Migraine is a long-term neurological condition that typically involves throbbing head pain of moderate-to-severe intensity, with attacks usually lasting between four and 72 hours, which can be highly disabling. In addition to head pain, migraines are often accompanied by nausea, vomiting, dizziness, and sensitivity to light, sound and smells.
Approximately 10 million people live with migraine in the UK - that is one in seven people. The Migraine Trust estimates that over one million live with chronic migraine, meaning they experience symptoms for at least 15 days a month. Symptoms include headaches, dizziness and nausea, but up to one in three people with the condition can suffer a "migraine aura" - a set of temporary symptoms, usually visual disturbances such as flashing lights, shimmering spots or zigzag lines, that happen before or during an attack.
Migraine or stroke: how to tell the difference
Vision changes, tingling or numbness, and trouble speaking can occur during migraine aura, while true weakness can occur in the less common hemiplegic migraine subtype. These symptoms can also signal a stroke. According to Dr Nada Hindiyeh, a neurologist and headache specialist who is Chief Medical Officer of Haven Headache & Migraine Center, one of the most important differences is how quickly those symptoms develop.
Dr Hindiyeh says: "Migraine aura usually builds gradually over at least 5 minutes, with each individual symptom typically lasting 5 to 60 minutes." Symptoms may occur in succession and spread from one area to another - for example, you might first notice a small blind spot, followed by tingling in your hand and then difficulty finding words.
The doctor advises: "Stroke symptoms are more likely to begin suddenly and reach their maximum severity almost immediately." Migraine aura often causes 'positive' symptoms, such as flashing or zigzagging lights or tingling that gradually travels up an arm. Stroke more often causes a sudden loss of function, such as loss of vision, sensation, strength, or the ability to speak. However, these patterns can overlap, and headache may be present or absent in either condition.
Stroke symptoms to watch for
New weakness, a first-ever aura, symptoms that are different from a person's usual aura, or symptoms that do not fully resolve should always be evaluated urgently. Dr Hindiyeh also recommends remembering the BE FAST warning signs of stroke. She explains: "Balance problems, Eyes (sudden vision loss or double vision), Face drooping, Arm weakness, Speech difficulty, and Time to call 911.
"The key word is sudden. If any of these symptoms appear unexpectedly, it's important to seek emergency care immediately because stroke treatments are most effective when they're given as early as possible."
A headache can also offer an important clue, although stroke does not always cause one. The doctor advises: "If you have a new, sudden or severe headache that's unlike anything you've experienced before, or a headache that's accompanied by sudden weakness, numbness, trouble speaking, confusion, difficulty walking, or vision loss, don't assume it's a migraine attack.
"I'd much rather see someone come to the emergency room for a migraine than have someone stay home during a stroke. When it comes to stroke, every minute matters because early treatment can save brain tissue and improve recovery."
