VHOSPITAL.CLINIC · Differential Diagnosis
Migraine vs Stroke
Clinical comparison — shared symptoms, key differences, distinguishing diagnostic tests, treatment pathways, and when to seek urgent evaluation.
Condition Overview
Condition A
Migraine
Migraine is a neurological disorder characterized by recurrent, severe headaches often accompanied by nausea, vomiting, and sensitivity to light and sound. Attacks can last 4–72 hours and significantly impair daily functioning.
Condition B
Stroke
A stroke occurs when blood supply to part of the brain is cut off (ischemic) or a blood vessel ruptures (hemorrhagic), causing brain cells to die. Fast action is critical — every minute matters. Use the FAST acronym: Face drooping, Arm weakness, Speech difficulty, Time to call emergency.
Shared Symptoms — Why They're Confused
Both conditions present with 4 overlapping symptoms, making clinical differentiation essential.
Key Clinical Differences
Migraine
- Unilateral throbbing headache with aura (visual scintillations, sensory tingling)
- Aura typically lasts 20–60 min and fully resolves
- Positive (spreading) phenomena during aura
- No motor deficit; headache follows aura
Stroke
- Sudden focal neurological deficit (face, arm, speech, vision)
- Deficits maximal at onset — no spreading
- May have no headache (silent stroke)
- Deficits persist >24 h (or cause death/disability)
Distinguishing Diagnostic Tests
| Test | Migraine | Stroke |
|---|---|---|
| Time course of aura/deficit | Aura spreads slowly over minutes (cortical spreading depression) | Deficit maximal at onset — vascular occlusion pattern |
| MRI brain with DWI | Normal DWI — no ischaemia (unless hemiplegic migraine) | Restricted diffusion in vascular territory — ischaemic stroke |
| Symptom type | Positive symptoms: visual flashes, tingling, spreading wave | Negative symptoms: vision loss, numbness, weakness, aphasia |
Treatment Approaches
When Doctors Consider Each Diagnosis
🔵 Consider Migraine when:
- →Spreading positive aura, fully resolves, recurrent headache history, normal DWI
🟢 Consider Stroke when:
- →Maximal deficit at onset, negative symptoms (loss of function), DWI infarct
Explore Each Condition in Detail
Related Clinical Pages
Medical References
Content on this page is informed by evidence-based clinical sources including:
- World Health Organization (WHO)Global health guidance and disease classification
- National Health Service (NHS)UK clinical guidelines and patient information
- National Institute for Health and Care Excellence (NICE)Evidence-based clinical practice guidelines
- Centers for Disease Control and Prevention (CDC)US public health data and clinical recommendations
- PubMed – NCBIPeer-reviewed biomedical literature and clinical studies
- Cochrane LibrarySystematic reviews and meta-analyses in evidence-based medicine
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