DOMINICA PADILLA KNEW something was wrong when she didn’t feel well enough to attend her son’s middle school football game in September 2023. “I had a headache. But it was a different headache than I was used to,” she says. She’d experienced migraines in the past, but this time, she just felt off in a way that’s hard to explain now.
Her headache also came with nausea and stomach-turning GI symptoms, causing her to question if she had food poisoning or the flu. So Padilla—just 35 at the time—rested. She drank fluids. She took ibuprofen and Tums. “I actually wanted to go to sleep and cover my head, but I’m glad I didn’t.”
She resorted to watching her son’s middle school game as it was streamed live on YouTube. As she stood to celebrate a big play he’d made (capturing the football and setting up the team for a touchdown), she collapsed. When she opened her eyes, “it seemed like someone was dimming the lights.” Then her vision shrank: It felt as if she were “looking through a straw.” She was numb. The left side of her body hurt and was weak. Her 9-year-old son was able to call 911.
As the operations manager for the department of medicine at Banner-University Medical Center in Tucson, Arizona, Padilla knew how to recognize a stroke. Her role at the hospital covered the cardiology division, where she had learned the signs and symptoms of a stroke from various meetings and lectures.
So when the EMTs arrived at her house, they didn’t see her distress as clearly as she did. “I was yelling that something was wrong with me, to please help me. They told me it was a panic attack and urged me to calm down,” she recalls.
Fortunately, she pushed hard and asked that they take her to a certified stroke center, which she knew could give her the most effective treatment. At the hospital, doctors confirmed that she’d had a stroke and gave her a tPA, an IV medication that breaks down blood clots that block the flow of blood in the brain. Although that saved her life, her diagnosis was murkier—doctors categorized her stroke as cryptogenic (a stroke without a known cause). Padilla needed time to recover. “I was paralyzed for about a month. With stroke rehab, I regained movement,” she says.
Today, she is a volunteer for the American Stroke Association. “People look at me surprised and say, ‘You had a stroke? You don’t look like that would happen to you,’ ” says Padilla. “That’s hard to hear, because I still suffer from the effects of my stroke.” While it’s been more than two years, she struggles with her vision, having blindness on the left side of each eye.
Padilla’s story illustrates an upward stroke trend happening in younger people that’s confounding experts. The numbers speak for themselves: 10 to 15 percent of all strokes occur in adults ages 18 to 49, a rate that’s been growing over time, according to a report from the CDC. In fact, other data revealed an 8 percent increase in death from stroke among young adults ages 25 to 34 years old over the past decade, according to a report recently published in Circulation.
“More young people are having strokes,” says Michelle Hu Leppert, MD, an assistant professor of neurology at Tufts Medical Center. “And as we started to research this, one thing that was shocking and disturbing to find was that women are having more strokes than men.” This discovery has triggered extra concern over how to protect women.
The reality is that for so long, we’ve looked at only the traditional risk factors for a stroke: hypertension, diabetes, high cholesterol. But now, experts are exploring why strokes happen in women specifically. To be clear, the original risk factors still matter greatly, and addressing them represents a distinct way to lower one’s individual risk. However, it’s obvious that there’s more going on for women—and understanding what is key to saving lives.
What Happens During a Stroke
First things first: You should know that there are several types of strokes. The most common one is an ischemic stroke, which is when a blockage in an artery interrupts blood flow to the brain. A hemorrhagic stroke, sometimes dubbed a “brain bleed,” happens when a blood vessel in the brain ruptures. There is also a transient ischemic attack, a.k.a. a TIA or mini-stroke, which is a short-term blockage in an artery. Additionally, a brain stem stroke occurs if blood flow to the brain stem is blocked or reduced.
Finally, there are cryptogenic strokes like Padilla’s—an ischemic stroke with no identifiable cause, which often happens in healthy people (they’re also more common in African American and Hispanic people).
Some strokes that are unusual in the general population are vastly more common in young adults. “Typically, a stroke that happens to someone who is 25 years old does not occur for the same reason as someone who is 85,” says Eliza C. Miller, MD, an American Stroke Association national volunteer expert and division chief of women’s neurology at the University of Pittsburgh Medical Center.
One of the most common causes she sees in her younger patients is cervical artery dissection. This is when a carotid or vertebral artery in the neck develops a tear, resulting in a blockage in the artery or the formation of a clot that flies off into the brain, leading to a stroke. Among adults under age 50, dissection is responsible for one in four ischemic strokes, compared to just 2 percent of strokes across all ages, according to a study published in Stroke.
The Female Factor
Women bear several risk factors for a stroke that are less common or nonexistent in men. The first: Migraine—especially migraine with aura—is emerging as one of the reasons strokes affect women differently than men. Migraine was once viewed as a “bad headache,” but there’s been a push to recognize it accurately as a disabling neurological disease. It’s most frequent in 20- to 50-year-olds and up to four times more common in women (likely due to hormonal fluctuations). “We found that a lot of strokes are associated with migraine,” says Dr. Leppert. Among adults ages 18 to 55 who’d had a stroke, migraine was associated with 35 percent of them in women, according to a 2025 study that Dr. Leppert coauthored.
