Stroke: Knowing the warning signs in women

It wasn't supposed to happen to her. Just 32 and pregnant, Holly Carson woke with a crushing headache.

"It was ... like if somebody had a baseball bat taken to (my) head," says Carson.  Having some medical training, she immediately suspected she was having a stroke.

At 26, med student Lauren Barnes' migraine took a turn for the worse. Then, "I had a rush of pins and needles sensation and tingling throughout the entire right side of my body," she says.

Stroke isn't just for the elderly, as Carson and Barnes can attest.  Scientists have known for some time that women have some risk factors for stroke that are unique to them and others that are more commonly seen in women than men.

To make women more aware, the American Heart Association released the first guidelines for the prevention of stroke in women on Thursday. "Prevention can start when women are very young, during childbearing years," says Dr. Cheryl Bushnell, chair of the American Heart Association/American Stroke Association writing group and an associate professor of neurology and stroke director at Wake Forest Baptist Medical Center in Winston-Salem, North Carolina.

Awareness is key, because when it comes to strokes, "time lost is brain lost," according to the AHA.

Stroke 101
A stroke is often referred to as a brain attack because, like a heart attack, it's usually caused by a clot blocking blood flow in a vessel. With stroke the blockage is in the brain, and without "food" the affected area starts to die. A small percentage of strokes are caused by bleeding in the brain from a ruptured blood vessel instead of a blockage.

Stroke recommendations unique to women:

Women have certain stroke risk factors that are unique to their sex such as pregnancy, blood pressure disorders brought on by pregnancy, oral contraceptives and postmenopausal hormone use.  Many of the new guidelines focus on managing blood pressure, one of the best ways to help prevent stroke.

– High blood pressure before pregnancy
If a woman wanting to start a family has high blood pressure, it's recommended that she be considered for low-dose aspirin and possibly calcium supplements to lower the risk for blood pressure disorders during pregnancy.

– High blood pressure during pregnancy
If a pregnant woman is suffering from moderately high blood pressure, the new guidelines suggest she talk to her doctor about possible treatment. If blood pressure numbers continue to climb, women should get treated with safe and effective medicines. Some hypertension drugs are known to be dangerous to a mother-to-be and child, so consult with your doctor.  After delivery, moms should continue to have their blood pressure checked regularly.

– History of preeclampsia
After getting pregnant, some women develop high blood pressure along with high protein in the urine. This disorder is called preeclampsia and between 3% to 8% of pregnancies in the United States are affected. Experts aren't sure of its cause but know it increases the chance of stroke during pregnancy and long after the baby is born. Having preeclampsia doubles the risk of stroke and quadruples the risk for high blood pressure later in life.

Because of these concerns, the new guidelines urge doctors and patients to take this condition seriously, not only by routinely monitoring blood pressure during the childbearing years and beyond, but treating other lifestyle problems early as well such as smoking, high cholesterol and obesity.

– Birth control pills 
Women should be screened for high blood pressure before taking birth control pills because the combination can double the risk for stroke. If you smoke, don't take the Pill, because it also increases the likelihood of stroke.

– Hormone replacement therapy
For years doctors thought hormone replacement therapy after menopause would protect women from heart disease and stroke. That's been questioned for a decade now.  These new guidelines clearly state: "Hormone replacement therapy should not be used to prevent stroke in postmenopausal women."

Risk factors more common in women:
The new guidelines also highlight health issues that are more common in women than men, such as migraines with aura (distortions in vision and hearing) and atrial fibrillation, a type of irregular heartbeat.

– Migraines with aura
Women are four times more likely to have migraines than men. Rarely do they lead to stroke, but migraines with aura may be different, especially in women who also smoke. The new recommendations suggest "smokers who have migraines with aura should quit to avoid higher stroke risk."

– Irregular heartbeat
Atrial fibrillation is an irregular heartbeat in the upper heart chambers and is much more common in the elderly.  The condition quadruples stroke risk and is more common in women than men after age 75, which is why the AHA/ASA recommend all women over age 75 get screened for this arrhythmia.

Diabetes, depression, and emotional stress are additional stroke risk factors more common in women than men, but because treatment options are similar between the sexes, there are no new recommendations in the stroke guidelines.

Carson and Barnes are doing well today because they both recognized the signs of stroke and got help right away. A quick way to learn the warning signs is by remembering F.A.S.T.
F – Face drooping
A – Arm weakness
S – Speech difficulty
T – Time to call 911

Stroke can also cause numbness in the face, arms and legs, especially on one side, problems with walking and balance, sudden confusions and problems with understanding, vision problems in one or both eyes and a sudden headache with possible vomiting.

Barnes has recovered completely and continues medical school. Carson delivered a healthy baby, but despite rehab still has some limitations. She has little use of her left arm and hand and when people stop to ask her about it she tells them her story and talks about the warning signs.

"I've allowed this to be a living message for others. A stoke didn't ruin my life - it changed it," Carson says.