Migraine or TIA?
“It’s common when the patient presents the first time [with migraine without headache] to consider a stroke or TIA,” says Matthew Robbins, MD, director of the neurology residence program at the New York Presbyterian/Weil Cornell Medical Center, and member of the ANA.
“If you get an aura without headache one time, it might look like a TIA, but if it happens often, it’s probably a migraine,” adds Silberstein.
Robbins points out that typical aura entails a mix of symptoms—both negative and positive, both loss and addition. For example, the patient might have both numbness and tingling; loss of vision and flashes of color or patterns. Stroke, on the other hand, is more likely to present with only loss.
“Another important difference between stroke and migraine is that migraine aura is migratory, it moves around the body,” Robbins points out. “The numbness might be on one side and then on the other. With stroke, it stays on one side of the body.”
When additional testing is not conclusive for stroke, gastrointestinal issues, or other neurologic problems, it’s time to call on your inner Sherlock Holmes. “Listen carefully. Take a good history. Pay attention to the sequence of events and try to understand the pattern,” says Robbins. “Listening well is our most important tool.”
“Listen carefully. Take a good history. Pay attention to the sequence of events and try to understand the pattern,” says Robbins. “Listening well is our most important tool.”