Whether It’s a Stroke or Migraine, Never Ignore These Symptoms

Even though CBS reporter Serene Branson did not end up having a stroke, the disturbing viral video of her on-air health scare was a serious symptom not to be ignored. She struggled to give her live broadcast, and obviously frightened herself as she tried to speak while only garbled words came out.

Posted on | Leigh Vinocur, MD FACEP | Comments ()

Even though CBS reporter Serene Branson did not end up having a stroke, the disturbing viral video of her on-air health scare was a serious symptom not to be ignored. She struggled to give her live broadcast, and obviously frightened herself as she tried to speak while only garbled words came out.

This is a type of communication problem is called aphasia and it can be a sign of a stroke. All this was particularly worrisome in light of a brand new study from the Centers for Diseases Control and Prevention (CDC) that had just been presented at the recent American Stroke Association meeting. This was the first large scale nationwide study that looked at hospitalizations of stroke according to age from the period of 1994 through 2007. The results showed an alarming increase in the number of hospitalizations for strokes occurring in teens and young adults under the age of 45.

Branson’s workup showed she was not having a stroke, but a migraine with an aura also called a complex migraine. She reported that after this episode on-air her producer immediately called 911 and she was evaluated by EMS. Since her symptoms had resolved, she opted to go home instead of going to the ER to be checked out. This was a big mistake, which fortunately for her didn’t result in a tragedy. These types of symptoms are very serious and should never be dismissed.

In fact, when she did go to see a physician the following morning she reported that she was sent for 3 days worth of testing to make sure this was not the symptom of a stroke or transient ischemic attack (TIA). TIAs are called warning or mini-strokes even though the symptoms resolve on their own; they often put you at risk for a future stroke. A recent British study found as many as 70% of patients were unaware that they had suffered a minor stroke or TIA and delayed seeking medical attention. We now think of a TIA as “angina of the brain.” Often it is caused by a blockage or very small clot in an artery of the brain that dissolves on its own. According to the National Institutes of Health, about one-third of patients will go on to eventually have a full-blown stroke. Other studies found some patients will go on to full blown stroke within 1 week.

According to the American Heart Association almost 800,000 people suffer a new or recurrent stroke each year. Strokes will kill about 140,000 people a year in United States. They are the 3rd leading cause of death today in the US, behind heart disease and cancer. They are also the leading cause of disability today. Most strokes, called ischemic strokes, are caused by blockage or clot in an artery of the brain as opposed to broken blood vessel, called a bleeding stroke. Because there are medications now available to break up the clot and restore the blood flow similar to treatment for heart attacks, we think of these types of ischemic strokes as a “brain attacks.” This is why it is imperative to get to an ER for evaluation if any symptoms or warning signs occur, preferably within optimal 3 to 4-hour window for treatment. 

It is critical to be aware of the signs and symptoms of a stroke or TIA which include sudden onset of the following:

  • Numbness, weakness, paralysis, of face arm or leg especially one side of the body
  • Trouble seeing, double vision, things suddenly blurry
  • Confusion or trouble understanding speech
  • Slurred or garbled speech
  • Trouble walking unsteady gait dizziness or clumsiness
  • Severe headache

Similar to heart disease, the things that put you at risk for having a heart attack by clogging the arteries in your heart also can clog the arteries supplying blood to your brain. These risk factors are the following; smoking, poor diet and high cholesterol, not enough exercise or physical activity as well as diabetes, high blood pressure and obesity.

For younger women other risks also include taking oral birth control pills, autoimmune disease such as lupus as well as clotting diseases of the blood. Another big risk factor for women is migraines with an aura, such as the one suffered by Branson.

Migraines are a type of headache called a vascular headache in which the sensitive blood vessels in the brain respond to the sympathetic nervous system. This system also affects the GI tract and that is why nausea and vomiting can be associated with migraines too. Only about 20% of migraines have an aura, which causes symptoms similar to stroke symptoms. These occur usually before the headache.

Sometimes these symptoms might be flashing lights and visual problems, muscle weakness or difficulty speaking. The blood vessels in the brain contract during the aura then dilate causing the headache. Recent studies have shown women who frequently have these complex migraines with aura were almost twice as likely to have a future stroke. And the risk was increased even further if they had any of the other risk factors such as taking oral birth control pills, having high blood pressure or if they are smokers.

The fact the Branson had this type of migraine actually puts her at greater risk for a future stroke. The key lesson to be learned from all of this is that you cannot and should not on your own; discern whether it is stroke or migraine. At the first sign of these symptoms call 911 and get to and ER right away. Your grandmother’s old saying “better safe than sorry” really applies here!

Blog written by Leigh Vinocur, MD FACEP
Dr. Leigh Vinocur is a board certified emergency physician and national spokesperson for the American College of Emergency...