How can I tell a migraine from a stroke?

Timing and type of symptoms are the main clues. Migraine aura usually builds up over several minutes and spreads, and it tends to add things, like flashing lights or tingling that moves. A stroke usually starts suddenly and takes things away, like strength in an arm, vision or speech. But the two can overlap, and only a medical assessment can tell for sure. If you're unsure, call 911.

How long does a migraine aura last?

The NHS says aura symptoms usually develop over about 5 minutes and last up to an hour, and the headache often follows. An aura that lasts much longer than an hour, is different from your usual aura, or comes with weakness on one side needs urgent medical assessment.

Can a migraine cause weakness on one side?

Rarely. A type called hemiplegic migraine can cause temporary weakness on one side of the body, which looks just like a stroke. That's why new weakness on one side should always be treated as a possible stroke: call 911, even if you have migraines. A diagnosis of hemiplegic migraine can only be made by a doctor after a stroke has been ruled out.

What if the symptoms go away on their own?

Stroke symptoms that go away within minutes or hours may be a transient ischaemic attack (TIA), sometimes called a mini-stroke. The NHS says a TIA is a warning that you're at risk of a stroke and you should call 999 (in Jordan, 911) or get urgent help even if the symptoms have stopped. Don't assume it was 'just a migraine'.

Should I go to the ER for my first migraine with aura?

A first-ever aura should be checked by a doctor, especially if you're over 50, the aura doesn't follow the usual gradual pattern, or you have weakness, slurred speech or confusion. If any stroke sign is present, call 911 straight away. If you feel well apart from a typical aura that has fully passed, a same-day or prompt doctor's visit is reasonable.

Can I walk in to Emergency Plus with a bad migraine?

Yes. Emergency Plus in Dabouq, west Amman has emergency doctors on site 24/7 and walk-in care with no appointment, and they can assess a severe or unusual migraine. But if there are any stroke signs, such as face drooping, arm weakness or slurred speech, call 911 so the ambulance can take the person to a hospital that can treat stroke. Don't drive yourself.

Migraine or Stroke? How to Tell the Signs Apart

Zigzag lines shimmer in front of your eyes, then your hand tingles, then the headache arrives. If you get migraines, you may know this well. But some aura symptoms look like a stroke, and getting it wrong the wrong way round can cost precious time. This guide explains the differences and when you must not wait. For every stroke sign in detail, see stroke symptoms: the FAST test.

What is the difference between a migraine aura and a stroke?

An aura is a temporary wave of disturbed brain activity that spreads slowly, so its symptoms build up and move. The NHS says aura symptoms usually develop over about 5 minutes and last up to an hour. A stroke is a sudden loss of blood supply to part of the brain, or a bleed, so symptoms usually appear all at once. A useful rule: aura tends to add symptoms (lights, tingling), and stroke tends to take things away (strength, vision, speech).

Feature	Migraine with aura	Stroke
How it starts	Gradually, building and spreading over several minutes	Suddenly, often all at once
Vision	Extra things: zigzag lines, flashing or shimmering lights, a blind spot that moves	Loss: sudden blurred or lost vision, often in one eye or one side, or double vision
Feeling and movement	Pins and needles that travel, e.g. from the hand up the arm to the face	Numbness or weakness on one side that appears at once; face drooping, arm can't be lifted
Headache	Usually follows the aura; throbbing, often one-sided, with nausea and light sensitivity	Often no headache; a sudden, severe 'worst ever' headache can be a bleed
History	Similar attacks before, often since a younger age	New and unlike anything before; more likely with age, high blood pressure, diabetes or smoking

These differences help but they aren't definite: some strokes come on in stages, and some rare migraines cause real weakness on one side. So don't use the table to talk yourself out of getting help.

What is the FAST test for stroke?

Face: has one side of the face dropped? Can they smile evenly?
Arms: can they lift both arms and keep them up?
Speech: is their speech slurred or muddled?
Time: if you see any of these, call 911 straight away and note when the symptoms started.

Other signs include sudden loss of vision, sudden severe dizziness or loss of balance, and sudden numbness on one side. For more on sudden numbness, read when numbness or tingling is an emergency.

When should you go to the ER for a migraine or stroke symptoms?

Call 911 or go to the ER now if:

Face drooping, weakness or paralysis in an arm or leg, or slurred speech, even if it goes away.
A sudden, severe headache that peaks within minutes, like the worst headache of your life.
Sudden loss of vision, or double vision that doesn't go away.
Confusion, trouble understanding speech, or extreme drowsiness.
A headache with fever and a stiff neck or a rash.
A seizure or passing out.
A headache after a head injury.

See a doctor the same day if:

It's your first-ever aura and it has fully passed with no stroke signs.
Your usual aura or headache has changed, or the aura lasts longer than an hour.
A new type of headache that started after 50.
A migraine that isn't responding to your usual treatment and has lasted more than a day.

Usually fine at home if:

A diagnosed migraine that is exactly like your usual attacks.
It responds to your usual treatment and rest in a dark, quiet room.
You have none of the red-flag signs above.

For when any headache is worrying, see when to worry about a headache: 8 red flags. If your headaches or dizziness follow vaping, read can vaping cause dizziness or headaches? and our main guide to vaping warning signs.

What should you do while waiting for the ambulance?

Note the time the symptoms started, or when the person was last known to be well.
Don't give food, drink or any medicine, including aspirin.
Help them sit or lie in a comfortable position, and stay with them.
Have a list of their medicines and conditions ready for the paramedics.

What happens when you come to Emergency Plus?

At the emergency department at Emergency Plus in Dabouq, emergency doctors are on site 24/7 and you can walk in without an appointment to have a severe or unusual migraine assessed. The doctor will ask about your symptoms and how they started, check your blood pressure and nervous system, and may request tests from the on-site laboratory. The team will explain the right next step for you. For any stroke sign, call 911 directly.

Not sure if it's an aura or a stroke?

For any FAST sign, call 911 and don't drive yourself. For a severe or unusual migraine without stroke signs, the emergency department at Emergency Plus in Dabouq, Amman is open 24/7 with no appointment, with an Arabic and English speaking team.

Call our 24/7 ER: +962 79 247 1313

Sources

Medical disclaimer: This article is for general information only and is not a substitute for professional medical advice, diagnosis, or treatment. If you think you are experiencing a medical emergency, call 911 or go to the nearest emergency department immediately. Emergency Plus in Dabouq, Amman is open 24/7 — +962 79 247 1313.