats the best thing you can do, so I would definitely recommend using preventive medication, cognitive behavioral therapy, and lifestyle changes. Studies are needed however to determine whether preventive treatment that reduces the frequency of migraine actually reduces the risk of stroke.
People with aura should also control hypertension and hyperlipidemia, Tietjen said. Avoiding smoking and maintaining a healthy weight can also reduce risk, since obesity can increase the chances of a stroke. And since younger women might face a higher risk for migraine-related stroke, Tietjen advises women with aura avoid using contraceptives with ethinylestradiol, or estrogen supplements. Those ingredients can increase formation of small blood clots, which can increase the risk of stroke in women with migraine with aura, Tietjen said.
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Study Suggests 5 Stroke Risk Factors For Those With Migraine Aura
The research revealed 5 risk factors for stroke for patients with migraine with aura.
A simple risk score prediction model has been developed to determine stroke risk in adults who experience migraine with aura, according to preliminary research.
The research was presented at the American Associations International Stroke Conference 2020 this past week in Los Angeles, California. Researchers used data from the Atherosclerosis Risk in Communities Cohort , a community-based group of people from 4 localities, including Forsyth County, North Carolina Jackson, Mississippi Washington County, Maryland and suburbs of Minneapolis, Minnesota. The group of individuals had been followed and monitored since 1987.
“People who have migraine with aura are at increased risk for an ischemic stroke,” Souvik Sen, MD, MPH, study co-author, and professor and chair of the neurology department at the University of South Carolina School of Medicine, said in a statement. “With our new risk-prediction tool, we could start identifying those at higher risk, treat their risk factors and lower their risk of stroke.”
In total, 429 adults with a history of migraine with aura and in their 50s at first visit were evaluated. The researchers analysis revealed 5 risk factors for stroke and they created a prediction model with each factor assigned a number of points proportional to its influence.
These points included:
Reference
Migraines With Aura May Raise Stroke Risk
Study Shows Increased Risk of Heart Disease and Stroke for Migraines With Aura
Aug. 24, 2010 — Evidence is accumulating that migraines with aura — a transient visual or sensory disturbance, such as light flashes or zigzag patterns– may increase the risk of heart disease and stroke.
Researchers have also found that migraine with aura seems to boost the risk of earlier death from any cause, including cardiovascular disease, compared to those who donât have the condition, and that women with migraine with aura may be at increased risk for an additional type of stroke called hemorrhagic stroke.
The two new studies, both published in BMJ, add to the evidence of a suspected migraine-disease link. But both research teams say the findings should not alarm those who suffer migraine with aura because the risk is still low.
”We don’t want to scare people at all,” researcher Tobias Kurth, MD, ScD, director of research at INSERM at the Hospital del la Pitie Salpetriere in Paris, tells WebMD. The vast majority of migraine sufferers, he says, will not get a stroke because of their migraines.
More than 29 million Americans suffer from migraines, according to the National Headache Foundation. About 20% of middle-age women have migraines, the researchers say, and up to a third have the aura.
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Study Design And Population
The study design was a prospective twin study, and the study population consisted of twins from two cohorts within the Swedish Twin Registry . In the Screening Across the Lifespan Twin study , all twins in the Swedish Twin Registry born 1958 or earlier were contacted for telephone interviews and they answered questions regarding demographics, lifestyle factors and medical history. In the SALT headache study , a subset of participants born between 1935 to 1958 answered questions on recurrent headaches enabling a diagnosis of primary headaches according to ICHD criteria. Data were collected between 1998 and 2002. In the Swedish Twin Study of Adults: Genes and Environment study , similar data were collected for twins born between 1959 and 1985 using a web-based questionnaire during 2005 and 2006. The data collection in SALT and STAGE is described in detail elsewhere . Individuals were excluded from the study population if information on date of study entry was missing , or a diagnosis of stroke prior to the start of follow-up was found in the national patient register . In total, 53 404 individuals were included in the final cohort . Of these, 30.2% of the twin pairs were monozygotic, 33.5% were same-sexed dizygotic, and 34.4% opposite sexed. In 1.9% of the twin pairs, zygosity was unknown. There were 38 908 twins complete twin pairs. The study was approved by the regional ethics board, Stockholm, Sweden.
Description of study population .
When Migraine Mimics Stroke
The symptoms of some types of migraine can mimic stroke, such as hemiplegic migraine where there is weakness down one side.
Migraine auras can be confused with transient ischaemic attack , 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.
