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

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 Answer

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.