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Is There A Link Between Migraine With Aura and Stroke?

What is Migraine with Aura?

Anyone who suffers from regular migraine headaches knows how terrible and debilitating the pain can be. A migraine aura or a migraine with aura refers to a collection of symptoms that develop just before or during a migraine attack.(1, 2, 3, 4) Migraine auras can cause disturbances in your sensations, speech, or vision. According to estimates by the American Migraine Foundation, 25 to 30 percent of people with migraine experience the phenomenon of aura.(5, 6) Since an aura often starts before a migraine attack begins, it serves as a warning sign to let the individual know that a migraine attack is on the way.

A migraine aura typically starts just an hour before the actual migraine pain begins and can last for less than 60 minutes. However, it is essential to note that not all migraine attacks are accompanied by an aura. A migraine aura is not to be confused with a prodrome. The prodrome stage can begin several days before the actual attack to indicate that a migraine is coming on. On the other hand, an aura tends to occur just before or sometimes even during a migraine attack. The prodrome stage symptoms may also include irritability, neck pain or fatigue.(7, 8, 9)

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A migraine with aura is sometimes also known as an ocular migraine.

Migraine with aura typically impacts both the eyes, and the visual distortions may give you the feeling of looking through a kaleidoscope. Some of the other symptoms of migraine with aura can include:(10, 11)

  • Change in speech
  • Seeing shimmery or sparkling spots in your field of vision
  • Seeing zig-zag lines, colorful tars, or other patterns
  • Developing blind spots in your vision
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Many times, bright or flashing lights can also act as a trigger for migraine with aura. In people with aura, a migraine attack tends to begin with just a small spot that expands slowly. It may disappear when you try to focus on the spot, but you may continue to see it when you close your eyes. These spots can definitely be disturbing, but they are usually not harmful and mostly temporary. The attack can last for anywhere between 20 to 30 minutes, after which your vision will return back to normal.

Some people may experience an aura as a warning sign that a migraine headache is coming on, and the other symptoms soon follow. Others experience aura and headache pain at the same time. In some cases, a migraine attack can also occur by itself, with no pain. This is known as silent migraine or acephalgic migraine.(12, 13, 14)

Is There A Link Between Migraine With Aura And Stroke?

As mentioned above, migraine with aura typically involves visual disturbances that may occur with or without the migraine pain. Many times, the unusual moving patterns that come up in your field of vision can be startling, especially when you are unsure of what’s happening and why. However, it is important to realize that migraine with aura is not a stroke, and generally, neither is it a sign that you are about to have a stroke. It has been observed that individuals who have a history of migraine with aura are at a greater risk of having a stroke. This is why it is important to know the signs and symptoms of both migraines with aura and a stroke. While a stroke and migraine can occur together, it is pretty rare for this to happen.(15, 16)

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A study published in 2016 carried out a comparison between people with migraine and people without migraine. The average age of participants in the study was 59. The results of the study found that there was a significant link between migraine with visual aura and ischemic stroke over a period of 20 years. No association was found for stroke in people with migraine without visual aura.(17)

Other studies have also found associations between stroke and migraine, especially when it comes to migraine with aura increasing the risk of stroke. A study from 2019 focused on young female patients with no other risk factors other than migraine with aura. The study found that migraine with aura nearly doubled the risk of having a stroke.(18)

While the reason behind this increased risk of stroke in people with migraine with aura is not completely understood, but it is believed that both stroke and migraine lead to changes in the blood vessels of the body. People who have migraine with aura have been found to have a greater likelihood of developing blood clots from narrowed blood vessels, thus increasing the risk of having a stroke.(19, 20)

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What is a Migrainous Infarction?

In the rare case where the ischemic stroke occurs together with migraine with aura, it is known as a migrainous infarction or migrainous stroke. This is caused by the restricted flow of blood to the brain. It is estimated that only 0.8 percent of all strokes are migrainous strokes, making it a rare occurrence.(21) The risk of migrainous infarction is higher in women who are 45 years of age or younger. This is believed to be because of hormonal changes and the use of hormonal contraceptives, which increases the risk of the formation of blood clots.

Is It Possible To Differentiate Between A Stroke And Migraine?

At times, the symptoms of a stroke and migraine attack can be quite similar. However, it is possible to differentiate between the two if you take note of certain key differences. Here are the essential facts you need to know about the symptoms of each.(22, 23, 24)

  • Migraine with Aura: In migraine with aura, the symptoms tend to develop slowly and gradually worsen over time. The biggest identifier of migraine with aura is that there is usually something in your field of vision that is physically not present. Migraine with aura also involves both the eyes.
  • Stroke: The symptoms of a stroke appear suddenly, and you are unlikely to notice anything floating around in your field of vision. However, you may experience loss of vision or tunnel vision. A stroke usually only involves one eye.

