Are Headaches a Sign of Stroke?

Headaches in specific areas can sometimes signal a stroke. For example, a stroke in the carotid artery, which supplies blood to the front of the brain, might cause pain in the forehead or face. Stroke-related headaches can also be more general, with mild to moderate pain, or they can be sudden and severe, like "thunderclap headaches," which are common in hemorrhagic strokes (bleeding in the brain from a burst blood vessel).

In addition to headaches, strokes often cause other neurological symptoms, such as facial drooping, arm weakness, slurred speech, confusion, and trouble seeing. If you experience a sudden, severe headache along with any of these symptoms, it’s critical to seek emergency medical attention right away, as timely treatment can be lifesaving.

How Stroke Causes Headaches

Strokes are a medical emergency that happens when blood flow to the brain is interrupted. This is what causes headache. There are two types of strokes, both of which can cause this symptom:

• Ischemic stroke happens when the artery that supplies oxygen-rich blood to the brain gets blocked. The lack of blood flow causes brain cell death. Around 80% of strokes are ischemic.
• Hemorrhagic stroke happens when an artery in the brain bursts. This leads to bleeding into the brain. A common example of a hemorrhagic stroke is a subarachnoid hemorrhage, where bleeding occurs between the brain and its surrounding membrane.

A transient ischemic attack (TIA) is a temporary interruption of blood flow in the brain that is sometimes called a "mini-stroke." It comes on suddenly and gets better fairly quickly. (Most TIAs last around five minutes, but some can last for up to 24 hours.)

Despite the "mini-stroke" name, a TIA diagnosis is not based on the severity of symptoms, including headache. No matter how mild the symptoms are, a TIA should be treated just like a stroke and can be an early warning sign of a full stroke.

What Does a Stroke Headache Feel Like?

Both ischemic and hemorrhagic strokes cause headaches, but the headaches associated with them can vary in severity and location.

Hemorrhagic stroke is known for causing a "thunderclap headache." People often describe this headache as the worst headache of their life. It hits hard and fast, reaching peak intensity within seconds to minutes. It usually affects the whole head.

Ischemic stroke headaches often develop gradually and are more persistent. They tend to be less severe than thunderclap headaches, and are often described as being similar to a tension headache. Ischemic stroke headaches can affect one or both sides of the head.

There isn't a specific headache location that means stroke. The location of the headache depends on the part of the brain affected. For example:

• Strokes that start in the carotid artery (a major artery in the neck that brings blood to the brain) can cause a headache in the forehead or behind the eyes.
• Strokes in vertebrobasilar (VB) system (which supplies blood to the back of the brain) may cause a headache at the back of the head or top of the neck.

Headache can occur before, during, or after stroke symptoms start. According to one study, 86% of people reported a headache within the same day of stroke symptoms. The remainder of the individuals developed a headache two to five days later.

Stroke Headache vs. Migraine

As migraine headaches are also severe, you might wonder if you are experiencing one of them instead. There are some key differences between the two that are worth noting.

Rarely, a migrainous stroke can occur. In this case, a person experiences both a migraine with aura (head pain and sensory disturbances) and a stroke.

Could It Be an Aneurysm?

An aneurysm is a bulge or weak area in the wall of a blood vessel in or around the brain. Not all aneurysms rupture. But when one does, it can cause bleeding in the brain, leading to hemorrhagic stroke.

A ruptured brain aneurysm typically triggers an intense thunderclap headache. There may also be other aneurysm-related headache symptoms, such as:

• Severe neck stiffness
• Nausea and vomiting
• Pain around or behind the eyes
• Loss of consciousness

Many aneurysms start with small "microbleeds" before a more severe rupture occurs. These leaks often come with sudden headache pain, but the pain may not be as severe as a thunderclap headache.

Unruptured aneurysms may not cause any symptoms at first. However, a large unruptured aneurysm is known to cause:

• Headaches that get progressively worse
• Numbness or weakness on one side of the face
• A change in vision or double vision
• A dilated pupil

Other Stroke Symptoms

When a headache is caused by a stroke, people usually have other stroke symptoms as well, such as:

• Weakness on one side of the body
• Numbness on one side of the body
• Dizziness (vertigo) or loss of balance
• Slurred speech
• Inability to write or manage fine hand movements
• Difficulty understanding others
• Double vision or blurred vision

The symptoms one experiences depend on the region of the brain affected. For example, strokes affecting the cerebrum may primarily impair speech abilities, while those affecting the cerebellum can result in loss of coordination.

Importance of Immediate Stroke Treatment

If you have a severe headache that hits you suddenly and is unlike any pain you've had before, or you have other signs or symptoms of a stroke, do not delay in getting emergency medical attention.

A stroke can be fatal and every minute matters. Strokes damage the brain, and early diagnosis and treatment are key for preventing the long-term effects of the condition.

Even if you're not having a stroke, a sudden, extremely painful headache can be a sign of other serious medical conditions (e.g., bleeding or infection in the brain) that also need to be treated right away.

Summary

There are two main types of stroke: ischemic stroke and hemorrhagic stroke. Ischemic strokes often cause headaches that have a tension-type quality affecting one or both sides of the head. Hemorrhagic strokes are known to cause thunderclap headaches, which hit fast and hard and usually affect the entire head. Both tend to occur without warning and happen along with other classic stroke symptoms, like weakness, numbness, dizziness, and slurred speech.

Strokes are a medical emergency. If you have any stroke symptoms, including a headache that is sudden and severe, call 911 or go to your nearest emergency room.