Migraine vs. Stroke: How to Tell the Difference

Medically Reviewed by Carol DerSarkissian, MD on July 28, 2021

You have a terrible headache. How do you know if it's something serious? Some of the symptoms of a migraine can be very much like those of a stroke.

If you think there's even the slightest chance you're having a stroke, call 911 right away. Early treatment can limit the damage to your brain and possibly save your life.

If you're over 40 and have never had a migraine, assume your pain is something more serious. People who get migraine typically have it most of their lives. It's rare to have your first symptoms when you're older.

If you get migraine and your aura symptoms or headaches seem different than what you’ve typically experienced, get checked out. Most people with migraine have similar symptoms each time.

What Is a Stroke?

During a stroke, blood flow to part of your brain is cut off. Cells there don't get enough oxygen and start to die.

There can be two causes. Either a blood vessel is blocked, for instance with a blood clot, or a blood vessel tears or bursts and causes bleeding in or around the brain.

A sudden severe headache can be a sign of a stroke. Other common symptoms are:

  • Numbness or weakness, especially on one side of your body
  • Trouble speaking or trouble understanding others
  • Vision problems in one or both eyes
  • Sudden dizziness or loss of balance or coordination
  • Confusion

The kind of stroke that tends to be mistaken for a migraine is called a transient ischemic attack, or TIA. It's also known as a "mini stroke" because blood flow to your brain is cut off only for a short time. Symptoms are less severe than with a regular stroke and may last less than an hour.

What Is a Migraine?

Migraine is a disease that causes recurrent attacks of head pain together with other symptoms such as a bad headache that often comes with nausea, vomiting, and sensitivity to light, sound, smell, or touch. The pain may throb or pulse, and you usually feel it on one side of your head around your eye or temple.

A migraine with aura is the kind that can be confused with a stroke. An aura affects your senses and usually happens before the headache. You may see light flashes, zig-zagged lines, or blind spots, or you might feel tingling or numbness in your arms, legs, or face. You might have ringing in your ears or trouble speaking. Sometimes, you'll have those symptoms but never get a headache. That tends to happen more often as you get older.

How Can You Tell the Difference?

It can be hard to tell the difference between a migraine with aura and a TIA. Here's what to look for:

  • With a stroke, symptoms usually come on suddenly. With a migraine, they happen gradually; the headache usually starts small and gets more painful.
  • A stroke is more likely to have what are called "negative" symptoms such as you might lose sight in one eye or lose feeling in one of your hands or feet. A migraine is more likely to have "positive" symptoms. That means added sensations, like flashes in your vision or tingling in your skin.
  • If you're young, it's more likely to be a migraine. If you're older, it's more likely to be a stroke, especially if you've never had a migraine before or you have high blood pressure or an irregular heartbeat.

What's the Connection?

Doctors aren't sure exactly how migraine and strokes are linked. They do know that people who get migraine with aura are about twice as likely to have a stroke as people who don't get migraine at all. The risk goes way up if you're also a young woman who smokes and takes birth control pills.

A migraine without aura don't seem to affect your chances of having a stroke. But they may make you more likely to have other heart-related problems.

One theory about the connection has to do with damage to the cells that line the blood vessels. Some research has found that a migraine can cause inflammation inside your arteries. That can make them stiff and cause your blood to clot more easily. Both of those increase your chances of a stroke.

It's possible to have a stroke while you're having a migraine, but that doesn't mean the migraine caused the stroke. A stroke can trigger migraine symptoms, including the aura.

Certain medications for migraine headaches, including ergot alkaloids and triptans, can narrow your arteries. If you've had a stroke, you shouldn't take those.

In general, medicines and lifestyle changes (like quitting smoking) that lower your risk of a stroke may also keep you from having migraine.

Show Sources


National Institute of Neurological Disorders and Stroke: "Stroke Information Page," "Transient Ischemic Attack Information Page," "Migraine Information Page."

American Heart Association/American Stroke Association.

National Headache Foundation: "Transient Ischemic Attacks (TIA)," "Migraine," "Aura."

The Migraine Trust: "Stroke and Migraine."

American Migraine Foundation: "Migraine, Stroke and Heart Disease."

Migraine Research Foundation: "Migraine Facts."

National Stroke Association: "Do I Have A Migraine, Or Is This A Stroke?"

Kurth, T. Stroke, November, 2012.

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