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Migraines And Stroke: Is There a Link?

If you suffer from the intense, debilitating pain of migraine headaches, you may have wondered if this acute pain in your head could eventually lead to a stroke. After all, both conditions affect the blood vessels of your brain.

Doctors have long thought that the constriction and dilation of arteries in the head during a migraine could increase a person’s likelihood of having a stroke. Other theories about the connection between migraine and stroke are that chemicals released during a migraine may make blood in your brain more likely to clot, or changes in serotonin levels or neurotransmitter function during a migraine may increase stroke risk. 

Neurointerventionalist Bryan Ludwig, MD, a stroke specialist from Premier Health Neuroscience Institute, says that people who have migraines with auras (flashing lights, distorted vision, hearing sounds, or smelling odors that aren’t actually there) are twice as likely to have a stroke than people who don’t have migraines. For migraines without aura, the risk is smaller.

Headache specialist Richard Kim, MD, says that migraine headaches with an aura can mimic the symptoms of stroke, which can be alarming, but he advises how to tell the difference and when to be concerned.

Click play to watch the video or read video transcript.

“Having migraines with aura definitely increases your risk of having a stroke by double or greater. The numbers of people having migraine that leads to stroke are quite low, however, so there’s no need to panic,” Dr. Ludwig reassures. 

What’s important, he emphasizes, is to pay attention to migraine headaches as a risk factor for stroke and to take action to reduce your risk.

“We know a link exists and there are things we can do about it,” Dr. Ludwig states. 

Stroke risk factors you can work on include:

• Control high blood pressure and high cholesterol, both of which can negatively affect the health of blood vessels bringing blood to and from the brain.
• Control blood sugars if you have diabetes.
• Don’t smoke.
• Avoid certain medications that can affect arteries in the head. These include triptans and ergotamines, widely used for acute migraine treatment, and illegal drugs such as cocaine, heroin, and methamphetamines.
• If you are a woman, carefully evaluate with your doctor the pros and cons of taking estrogen hormonal therapy for birth control or postmenopausal treatment.

Dr. Kim explains that migraine headaches with an aura can increase women’s risk of stroke. To reduce your risk he advises controlling risk factors. 

Click play to watch the video or read video transcript.

Preventing Migraine As a Way Of Reducing Stroke Risk

If you have migraines, it’s beneficial to work on preventing these headaches, both for your own well-being and to guard against stroke in the future. 

Go to your doctor first to make a treatment plan with standard medical therapy, including medications.

Dr. Ludwig also highly recommends complementary therapy to relieve or prevent migraines. He suggests the following as helpful in reducing the number of migraines you have:

• Exercise, which reduces high blood pressure and stress
• Getting adequate sleep
• Stress management
• Avoiding caffeine
• Acupuncture
• Massage

Stroke Risks Unique To Women

Stroke risk increases with age, with nearly 75 percent of strokes occurring in people over age 65. But many younger people are having strokes, too. 

“No one knows for sure, but smoking, fast food, environmental exposures, and pollution all may play a role in strokes occurring at a younger age,” Dr. Ludwig says.

He notes that one of the groups at highest risk for stroke are women under age 45 who smoke, use oral contraceptives, have migraines with aura, and heart defects (such as a small hole in the heart or a valve problem).

Women make up the majority of people who suffer from migraines, according to the National Stroke Association. This is probably due to hormonal changes and fluctuating estrogen levels, Dr. Ludwig says.

Other risk factors for stroke that are more common in women than in men include atrial fibrillation (abnormal heart rhythm), diabetes, high blood pressure, depression, and psychosocial stress.

Stroke risk factors unique to women include pregnancy, preeclampsia, gestational diabetes (diabetes during pregnancy), oral contraceptives, postmenopausal hormone use, and changes in hormonal status.

Dr. Ludwig notes that it’s important for women with migraines to remain in close contact with their physician regarding medical treatment, especially if they are taking common migraine drugs, such as triptans and ergotamines, that may affect arteries in the head.

“The incidence of migraines causing an ischemic stroke is very, very low,” Dr. Ludwig concludes. “Yet, it’s important to educate people and help them understand disease processes, which may give them additional motivation to take care of themselves.”

Source: Bryan Ludwig, MD, Neurointerventional, Stroke Neurology Chair, Clinical Neuroscience Institute; Richard Kim, MD, Clinical Neuroscience Institute; National Stroke Association; American Heart Association

Bryan R. Ludwig, MD

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Richard J. Kim, MD

Clinical Neuroscience Institute

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