Harvard Heart Letter

Ask the doctor: Headache and stroke

Q. I have heard that one symptom of a stroke is "the worst headache you can imagine." I recently had a migraine that was so much more painful than previous ones that I worried it was a stroke. Is there any way to tell a migraine from a "stroke headache"?

A. The term "stroke" covers several distinct events that differ in location and cause. Some types of stroke can trigger a headache; others usually don't. To understand the connection, it's helpful to know a bit about the brain and pain. Brain tissue, and the blood vessels embedded in it, doesn't register pain. But the membranes that surround the brain and the blood vessels that run through them do register pain.

The most common kind of stroke — ischemic stroke — occurs when a blood clot blocks an artery in the brain. These don't usually bring on a headache. A hemorrhagic stroke stems from bleeding in the brain. Because bleeding stretches the outer membranes, headache, sometimes a very intense headache, commonly accompanies a hemorrhagic stroke.

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