Migraine and Stroke: Understanding the Connection

Section 1

Migraine, aura, and stroke are not the same

Migraine is a recurring headache disorder. An attack may include moderate or severe head pain, nausea, and sensitivity to light or sound.

Aura means temporary neurologic symptoms that occur with some migraine attacks. Aura may affect vision, sensation, or language. Not everyone with migraine has aura, and an aura does not mean that a stroke is happening.

Stroke is a brain injury caused by a blocked or bleeding blood vessel. It needs emergency assessment and treatment. [2]

Section 2

Why symptoms can overlap

Migraine aura and stroke can both involve changes in vision, sensation, or language. A person's previous aura pattern may give their clinician useful context, but no single feature makes a new symptom safe to evaluate at home.

Call 911 for symptoms that are:

• new or unlike the person's usual evaluated aura;
• sudden or severe;
• persistent, worsening, or accompanied by weakness;
• associated with major trouble speaking, seeing, balancing, or staying alert; or
• difficult to identify with confidence.

Do not wait for a headache to appear. Ischemic stroke can occur without headache, and time-sensitive treatment should not be delayed while deciding whether symptoms “feel like migraine.” [1]

Section 3

What migraine with aura means for stroke risk

Studies consistently show an association between migraine—especially migraine with aura—and ischemic stroke. An association means the conditions occur together more often than expected; it does not mean that migraine will cause a stroke in a particular person.

The 2024 American Heart Association/American Stroke Association guideline summarizes observational studies in which migraine with aura was associated with about twice the relative risk of ischemic stroke. The association was more evident in younger women. Even so, stroke remains uncommon in young adults, so a higher relative risk can still represent a low absolute risk for an individual. [2]

Risk can change when other factors are present. In studies summarized by the guideline, women ages 20 to 44 with migraine with aura who used combined hormonal contraception had a higher estimated absolute risk than women with neither factor. The estimates varied between studies and should not be used as a personal risk calculator. [2]

Section 4

Risk factors you can address with a clinician

Current guidance recommends evaluating and addressing vascular risk factors in adults ages 18 to 64 who have migraine, with or without aura. Depending on the person, this may include:

• not smoking or using tobacco;
• checking and treating high blood pressure;
• reviewing cholesterol and diabetes;
• regular physical activity, sleep, and other health habits; and
• reviewing contraceptive choices and other personal risk factors with a clinician. [2]

For people with migraine with aura who are choosing contraception, the guideline recommends clinician-guided progestin-only or nonhormonal options to avoid the increased ischemic-stroke risk associated with combined hormonal contraception. The best choice depends on the person's full medical history, preferences, and pregnancy-related considerations. [2]

Do not stop contraception or start aspirin, a blood thinner, or another medicine based only on this page. Discuss the decision with the prescribing clinician.

Section 5

Does preventing migraine prevent stroke?

Migraine preventive treatment may reduce attack frequency, severity, or disability. That can be an important treatment goal.

But it has not been proven that reducing migraine attacks reduces future stroke risk. The 2024 guideline lists this as a priority for future research. Migraine treatment and vascular-risk management should therefore be understood as related but different plans. [2]

This evidence gap is being tracked for future guideline or trial changes. It does not justify changing treatment automatically.

Section 6

What to remember

• Migraine with aura is associated with increased ischemic-stroke risk, but most people with migraine do not have a stroke.
• New, sudden, or clearly different neurologic symptoms need emergency action.
• Review vascular risk factors and contraception choices with a clinician.
• Treat migraine for appropriate migraine goals; do not assume that migraine prevention has proven stroke-prevention benefit.

This page provides general education. It cannot diagnose migraine, aura, TIA, or stroke and does not replace emergency care or advice from your treating clinicians.