Reader’s Mail: Should I Go to the Hospital with Every Aura Headache?

Question:
I know that a migraine with aura can mimic stroke symptoms, so should I go to the hospital with every aura headache?

Answer:
Migraines can be scary, especially migraine auras, until one becomes familiar with their personal patterns. Many people have rather stereotypical auras, meaning they are similar time after time. Even the headaches can be typically similar from attack to attack. So, most people with migraine come to recognize their symptoms and find that somewhat reassuring. Auras are mostly sensory, meaning visual disturbances, tingling numbness or sometimes weakness (hemiplegic migraines, which tend to run in families). Some auras affect the ability to speak, usually not so much slurring but rather wrong words and non-connected words.

There are a few danger signs or “red flags” that should alert you or your doctor to possible stroke or neurological event in someone who has recurrent headaches:

  1. New, different, unusual symptoms, not your typical symptoms or aura.
  2. Worst headache pain of your life (different from your usual pain).
  3. Weakness or numbness that starts close to the torso (proximal) that progresses down the arm or leg (distal). Strokes typically cause focal neurological symptoms that start close and move down, while migraines typically cause such symptoms starting at the fingers/hands or toes/feet (less often) and moves up the extremity. Note, there is a form of migraine called “hemiplegic,” which typically runs in families, and the auras cause stroke-like symptoms, but they go away like an aura does. Yes, the experience can be scary, and patients typically get a lengthy work-up.
  4. Systemic illness symptoms, such as fever, chills, vomiting, etc. could indicate an infection, such as meningitis.
  5. New onset of headaches at an age greater than 50 or 60 years without a history of recurrent headaches previously.
  6. The events are becoming more and more frequent and severe over time.
  7. Explosive onset, “like a bomb went off in my head” kind of headache (thunderclap headache). Those are not preceded by aura and one should seek medical care.

Please go to our website: headaches.org for more information on migraines, with and without aura, as well as info on risks of stroke in migraine sufferers (with aura).

James W. Banks, III, M.D.

Board member, National Headache Foundation

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