Migraines are a specific neurovascular disease marked by throbbing (hammering in the head) pain in the head. The pain can manifest as recurrent headaches and is often associated with autonomic nervous symptoms. The pain normally persists unilaterally and has a pulsatile nature. It persists for 2 to 72 hours. Most of the episodes are idiopathic; however, physical activity has been shown to aggravate the pain of migraine. The other symptoms apart from pain include extreme sensitivity to light, sound, or smell and are often associated with vomiting or nausea. The epidemiology of migraines is represented with increased prevalence in boys compared to girls, until the onset of puberty. However, after puberty the ratio reverses, and females are more prone than males. The basic contributory factors are genetic and environmental.

Pathophysiology includes increased excitability of the cerebral cortex and central sensitization of neurons in the trigeminal nucleus and brainstem. This leads to abnormal control of pain. Migraines are also associated with hormonal levels. Treatment includes symptomatic relief from pain and nausea. Migration is divided into four phases: prodrome (marked by depression, mood alterations, and fatigue), aura (a specific visual or sensory compulsive phenomenon), pain phase (lasting 2-72 hours), and postdrome (impaired digestion, weakness, and mood fluctuations). Food and environmental factors can trigger migraines. An increased level of serotonin has been associated with the development of migraines. The International Headache Society has classified migraines according to the type and frequency of pain attacks. The symptoms of glaucoma, subarachnoid hemorrhage, and meningitis often mimic migraines.

Stroke is a condition marked by poor perfusion (decreased flow) of blood in the brain. It is also referred to as a “cerebrovascular assault” or “brain attack.” It is classified as two types—ischemic and hemorrhagic. In the former case, the blood supply to the brain is decreased; and in case of the latter, the brain is devoid of appropriate blood flow due to bleeding (for example, subdural hematoma). The symptoms of stroke include neurological deficits in one half of the body, specifically in the extremities. Further, there are cognitive disabilities in orientation of speech, vision, and in vestibular apparatus. A stroke that persists for less than two hours is called a “transient ischemic attack.” Headaches can occur if there is excessive bleeding.

The major risk factors are high blood pressure and increased after-load of the heart. Both these conditions lead to ventricular failure; and, therefore, cardiac output is decreased, which reduces blood flow in the brain. In other instances, the blood can become hypercoagulable, and cholesterol plaques may form in the cerebral vessels. This creates emboli that produce obstruction in the flow of blood, leading to the ischemic episode. Diagnosis of stroke includes an MRI and CT scan. Often echocardiography is done to evaluate the ejection fraction of the ventricles to confirm the etiology of stroke. The symptoms of stroke are often confused with subdural hematoma. Management of stroke includes administration of anticoagulants like aspirin for the purpose of prophylaxis. Treatment of associated conditions like hypertension and dyslipidemia (impaired LDL/HDL ratio) is done with antihypertensive and lipid lowering agents respectively.

Figure: Represents lack of decreased blood flow to a portion of the brain (the area indicated by white arrow)

Comparison of Migraine and Stroke is given below:

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