A migraine expert has explained how to tell whether a headache could actually be a stroke, and which sign should prompt an immediate call to 999. Migraine is a long-term neurological condition typically characterised by throbbing head pain of moderate-to-severe intensity, with attacks generally lasting between four and 72 hours and proving highly debilitating.
Alongside head pain, migraines are frequently accompanied by nausea, vomiting, dizziness, and heightened sensitivity to light, sound and smells. Around 10 million people in the UK live with migraine, which means it affects one in seven people. The Migraine Trust estimates that over one million suffer from chronic migraine, meaning they experience symptoms on at least 15 days per month. Symptoms include headaches, dizziness and nausea, with up to one in three sufferers experiencing a "migraine aura" - a collection of temporary symptoms, most commonly visual disturbances such as flashing lights, shimmering spots or zigzag lines, which occur before or during an attack.
Migraine or stroke: what is the key difference?
Neurologist and headache specialist Dr Nada Hindiyeh, Chief Medical Officer of Haven Headache & Migraine Center, has explained how to distinguish between the two conditions. Vision disturbances, tingling or numbness, and difficulty speaking can all arise during a migraine aura, while true weakness may feature in the less common hemiplegic migraine subtype. These same symptoms, however, can also be warning signs of a stroke.
According to Dr Hindiyeh, one of the most crucial distinctions lies in the speed at which those symptoms appear. She said: "Migraine aura usually builds gradually over at least 5 minutes, with each individual symptom typically lasting 5 to 60 minutes." Symptoms may develop in sequence and move from one part of the body to another. For instance, you might initially notice a small blind spot, followed by a tingling sensation in your hand and then a struggle to find the right words.
The doctor advised: "Stroke symptoms are more likely to begin suddenly and reach their maximum severity almost immediately." Migraine aura frequently produces 'positive' symptoms, such as flashing or zigzagging lights, or a tingling sensation that slowly travels up the arm. A stroke, on the other hand, more commonly results in a sudden loss of function, such as loss of vision, sensation, strength, or the ability to speak.
That said, these patterns can sometimes overlap, and a headache may be present or absent in either condition. Any new weakness, a first-ever aura, symptoms that differ from a person's usual aura, or symptoms that fail to fully subside should always be assessed as a matter of urgency.
Stroke symptoms to watch for
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 provide a crucial indicator, although stroke doesn't always trigger 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." She added: "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."