Like a stroke, a migraine can be sudden and can lead to mild confusion. However, migraine aura symptoms tend to develop relatively slowly and then spread and intensify, while the symptoms of a TIA or stroke are sudden.
Migraine can sometimes be mistaken for a stroke caused by bleeding on the brain, called a subarachnoid haemorrhage , which is often characterised by a sudden, very severe headache. Unlike SAH, migraine headache is usually 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 a SAH. Patients with a SAH also develop neck stiffness, which is uncommon during a migraine attack.
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Which Migraine Types Can Resemble Stroke
Migraine with aura is the type of migraine most commonly mistaken for stroke. The aura in migraine with aura is a set of visual, sensory, or other nervous system symptoms that usually last between a few minutes and an hour, and usually precede the headache phase of an attack. Its possible to have aura symptoms with no headache.
About 25 percent of people with migraine experience auras, according to the Migraine Research Foundation.
The most common aura symptoms are visual effects such as bright flashing lights or spots or zigzags in a persons field of vision. Other possible aura symptoms include losing sight for short periods having tingling and numbness in the face, hands, or other areas of the body hearing sounds such as buzzing or music and having speech and language problems such as being unable to say words, slurring, or mumbling, according to the American Migraine Foundation. Any of those could easily be assumed to be signs of a stroke.
Another migraine type that can cause stroke-like symptoms is a very rare inherited condition called familial hemiplegic migraine, or sporadic hemiplegic migraine if it occurs in only one person in a family. Symptoms of a hemiplegic migraine attack are the same as migraine with aura but also include motor, or muscle, weakness on one side of the body that may persist for days or even weeks. Rarely, hemiplegic migraine can cause fever, confusion, loss of consciousness, or even profound coma.
How Can I Lower My Stroke Risk
Given that migraine with aura is a vascular risk factor, the best thing people with migraine can do is be extra-engaged in reducing the risk factors for stroke that everyone should pay attention to, says Liberman.
According to the CDC, the leading causes of stroke are high blood pressure, high cholesterol, smoking, obesity, and diabetes.
You can lower your risk of stroke by following a healthy diet, maintaining a healthy weight, being physically active, quitting smoking if you smoke, and avoiding drinking too much alcohol if you drink. Working with your doctor to control any medical conditions you may have such as high blood pressure, high cholesterol, obesity, diabetes, or heart disease will also help to lower your risk of stroke. And your doctor can help you quit smoking.
Women of childbearing age who have migraine will want to discuss their stroke risk with their doctor when choosing a method of contraception. While older formulations of birth control pills, with higher amounts of estrogen, were known to raise stroke risk particularly among women who smoke the use of low-dose hormonal contraceptives in otherwise healthy women with migraine does not appear to pose additional risk, according to a review in Current Headache and Pain Reports.
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How Can You Tell The Difference
It can be hard to tell the difference between a migraine with aura and a TIA. Here’s what to look for:
- With a stroke, symptoms usually come on suddenly. With a migraine, they happen gradually the headache usually starts small and gets more painful.
- A stroke is more likely to have what are called “negative” symptoms such as you might lose sight in one eye or lose feeling in one of your hands or feet. A migraine is more likely to have “positive” symptoms. That means added sensations, like flashes in your vision or tingling in your skin.
- If you’re young, it’s more likely to be a migraine. If you’re older, it’s more likely to be a stroke, especially if you’ve never had a migraine before or you have high blood pressure or an irregular heartbeat.
What Migraine Sufferers Need To Know About Stroke Risk
Please note: This article was published more than two years ago, so some information may be outdated. If you have questions about your health, always contact a health care professional.
Try not to let it give you a headache, but be aware: People who suffer migraines, especially women, seem to have a higher risk of stroke.
“It’s not like people with migraines should be waiting anxiously about the possibility of having a stroke, but it does occur,” said Dr. Mitchell Elkind, a New York City neurologist and professor at the Columbia University College of Physicians and Surgeons.
“More work needs to be done, but I think it’s accepted among physicians that among women, migraine with aura is associated with a doubling of risk.”
First, some perspective: According to the federal Office on Women’s Health, about 30 million Americans suffer from migraines, the recurring, throbbing headaches that can be debilitating and accompanied by nausea and weakness.
A particularly alarming variation of the disorder is known as migraine with aura. That’s when the headache is accompanied by sensory disturbances ranging from seeing flashes of light and zigzag lines to tingling sensations and difficulty speaking.
Three-fourths of migraine sufferers are women. Of the roughly 800,000 strokes suffered each year in the United States, the American Migraine Foundation estimates just 2,000-3,000 of them are linked to migraines.
