Understand your symptoms and whether your migraine may carry an additional stroke risk

Migraine attacks accompanied by aura are associated with stroke and heart disease, and women might be particularly at risk for migraine-related stroke, said Dr. Gretchen Tietjen, the chair of the University of Toledo’s Department of Neurology. But Tietjen, a neurologist who specializes in stroke and headache medicine, says that lifestyle choices, like sleeping well and using preventive medication, may help mitigate that additional risk.

Connections Between Migraine and Stroke

Migraine with Aura is a risk factor for stroke, particularly for women, even those younger than 45 or even 35, Tietjen said. People who experience aura might have increased tendency to form blood clots due to temporarily narrowed blood vessels, which can predispose them to stroke, Tietjen said, which studies suggest may increase stroke risk compared to women in that age group who don’t have migraines.

“These are people that otherwise, if they didn’t have migraine, might not be at risk,” Tietjen said. “You don’t expect young women to suffer a strokes.” The “absolute risk” is small, though, Tietjen said: There are about 800,000 strokes a year, half of them among women, and 2,000 to 3,000 might be related to migraine. Still, “I don’t think it’s something that should be discounted just because the numbers aren’t high,” she said.

Benefits From a Healthy Lifestyle

People who have migraine with Aura should get regular evaluations, Tietjen said. She also recommends preventive strategies to try to stop headaches before they happen. “Try to prevent the headaches,” Tietjen said. “I think that’s the best thing you can do, so I would definitely recommend using  preventive medication, cognitive behavioral therapy, and lifestyle changes.” Studies are needed however to determine whether preventive treatment that reduces the frequency of migraine actually reduces the risk of stroke.

People with aura should also control hypertension and hyperlipidemia, Tietjen said. Avoiding smoking and maintaining a healthy weight can also reduce risk, since obesity can increase the chances of a stroke. And since younger women might face a higher risk for migraine-related stroke, Tietjen advises women with aura avoid using contraceptives with ethinylestradiol, or estrogen supplements. Those ingredients can increase formation of small blood clots, which can increase the risk of stroke in women with migraine with aura, Tietjen said.

Recognizing Warning Signs

People with aura can further decrease their risk of migraine-related stroke by knowing the warnings signs of stroke, Tietjen said. A transient ischemic attack can serve as a “warning,” Tietjen said. Features of those attacks may include loss of vision in one eye, slurred speech or weakness or numbness in one side. The attacks typically last up to one hour.

If people notice a change in their aura — such as increased frequency, duration, i.e. lasting longer than one hour, or characterized by weakness on one side — then “maybe something more is going on” and they should seek medical attention, Tietjen said. “I think that people who have Migraine with Aura, need to know what the stroke warning signs are,” Tietjen said. “They also need to know  and control their other stroke risk factors. Lifestyle changes and medications may decrease the frequency of aura.”

A doctor specializing in migraine can help identify and treat stroke risk factors. Connect with a headache specialist in your area today to learn more about managing your symptoms and understanding your disease.