How can I be sure that a headache after a stroke isn't a ministroke, or TIA?

9 answers | Last updated: Apr 24, 2017
A fellow caregiver asked...

My mother had a stroke six months ago and is doing well. But recently she's been complaining of headaches that she insists are migraines. I'm worried that she might be having ministrokes. How can I tell the difference between a migraine and a TIA?

Expert Answers

James Castle, M.D. is a neurologist at NorthShore University HealthSystem (affiliated with The University of Chicago) and an expert on strokes.

Transient ischemic attacks (TIAs), also known as "ministrokes," are almost always painless. Headaches after a stroke are fairly uncommon, but they might occur for the following reasons:

  • a redirection of blood flow when healthy arteries stretch and grow to supply blood to the part of the brain that has lost its normal supply
  • stretching of the brain's covering from scarring, swelling, or atrophy of the brain
  • small amounts of bleeding into the area of the old stroke (less likely)
  • a small tear in an artery (also unlikely)

If you're concerned, talk to your mother's doctor. The more dangerous of these possibilities can be excluded by imaging the brain and its blood vessels. Imaging should also rule out the possibility of recurrent strokes or TIAs. If the images don't show any major problems, it means the headaches aren't likely due to anything serious.

Community Answers

A fellow caregiver answered...


Grannylove2 answered...

Dear Anonymous Caring,com community member,

According to Wikipedia, Antiphospholipid syndrome (APS or APLS) or antiphospholipid antibody syndrome is a disorder of coagulation that causes blood clots (thrombosis) in both arteries and veins as well as pregnancy-related complications such as miscarriage, stillbirth, preterm delivery, or severe preeclampsia. The syndrome occurs due to the autoimmune production of antibodies against phospholipid (aPL), a cell membrane substance. In particular, the disease is characterised by antibodies against cardiolipin (anti-cardiolipin antibodies) and β2 glycoprotein I.

The term "primary antiphospholipid syndrome" is used when APS occurs in the absence of any other related disease. APS is commonly seen in conjunction with other autoimmune diseases; the term "secondary antiphospholipid syndrome" is used when APS coexists with other diseases such as systemic lupus erythematosus (SLE). In rare cases, APS leads to rapid organ failure due to generalised thrombosis and a high risk of death; this is termed "catastrophic antiphospholipid syndrome" (CAPS).

Antiphospholipid syndrome is sometimes referred to as Hughes syndrome after the rheumatologist Dr. Graham R.V. Hughes (St. Thomas' Hospital, London, UK) who worked at the Louise Coote Lupus Unit at St Thomas' Hospital in London.

Antiphospholipid syndrome can cause (arterial/venous) blood clots (in any organ system) or pregnancy-related complications. In APS patients, the most common venous event is deep vein thrombosis of the lower extremities (blood clot of the deep veins of the legs) and the most common arterial event is stroke.

Rekijen answered...

I think i had a TIA 8 weeks ago now but i didnt get to my Doctor until over a week later so he couldnot tell if i had had one or not it has left me feeling very Angry at the smallset thing that people do (my poor husband mostly) and i keep getting Headaces on my Right side and down my nose and up over my eye the TIA left me with eye problems that i have been told will not get better these are black bits that are always in my right eye now and in the darkened room i get flashing light in the corner of that eye so i always have to have a good light on behind me or it shows up all the time in myself i am good and want to get on with lots of work yet i am worried that another TIA or a stroke is coming -what di you think? i cant see my Doctor for two more weeks as he is on Holiday and i dont want to see any one but him .(jenny)

Sandimueller answered...

First To Jenny: Be patient with yourself, and that patience will flow over to include your husband. (Some of us are not so fortunate to still have a husband in our lives that helps us in ways we never acknowledged when they were there). Running small errands, gassing the car, etc. Also, Would it be helpful to cover the Right eye with an eye patch from your drugstore? That way, it would not be so frustrating, I would think, in having to "see" the black spots, and flashing light so much.

To Anonymous re Migraine: I have suffered from migraines since I was 19. I am 61 now. Most people's get less as they age, but not mine. Mine started increasing in the number of episodes per month and in the severity. My migraines are those "with aura" (spotty or blurred vision). I have to retreat to a completely darkened room, with no sounds, take a sleeping pill (trazadone) and try and sleep through it. It lasts 6-8 hours or more.

Care bear. answered...

My partner suffered a stroke about 3 years ago, and ever since then he has had a continuous headache. Just by sheer chance we found out that there are such things as 'Pain Clinics'. I do not know the nationality of any of the above bloggers, but I would strongly advise that any one in my country (England) ask their doctor to refer them to the Pain Clinic. Getting any help from our local GP has been like trying to get blood out of a stone.

Maggieovercs answered...

To sandimueller: have you been tested to see if you have a PFO (Patent foramen ovale )? It's a congenital heart defect... A hole we are all born with and close up as babies but 20-30% do not close. Migraines with auras are a common symptom. I had a small stroke....a PFO that allowed the clot to go to my brain. I am having the hole closed early August. I've had terrible headaches behind my left eye since the stroke... Constant... Ugh!

Daron answered...

Maggie, I have very similar symptoms and have a pfo...had a stroke and now headaches. Have a personal e-mail? Would love to pick your brain. I went in to thave the PFO close and the cardiologist during the procedure told me the PFO was too small and didn't close it....

Djgil57 answered...

I had a 2 ischemic strokes back in September of 2010. Have been living with a horrible head pain since. Burning, crawling, throbbing, pain on the left side of my head. This is every minute of every day and is quite maddening. The Dr. said to close my PFO and I did. The end result of that was no improvement on my head pain and a whole new set of problems with the implanted device. 3 Ablations later I still suffer from frequent bouts of Atrial Tachycardia followed by Atrial Fibrillation. So if you have a smaller PFO do not bother to close it. Risk versus reward is not worth it. I have endured many MRI and CT scans and lumbar punctures. 3 Epidural Blood patches. Milogram and a Cisternogram. in desperation I had an Occipital neurolysis and Occipital artery removal. Nothing helps period.Everyone agrees something is not normal yet no one can offer any help. No pain reliever seems to be of any use.. I have taken every known migraine medication known to man in search of relief. So my advise to anyone living with this condition. The best and only advice I can offer is do nothing as the end result will be you being broke and in a worse place physically. Sorry if I was no help.