But the link is there, and it likely runs through the arteries.
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Migraines And Stroke Risk: The New Studies
In one study, researchers looked at nearly 19,000 men and women born between 1907 and 1935 who were enrolled in the Reykjavik Study, set up to study heart disease.
The researchers followed the men and women for 26 years, looking at death from all causes, including heart disease. They had information on which men and women had migraines, with or without aura, and also non-migraine headaches.
They found those with migraine with aura were about 21% more likely to die during the follow-up than those without the condition, and 27% more likely to die from cardiovascular disease compared to those with no headache.
Women with migraine with aura were 19% more likely to die from non-cardiovascular disease than those without.
The absolute risk, however, is low, says researcher Larus Gudmundsson, a doctoral student at the University of Iceland, Reykjavik. “‘In people with migraine with aura, compared to those without headache, the excess absolute 10-year risk of cardiovascular disease mortality at age 50 was low: 1.1% for men and 0.1% for women.
“From that we can calculate that due to migraine with aura, 11 extra men per 10,000 persons per year will die from cardiovascular disease and one extra woman per 10,000 persons per year.”
In Kurth’s study, he looked at the nearly 28,000 women participating in the U.S.-based Women’s Health Study, set up to look at the benefits and risks of low-dose aspirin and vitamin E in preventing cardiovascular disease and cancer among healthy women.
Clinical Presentation Of Mwva
The visual aura of migraine is a binocular phenomenon corresponding to cortical spreading depression, with the exception of retinal migraine which by definition is monocular, albeit quite rare. Due to the unilateral nature of visual aura, many patients perceive migraine aura as monocular when it is indeed binocular. Therefore, it is useful for providers to suggest that patients alternate covering one eye during an aura attack, to clarify if the visual disturbance is monocular or binocular.
MwvA
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Migraine And Oral Contraceptives
Migraine is particularly prevalent in the fertile period when women opt for oral contraception. While the risks of venous thromboembolism in users of oral contraceptives are well established, the risks of cardiovascular arterial diseases are more uncertain. The safety of oral contraceptives in women with migraine remains controversial. Numerous studies report increased risk of ischaemic stroke in women with migraine who use oral contraceptive. Stronger associations are found for MA and in those with additional vascular risk factors. Particularly smoking combined with the use of oral contraceptives in young women with MA increase risk of ischaemic stroke. The risk of stroke in women taking oral contraceptives seems to correlate with the dose of oestrogen contained in the formulation. Caution should be warranted when interpreting the data on the risk of stroke in women with migraine using oral contraceptives as migraine is often not diagnosed according to ICHD criteria, many studies do not distinguish between MA and MO, and the dose classification of oral contraceptives is often heterogeneous. Studies evaluating the effect of oral contraceptive use on the risk of haemorrhagic stroke is conflicting, and no firm conclusions can be made.
Clinical implication
What Is A Migraine
Migraine is a disease that causes recurrent attacks of head pain together with other symptoms such as a bad headache that often comes with nausea, vomiting, and sensitivity to light, sound, smell, or touch. The pain may throb or pulse, and you usually feel it on one side of your head around your eye or temple.
A migraine with aura is the kind that can be confused with a stroke. An aura affects your senses and usually happens before the headache. You may see light flashes, zig-zagged lines, or blind spots, or you might feel tingling or numbness in your arms, legs, or face. You might have ringing in your ears or trouble speaking. Sometimes, you’ll have those symptoms but never get a headache. That tends to happen more often as you get older.
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Migraine With Aura May Raise Stroke Risk
The risk of stroke could be increased by more than a quarter for people who experience migraine with aura. So concludes a twin study recently published in the journal Brain.
According to the Migraine Research Foundation, around 39 million children and adults in the United States are affected by migraine, a disorder characterized by the recurrence of moderate or severe throbbing pain on one or both sides of the head.
Around 25 percent of people with migraine experience aura, which is a set of neurological symptoms that accompany headache.
Neurological symptoms include visual disturbances, such as colored spots or temporary blindness, dizziness, numbness or tingling on one side of the body, and speech difficulties.
A number of studies have indicated that people with migraine particularly people who experience migraine with aura are at greater risk of stroke.
For the new research, co-author Dr. Maria Lantz of the Department of Clinical Neuroscience at Karolinska Institutet in Sweden and colleagues investigated whether familial factors might play a role in the possible link between migraine and stroke, as few studies have controlled for this factor.