The challenge here is that while the association is becoming clearer, the ability to do anything about it—in other words, actually preventing strokes in people with migraine—is not yet there, says Dr. Leppert. What you can do, though, is understand your own migraine symptoms. Symptoms of migraine and stroke often overlap, so knowing what is “normal” for you will help you distinguish typical signs from more serious and sudden stroke-related ones.
Then there’s pregnancy. Your ob-gyn pays close attention to your blood pressure for a reason. “Pregnancy is an extremely high risk factor for stroke,” says Louise McCullough, MD, PhD, a professor and codirector at UTHealth Houston Neurosciences. “We know that women who have hypertensive disorders in pregnancy, such as preeclampsia or eclampsia, have a higher risk for bleeding in the brain.” In fact, you may have an 80 percent higher likelihood of stroke if you have preeclampsia than if you don’t, some research shows. Also keep in mind that risk doesn’t go away after delivery—vulnerability persists into the early postpartum period, and even well beyond, into your 70s or 80s, she notes. “Pregnancy is a stress test, or a window, into future health,” says Dr. McCullough.
Hormonal shifts happen throughout life, though, and menopause represents another susceptible time. “We know that women likely experience a spike in ischemic stroke risk around menopause, probably due to hormonal change,” Dr. McCullough says. One treatment for general menopause symptoms is menopause hormonal therapy(MHT), so it’s critical to discuss your individual situation with a menopause-informed doctor who can advise on what’s best for you. In general, starting MHT around the time of menopause and using a patch instead of an oral pill can mitigate risk of meno symptoms (and, hypothetically, tamp the fluctuations that may also lead to stroke).
In addition, primary ovarian insufficiency (sometimes called premature ovarian failure), early-onset menopause (before age 45), and taking estrogen for gender-affirming care as a transgender woman are also associated with a higher stroke risk.
Endometriosis sufferers need to be extra aware, too. The condition occurs when endometrial tissue grows outside the uterus, causing inflammation, hormonal problems, bowel and bladder dysfunction, and infertility. Women with endometriosis have a 16 to 34 percent increased risk of stroke, research shows. They’re also more likely to have hypertension, high cholesterol, and inflammation, all of which can contribute to stroke. “Endometriosis can cause a lot of inflammation, and anything that causes inflammation can make platelets stickier and more likely to adhere to blood vessels and contribute to the formation of a clot,” says Dr. McCullough.
Is Prevention Really Possible?
Even with so many female-specific risk factors in play, we can’t forget about lifestyle, which could be a contributing piece of the “why” puzzle for the stroke rate rise in younger folks. Having high blood pressure, diabetes, obesity, or high cholesterol, being inactive, eating an unhealthy diet, and smoking all matter when it comes to the health of your arteries, including those that feed your brain.
As clichéd as it sounds, stroke prevention starts at home. “Some of the most important and treatable stroke risk factors, particularly high blood pressure, can begin much earlier in life,” says Lauren Patrick, MD, a stroke neurologist at the University of California San Francisco.
She singles out high blood pressure for a reason: More than 90 percent of women ages 18 to 44 now have uncontrolled high blood pressure, according to a study in JAMA Network Open. Even more alarming, nearly 70 percent don’t know they have hypertension. This is why hypertension is often dubbed “the silent killer”—most people don’t have symptoms and may not even know it’s an issue for them. “Regular blood pressure monitoring is one of the most impactful steps a woman can take to reduce stroke risk,” Dr. Patrick says. Check yours at a medical office, a pharmacy, or at home.
Maintaining healthy blood pressure is part of theAmerican Heart Association’s Life’s Essential 8, widely regarded as a strategy for preventing cardiovascular problems in everyone, says Dr. Miller, who coauthored the 2024 Guideline for the Primary Prevention of Stroke. The key recs are to follow a healthy diet (Mediterranean is recommended), engage in physical activity, maintain a healthy weight, get good sleep, avoid tobacco, and keep blood cholesterol, glucose, and blood pressure levels in the healthy range.
Still, even the healthiest among us are not immune to stroke. Trauma can cause an artery tear (dissection) in the neck, something that can happen spontaneously after a car accident, a roller coaster ride, helping your neighbor move a couch, aggressive chiropractic manipulation, waterskiing, or—gulp—weightlifting, says Dr. McCullough. This is not a call to stop with the weights (or skip the line for the Maxx Force) but a message that doctors shouldn’t be fooled by the fit person in front of them—and you shouldn’t be either.
Perhaps the best thing everyone can do is learn the symptoms and signs of a stroke. Every second counts—and this is ultimately what saved Padilla. The faster you get help, the better off you’ll be. A common acronym for identifying stroke in yourself or others is FAST, which stands for face drooping, arm weakness, speech difficulty, and time to call 911.
FAST is a helpful mnemonic device, yes, but women have additional things to look for. While about three-quarters of young adults who had a stroke had FAST symptoms, the rest had less expected signs, like headache, vision loss, vertigo, neuropsychiatric changes (such as anxiety, mood change, agitation), nausea, or reduced sensory processing (such as the inability to feel a light touch or temperature).
