The pain of each can be blinding and debilitating, so how do you know if the ache in your skull is a migraine or a more sinister stroke?

“First, if you think there is even a small chance that you’re having a stroke, call 911 for emergency help. As we say, time is brain!” said Karan Tarasaria, MD, a vascular neurologist with the Hartford HealthCare Ayer Neuroscience Institute.

> Connect with the Hartford HealthCare Headache Center

Shared symptoms

There are definite similarities between severe migraine and stroke, he explained. Migraine is a condition that causes recurrent attacks of head pain and symptoms such as nausea, vomiting, and sensitivity to light, sound, smell or touch. It can also cause an aura, which is when distinguishing it from stroke can get challenging.

Aura embodies symptoms that precede the migraine, such as:

  • Visual disturbances like flashes of light or colors
  • Numbness in the face, arms or legs

“These can often be confused with a stroke. Sometimes, patients can have the migraine aura without head pain, which is similar to the symptoms of a stroke or TIA,” Dr. Tarasaria explained, referring to a transient ischemic attack.

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Positive and negative

One way to tell the difference between migraine and stroke is how symptoms present.

“Stroke and TIA typically present with what we call ‘negative’ symptoms, as the patient loses functions like vision, strength or sensation in the face, arms and legs,” Dr. Tarasaria said. “Migraine has ‘positive’ symptoms, adding flashes in vision and tingling sensations in the skin.”

In addition, with stroke, symptoms come on suddenly, whereas migraine evolves more gradually.

Seek immediate help

Because most people with migraines tend to experience similar symptoms each time, if something seems different, it could be a sign of something worse, he said. At that point, further evaluation is needed, he added.

In general, he said, anyone over 50 who has never had a migraine should be evaluated if they have:

  • New, severe headache
  • Trouble with vision, speech, sensation, strength or balance

Increased susceptibility

Unfortunately, people who have migraines, especially those with aura, are more susceptible to stroke, Dr. Tarasaria said. The risk is higher in women who use birth control pills or smoke.

“Migraine without aura doesn’t seem to affect the risk of stroke, but may increase the risk of other cardiovascular conditions such as heart attack,” he said.