Did my mom have a stroke or just a migraine headache?

Akumaskills asked...

My mom went in the hospital for a stroke but it turned out to be migraine headache that caused stroke- like symtoms. Her speech was very bad but it has come back now. She seems to be air headed, almost like she's not herself. Now this is d day plus 4. How long do you think she will be like this? Will she get better or do you think she may have been misdiagnosed (maybe it is was a stroke)???

Expert Answer

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

Migraines are a very cryptic phenomenon, not completely understood by Neurologists.  They cause spasm of the blood vessels, and spreading depression of electrical activity across the brain that can mimic a stroke or TIA (transient ischemic attack).  In my experience, they, along with seizures, are the most common mimic of stroke and TIA.

The most common symptoms from a migraine (which incidentally doesn't always cause a headache - one reason I prefer the term "migraine" or "migrainous phenomenon" rather than "migraine headache") is visual changes (such as flashing lights and wavy lines), speech disturbance, numbness, and tingling.  A migraine can persist for several days, but it is a diagnosis of exclusion - meaning a stroke, seizure, or TIA should be ruled out.

Frequently, an MRI scan is used to diagnose a stroke.  If your mother's symptoms have lasted four days, and if she truly had a stroke, it should almost certainly show up on an MRI.  If the MRI was done too soon after her event, it can be falsely negative.  This is why I ideally wait at least 12 hours from the time the event started before getting an MRI.  If 12 hours has past, the symptoms are still present, and the MRI is negative, there is a very good chance the event was not a true stroke.

I think the best thing to do in this case is to discuss with your doctor whether or not an MRI should be repeated.  If your doctor feels very strongly that the event was not a stroke, perhaps no MRI is needed.  However, if a question remains, it would probably put everyone's mind at ease.  Particularly if done within 3 weeks of the event, a negative MRI would very likely rule out any possibility that she had a stroke.