How a Headache May Be a Sign of a Stroke

By
Colleen Doherty, MD
Colleen Doherty, MD, is a board-certified internist living with multiple sclerosis.
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Colleen Doherty, MD
Medically reviewed by
Medically reviewed by Huma Sheikh, MD on May 12, 2020

Huma Sheikh, MD, is board-certified in neurology and specializes in migraine and stroke. She co-founded the migraine and vascular section for the American Headache Society.

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Huma Sheikh, MD
Updated on May 16, 2020
A woman on the couch suffering from a headache

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A stroke is a medical emergency that may also be associated with a headache. Let's read about the types of stroke and how a stroke-related headache may be distinguished from a benign primary headache.

Understanding Stroke

Strokes occur when blood flow to the brain is interrupted. There are two types of strokes. An ischemic stroke occurs when an artery that supplies oxygen-rich blood to the brain becomes blocked, causing brain cell death due to lack of blood flow.

A hemorrhagic stroke occurs when an artery in the brain bursts, and there is bleeding into the brain. A common example of a hemorrhagic stroke is a subarachnoid hemorrhage. In this condition, a severe headache is the only symptom in about a third of the patients.

Both types of strokes are medical emergencies, and both may be associated with a headache.

Symptoms

According to a 2010 study from Italy, between 7% and 65% of stroke patients will report some sort of precipitating headache.

The focal point of a headache may depend on where the stroke is occurring. For instance, strokes that arise within the carotid artery (a major artery in the neck that brings blood to the brain) may produce a headache in the forehead, though this is not always the case.

Strokes in the vertebrobasilar system, which supplies blood to the back of the brain, may produce a headache at the back of the head.

People will often describe a stroke headache as the "worst of my life" or say that it appeared like a "thunderclap"—a very severe headache that comes on with in seconds or minutes. The pain generally won't be throbbing or develop gradually like a migraine. Rather, it will hit hard and fast.

Moreover, the headache will typically occur with other characteristic symptoms, including:

  • Weakness on one side of the body
  • Numbness on one side of the body
  • Vertigo or loss of balance
  • Slurred speech
  • Inability to write or manage fine hand movements
  • Difficulty comprehending others
  • Double vision or blurred vision

When compared to a migraine, a stroke headache is associated with the loss of sensation (such as feeling or vision). By contrast, a migraine is characterized by the emergence of sensations (such as auras, flashing lights, or tingling skin).

Transient Ischemic Attack

A kind of stroke often mistaken for a migraine is a transient ischemic attack (TIA), also called a "mini-stroke" because the obstruction of blood flow is only temporary. A TIA is not based on the severity of symptoms. Most last for around five minutes, but some can last for up to 24 hours.

For all intents and purposes a TIA should be treated just like a stroke, no matter how mild the symptoms may be; a TIA is often an early warning sign of a full stroke.

A Word From Verywell

If you believe you are experiencing symptoms of a stroke, call 911. Early treatment is the key to preventing any long-term effects of a stroke. This is especially true if a severe headache hit suddenly and is unlike anything you've experienced before.

Even if the symptoms are uncertain, seek emergency care if you have an underlying risk for a stroke, including high blood pressure, heart disease, a family history of strokes, diabetes, smoking, a diagnosed brain aneurysm, or are over 60.

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