When it comes to head pain, be on the alert for a terrible, sudden, worst-of-your-life headache. “I was talking to a woman who had a hemorrhagic stroke postpartum,” says Dr. Miller. “She described her symptoms as an explosive, horrible headache, but it didn’t occur to her that it could be a stroke, because of her age. She was in her early 30s.”
Headache is a symptom whose cause is tough to tease out, especially if you tend to have migraines to begin with. But what’s important to remember is that something that comes on suddenly and is out of the ordinary is a major red flag. Stroke is unlikely to start as a low, slow simmer. If your headache and other symptoms are following the pattern they typically do when you get a migraine, then it’s likely not a stroke. (It goes without saying, but have a detailed discussion with your doctor if you have migraine symptoms you’re worried about.)
Most important, if you’re thinking, This doesn’t feel right, get checked. Prompt treatment can also prevent future problems. “The highest risk for a recurrent stroke is in the next 30 days,” says neurologist Jayne Ward, DO, a professor and the chair of the department of neurology at Michigan State University in East Lansing. “Don’t wait at home over the weekend and say you’ll call on Monday.”
Why Time Is Brain—and How to Save Your Own Life
It should light a fire under you (or a loved one) if one minute you’re fine and the next you’re not. Sudden onset is an overwhelmingly common feature of stroke. “You need to come to the ER. There are things we can do to reverse the disability from a stroke,” says Dr. Leppert. “With the exception of headache, a lot of times strokes don’t hurt. Sometimes I wish that strokes hurt more so that people would call 911,” says Dr. Miller. “For all kinds of strokes, the sooner you’re treated, the better outcome you will have.”
Another big mistake, says Dr. Miller, is driving yourself to the ER if you live close to the hospital. Don’t do that. (Also, don’t ask your partner to come pick you up and drive you.) Calling 911 activates a “stroke chain of survival,” in which everyone from EMTs to vascular neurologists, neurosurgeons, and cardiologists is prepared to start care when needed.
That’s why you should mention stroke when you call and when you arrive at the ER for evaluation. (Padilla was specific with her wording, which made a big difference in her eventual care.) Emergency personnel and doctors may hold biases about what a stroke patient looks like, which contributes to misdiagnosis and lack of follow-up to help reduce the risk of another stroke, according to research in the Journal of Clinical Neuroscience.
When the EMTs told Padilla she was having a panic attack—the symptoms of which include sweating, shaking, nausea, headache, dizziness, and numbness—she knew otherwise, but not everyone would be as certain. While it is up to care providers to recognize stroke symptoms, to take them seriously, and to start the proper testing, unfortunately it’s sometimes the patient who has to speak up. “Especially for younger patients, sometimes you can’t take no for an answer,” says Dr. Miller. “You shouldn’t have to advocate for yourself or a loved one, but sometimes you have to.” Hopefully, it’s a false alarm and not a stroke, but, she adds, “I’d much rather you come in anyway.”
The refrain from every neurologist Women’s Health talked to for this story was: Time is brain. “We lose millions of neurons every minute that we don’t get effective blood flow to the brain,” says Dr. McCullough. Fortunately, there are good treatments for stroke—but they’re time-sensitive.
While some risk factors differ between men and women, treatment is the same across the board. One treatment for ischemic stroke is the clot-buster drug tPA, an injection that dissolves blood clots. (The catch is that tPA needs to be given within 3 to 4.5 hours from the time symptoms start.)
There’s also a thrombectomy, which is a minimally invasive procedure that can be used with or in lieu of medication; it employs a device that basically goes in and sucks out the clot. “The best thing for your brain is to get blood flow going again,” says Dr. McCullough. “We see patients who come into the hospital who are paralyzed on one side and unable to see or talk, and they get a thrombectomy and can walk out of the hospital two days later.” A thrombectomy is typically done within six hours of symptom onset. Even people who are treated within 12 to 24 hours—or longer—may benefit. Bottom line: Get help, and the quicker, the better.
Padilla credits her 9-year-old for saving her life with his quick-action call to 911, but it was also her recognition of FAST symptoms.
Given that she was diagnosed with a cryptogenic (unknown cause) stroke, she remains at high risk for a future stroke. “For me, learning more about stroke and being around the stroke community has shown me the importance of doing what I can to take care of myself and my health,” she says. “I’m more active than I ever was with walking and strength training, and my life before my stroke was nonstop busy and stressful. It was the wakeup call I needed to slow down more.”
And yes, a great reminder to always, always listen to your gut and never be afraid to speak up and advocate for your own health.
Watch for These Signs
Strokes in women don’t always show up as doctors expect. Here’s a list of symptoms that experts say should raise an alarm. If any of the below come on quickly and severely and are outside your ordinary, call 911.
• Anxiety
• Confusion
• Double vision
• Face and neck pain
• Facial droop
• Inability to speak
• Numbness
• Slurred speech
• Sudden-onset headache
• Sudden-onset vertigo
• Tingling
• Vision loss
• Weakness on one side of the body