Some of the other commonly observed symptoms of migraine with aura include:

Other potential symptoms of a stroke may include:

  • Severe headache, accompanied by dizziness in some cases
  • Weakness on just one side of the body
  • Hearing loss
  • State of confusion
  • Trouble understanding
  • Trouble speaking
  • Loss of balance
  • Loss of motor control

There are a few things that sometimes make it more challenging to identify the difference between a stroke and migraine without visiting a doctor. These may include:

  1. Hemiplegic Migraine: This type of migraine causes numbness, weakness, and tingling sensation on just one side of the body. Similar to migraine with aura, these symptoms also tend to set in before a headache.(25)
  2. Transient Ischemic Attack (TIA): Also referred to as a ministroke, a transient ischemic attack takes place when there is a temporary lack of blood flow to a part of the brain. The symptoms of this type of stroke appear suddenly and also pass quickly, sometimes even within minutes.(26)
  3. Subarachnoid Hemorrhage: A subarachnoid hemorrhage occurs when there is bleeding between the brain and the tissues covering the brain. This can lead to a sudden and severe headache.(27)

While migraine with aura does not require immediate medical attention, a stroke can be fatal if immediate medical attention is not given. Remember that every second counts when you have a stroke, and you should seek immediate medical assistance if you experience any of the warning signs of stroke, including:

  • Sudden and severe headache
  • Sudden loss of control over one side of the body
  • Sudden onset of vision loss in one eye
  • Inability to speak

Is It Possible To Lower The Risk Of Stroke?

Yes, it is possible to lower your risk of stroke if you have migraine with aura. One of the most important things to do is to undergo a proper physical exam every year and consult your neurologist for the correct prevention and treatment of migraine. Some questions you should ask your doctor about include:

  • An assessment of your overall risk factors for stroke.
  • Medications that can lower the frequency of migraine attacks.
  • Any birth control methods that will not increase your risk of developing blood clots.

At the same time, there are several lifestyle changes that you should make to lower the risk of stroke. Some of these include:

  • Quit smoking
  • Maintain a healthy weight
  • Follow a balanced diet that is rich in fruits and vegetables
  • Restrict your salt intake
  • Limit your alcohol consumption to a minimum
  • Exercise regularly

It is also essential to manage and monitor medical conditions that increase the risk of stroke. These include:

Conclusion

Even though migraine with aura and stroke are two totally different conditions, but having a migraine with aura does increase the risk of having a stroke. At the same time, having a migraine attack does not automatically mean that you are having a stroke or that you are about to have one. If you have a migraine with aura, you should talk to your doctor about your risk of stroke and find out the steps you can take to reduce that risk. Some of the lifestyle changes you should incorporate to lower your risk of stroke include quitting smoking, exercising regularly, maintaining a healthy weight, and restricting your salt intake.

References:

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  2. Goadsby, P.J., Lipton, R.B. and Ferrari, M.D., 2002. Migraine—current understanding and treatment. New England journal of medicine, 346(4), pp.257-270.
  3. Lipton, R.B., Diamond, S., Reed, M., Diamond, M.L. and Stewart, W.F., 2001. Migraine diagnosis and treatment: results from the American Migraine Study II. Headache: The Journal of Head and Face Pain, 41(7), pp.638-645.
  4. Steiner, T.J., Stovner, L.J. and Birbeck, G.L., 2013. Migraine: the seventh disabler. cephalalgia, 33(5), pp.289-290.
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  7. Silberstein, S.D. and Young, W.B., 1995, June. Migraine aura and prodrome. In Seminars in neurology (Vol. 15, No. 02, pp. 175-182). © 1995 by Thieme Medical Publishers, Inc..
  8. Luciani, R., Carter, D., Mannix, L.A., Hemphill, M., Diamond, M. and Cady, R., 2000. Prevention of migraine during prodrome with naratriptan. Cephalalgia, 20(2), pp.122-126.
  9. Blau, J.N., 1980. Migraine prodromes separated from the aura: complete migraine. Br Med J, 281(6241), pp.658-660.
  10. Russell, M.B., Iversen, H.K. and Olesen, J., 1994. Improved description of the migraine aura by a diagnostic aura diary. Cephalalgia, 14(2), pp.107-117.
  11. Kline, L.B. and Kelly, C.L., 1980. Ocular migraine in a patient with cluster headaches. Headache: The Journal of Head and Face Pain, 20(5), pp.253-257.
  12. Kunkel, R.S., 1986. Acephalgic migraine. Headache: The Journal of Head and Face Pain, 26(4), pp.198-201.
  13. O’Connor, P.S. and Tredici, T.J., 1981. Acephalgic migraine: fifteen years experience. Ophthalmology, 88(10), pp.999-1003.
  14. Shah, D.R., Dilwali, S. and Friedman, D.I., 2018. Migraine Aura Without Headache [corrected]. Current Pain and Headache Reports, 22(11), pp.77-77.
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  17. Androulakis, X.M., Kodumuri, N., Giamberardino, L.D., Rosamond, W.D., Gottesman, R.F., Yim, E. and Sen, S., 2016. Ischemic stroke subtypes and migraine with visual aura in the ARIC study. Neurology, 87(24), pp.2527-2532.
  18. Yemisci, M. and Eikermann-Haerter, K., 2019. Aura and Stroke: relationship and what we have learnt from preclinical models. The Journal of Headache and Pain, 20(1), pp.1-8.
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