When to Know it’s not “Just” a Migraine

By Kirstie

Migraines often mimic other conditions and can even cause other health issues to arise. Sometimes even for the seasoned migraineur it’s hard to tell when it’s “just” a migraine, or if something more serious is happening.

It happened to me in the form of a TIA.

TIA is the short name for transient ischemic attack, which is sometimes called a “mini-stroke” or a warning stroke. Strokes have many similar symptoms to migraines with aura as well as hemiplegic migraines (which I also have). They include visual disturbances, speech impairment, and muscle weakness.

When a TIA is over, there is usually no long-term brain damage, such as seen with a full stroke. But that doesn’t mean they aren’t a serious medical matter. These mini-strokes are called warnings because people who have them are at a higher risk of having a full-blown stroke someday.

In fact, according to the National Stroke Foundation, 40% of patients who experience a TIA will go on to have a full stroke in their lifetime, and 5% of those people will experience the full stroke within 2 days following their TIA.


(Above: Diagram of a Transient Ischemic Attack via National Stroke Foundation)

Knowing the Differences in Symptoms of Migraine & TIA or Stroke

A migraine, by definition, is a severe headache that can induce nausea, vomiting, cognitive problems, and sensitivity to light, sounds, and smells. In up to 30% of all incidents, sufferers experience an aura, which can be in the form of seeing zigzagging lights, flashes, spots, feeling tingles or numbness, and even smelling strange odors. 

A stroke, whether TIA or full stroke, is medically known as an attack caused by either a blockage or a clot in an artery of the brain (ischemic) or by bleeding (hemorrhage).

Stroke and TIA symptoms include:
• Numbness or weakness on one side of the body (paralysis)
• Partial or full vision loss
• Trouble understanding speech
• Slurred speech
• Headache
• Dizziness

The differences can be subtle, but certain things can help you determine if you are experiencing a migraine with aura, hemiplegic migraine, or a more serious attack like TIA or stroke. 

There is an acronym called “FAST” that lets you and others know in a quick and easy way what to look for when stroke is suspicioned.

F = Face Drooping

A = Arm Weakness

S = Speech Difficulty 

T = Time to Call 9-1-1!

There’s more to stroke than just the “FAST” acronym, though. Here are some other things to look out for, especially if you are a chronic migraineur:

1. The key word for a stroke is “sudden.” Strokes occur very suddenly. One second you’re fine, and the next, your head is pounding, your arm goes numb, and you can’t speak (or a combination of these symptoms). With migraine aura and hemiplegic migraines, the symptoms occur over a gradual timeframe, and the accompanying headache intensifies more slowly, rather than coming on suddenly.

2. Visual disturbances. Both migraines and strokes can interfere with vision—it’s what you see or don’t see that really makes all the difference. With migraine, you can have as I mentioned above: flashing lights or zigzagging lines, while a stroke detracts. With a stroke, you may not realize immediately that your vision has been impaired until you begin bumping into things.

3. Your Medical or Family History. Some can have a migraine for the first time later in life, however it’s less common. Migraineurs often have their first migraine as a child or teen—and their aura tends to be the same every time. I’ve had hemiplegic migraines since I was 11 years old.  These type if migraines often mimic stroke-like symptoms. Like other migraines, hemiplegic migraines can cause throbbing pain, nausea, and sensitivity to light and sound. They also cause temporary weakness, numbness and tingling, and paralysis on one side of the body. These symptoms often start before the headache itself. “Hemiplegia” means paralysis.

When in doubt, always keep on the side of caution. I had my TIA in the middle of the night, it came on suddenly, and my symptoms lasted only a few minutes. A sharp pain in my head and chest, numbness in my left side of my body, and lack of words were my prominent symptoms.

For me personally, my migraine is always right sided, but for you it may differ. If your migraine is different than ‘normal,’ get to an emergency room as soon as possible to rule out a stroke or TIA. Don’t hesitate to call 9-1-1. Immediate medical attention can save your life. If treated immediately you can prevent permanent brain damage or possible death.

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