What kind of headache warns of stroke?

My father is 64 years old and just had a stroke. The doctor said he needs to control his blood pressure and blood sugar. If he has a sudden headache, he should go to the hospital soon.

I wonder what headache symptoms signal a stroke recurrence? (Lan Le, Ho Chi Minh City)

Reply:

Everyone gets headaches from time to time, and some people get them more often. Most headaches are not serious, for example caused by stress, lack of sleep, changes in environment... and will eventually go away on their own. However, some headaches can be a symptom of a more serious problem, including a stroke.

To recognize an impending stroke, the American Stroke Association recommends the FAST principle. This is an acronym for the main symptoms associated with early signs of stroke, including: F (face): drooping or drooping on one side; A (arm): numbness or weakness in an arm or leg or on one side of the body; S (speech): slurred or difficult speech; and T (time): call 911 immediately.

In addition to the FAST warning signs of stroke, up to 65% of stroke patients experience some form of headache. Stroke-related headaches are often described as very severe headaches that come on within seconds or minutes. Typically, the area of the head that is affected is directly related to the location of the stroke. For example, a blocked carotid artery may cause a headache in the forehead, while a blockage in the back of the brain may cause a headache in the back of the head. There is no single location that is a universal sign of a stroke, as headaches can occur anywhere on the head.

A person having a stroke may experience a very severe headache that occurs within seconds or minutes. Photo: Freepik — A person having a stroke may experience a very severe headache that occurs within seconds or minutes. Photo: *Freepik*

In some cases, it can be difficult to tell the difference between a migraine and a stroke-related headache. This is because both migraines and stroke-related headaches share some of the same symptoms, such as disorientation, a general feeling of unwellness, changes in vision, and dizziness.

The easiest way to tell the difference between a migraine and a stroke-related headache is to pay attention to how it feels. Migraines can feel like auras, flashing lights, or tingling skin, while stroke-related headaches can feel like a loss of vision or sensation. Migraines also tend to have easily identifiable triggers, and the pain tends to gradually increase from throbbing to worse. A stroke, on the other hand, can come on suddenly and cause a sudden, severe headache.

A stroke occurs when the blood flow to the brain is interrupted. There are two types of strokes. An ischemic stroke occurs when an artery supplying blood to the brain becomes blocked and causes brain cells to die. A hemorrhagic stroke occurs when an artery in the brain ruptures, causing bleeding in the brain.

A “mini-stroke” (also called a transient ischemic attack, or TIA) can also cause a stroke-related headache. A mini-stroke is characterized by a temporary interruption of blood flow, with brain tissue only temporarily damaged and recovering once blood flow is restored. However, a TIA produces symptoms identical to a stroke, which can last from 5 minutes to 24 hours. TIAs should be treated the same as strokes, as they are often warning signs of a full-blown stroke. The sooner a TIA is treated, the more likely it is that a stroke can be prevented.

Readers can ask questions here to get answers from doctors about neurological diseases.

Dr. Nguyen Thi Minh Duc
Head of Department of Neurology, Tam Anh General Hospital, Ho Chi Minh City

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