Comparing Stroke Symptoms: Tips for Discerning Emergency Levels from the “Strength” and “Description” of Headaches

The speed of onset, intensity of headache, and presentation of paralysis differ critically among the three types of stroke: Ischemic Stroke (vessel blockage), Intracerebral Hemorrhage (vessel rupture), and Subarachnoid Hemorrhage (aneurysm rupture). Knowing these symptom differences provides vital information for doctors to make a rapid diagnosis in an emergency setting where every minute counts.

Symptom Differences Across the Three Types of Stroke

SymptomIschemic Stroke (Cerebral Infarction)Intracerebral HemorrhageSubarachnoid Hemorrhage (SAH)
Speed of OnsetSlow to suddenSuddenInstantaneous, like being struck by lightning
HeadacheRarely strong (10–20%)Strong to severe (50–70%)Worst headache ever experienced (≥90%)
Headache Description“Heavy,” “throbbing” (mild)“Hit by a bat,” “explosion”“Struck by lightning,” “Hit by a hammer” (Full-swing)
Nausea/VomitingInfrequentFrequent (over half)Extremely Frequent (≥80%)
One-sided Paralysis/Numbness◎ Almost always present◎ Often present△ Infrequent (if present, usually delayed)
Slurred Speech (Dysarthria)◎ Often present◯ Present△ Infrequent
Consciousness Maintained?◯ Usually maintained△ Quickly become dazed/sluggish× Over half lose consciousness immediately
Sudden Death RiskLowMediumExtremely High (40% die before arrival)
Clearest Sign“Wake up in the morning and one hand doesn’t move.”“Sudden, splitting headache during activity + paralysis.”“Worst headache of lifeexplodes without warning!”

Quick Guide for the Scene (Tips to Distinguish the 3 Types)

SituationAlmost 100% This!
Sudden, worst-ever headache + Immediate collapse→ Subarachnoid Hemorrhage!!
Severe headache + Nausea + Paralysis→ High probability of Intracerebral Hemorrhage
Almost no headache, just one-sided paralysis→ Ischemic Stroke! (Especially if noticed in the morning)

Actual Patient Quotes (Real-Life Examples)

  • Ischemic Stroke: “I tried to get up to use the restroom this morning, but my whole right side was completely paralyzed… My head didn’t hurt.”
  • Intracerebral Hemorrhage: “I strained myself, and suddenly my head went KA-BOOM! I threw up repeatedly and couldn’t stand up.”
  • Subarachnoid Hemorrhage: “I was just watching TV, and suddenly it felt like a hammer had been swung full-force against the back of my head…”