10 Warning signs of a stroke that can appear a month in advance

Time is brain! Every minute counts when it comes to treating a stroke.

Life’s busy, right? You’re juggling work, family, and a to-do list that never seems to end. It’s so easy to ignore that weird little twitch, that fleeting dizzy spell, or that headache you brush off as ‘just stress.’ But what if it’s not ‘just stress’? What if it’s your body’s version of a ‘check engine’ light, blinking urgently about something serious?

Let’s get real for a second. CDC reports that every 40 seconds, someone in the United States has a stroke. And every 3 minutes and 14 seconds, someone dies from one. This isn’t just a problem for the elderly; in 2014, a startling 38% of people hospitalized for stroke were under the age of 65. Here’s the good news, though.

A full-blown stroke often doesn’t come out of nowhere. Your body can send out warning flares days, weeks, or even a month in advance.

The “mini-stroke” that’s a huge deal

First things first, let’s get one thing straight: there’s nothing “mini” about a mini-stroke. The official term is Transient Ischemic Attack (TIA). It’s a brief episode where blood flow to the brain gets temporarily blocked, causing all the classic stroke symptoms. However, the clot dissolves or dislodges on its own, and the symptoms subside. This can occur in just a few minutes, and most TIAs typically resolve within an hour.

And that’s precisely what makes them so dangerous. Because the symptoms go away, it’s incredibly tempting just to brush it off. You feel weird, then you feel fine. Crisis averted, right? Wrong. So, so wrong. The underlying problem; be it a clogged artery from plaque buildup (atherosclerosis), a clot from an irregular heartbeat (atrial fibrillation), or another vascular issue—is still there, waiting.

The American Heart Association reports that ten percent to 15% of patients with TIA have a stroke within 3 months, with half occurring within 48 hours.

The sudden, unusual headache

We all get headaches. But the kind that can signal an impending stroke is different. It’s not your typical tension headache from staring at a screen all day. This is what’s known as a “sentinel headache,” which appears suddenly and severely, often with no apparent cause.

A 2020 National Institutes of Health study found that this type of warning headache occurred in 14.7% of people who later had an ischemic stroke (the kind caused by a clot). These headaches weren’t just bad; they were described as being different from any previous headache the person had ever experienced. They typically started within a week of the stroke and often lasted right up until the main event.

For a hemorrhagic stroke, where a blood vessel actually bursts in the brain, the headache can be even more dramatic. It’s often called a “thunderclap” headache—a sudden, excruciating pain that’s frequently described as the “worst headache of your life”.

So, if you experience a headache that feels brand new in its intensity or type, don’t just pop a painkiller and hope for the best. Treat it as a vascular alarm bell.

When your vision suddenly goes weird

This is the “E” for Eyes in the expanded “BE FAST” stroke acronym, and it’s one of the most overlooked signs. Stroke-related vision problems come on suddenly and can manifest in a few different ways:

• Blurred vision in one or both eyes.
• Seeing double (a condition called diplopia).
• A complete, painless loss of vision in one or both eyes.

Sometimes it can feel like a curtain or shade is being pulled down over one eye (this is called amaurosis fugax), or you might lose the left or right half of your visual field in both eyes.

These fleeting vision problems are a classic symptom of a TIA. In one real-life case highlighted by neurologist Dr. Sudhir Kumar, a 60-year-old man kept having episodes of blurred vision that lasted only a minute or two. He brushed them off. An eye exam showed nothing wrong with his eyes, but a scan of his neck revealed an 80% blockage in his carotid artery—a major highway for blood to the brain. Those vision blackouts were his body’s “SOS signals”.

The key takeaway here is that sudden, painless vision loss is not an eye problem, but rather a brain problem.

You might also be interested in: A Simple Eye Exam Can Catch These Serious Diseases

A sudden loss of balance or coordination

This is the “B” for Balance in BE FAST. You’re walking along just fine, and then suddenly, you’re stumbling. Or you’re sitting still and the whole room starts spinning (vertigo). This isn’t just feeling a little lightheaded from standing up too fast. This is a sudden, unexplained loss of your body’s ability to perceive its position in space. It can feel like:

• Sudden, intense dizziness.
• Trouble walking in a straight line.
• A general feeling of clumsiness or lack of coordination.

These symptoms are often associated with strokes that occur in the back of the brain, specifically in the cerebellum or brainstem. The cerebellum is the coordination command center of your body.

As Dr. Sam Laali, MD, a neurologist on the medical staff at Baylor Scott & White Medical Center – Grapevine, explains, “Posterior circulation strokes can be tricky to recognize” because they often don’t present with the more familiar symptoms of a stroke, such as a drooping face or a weak arm.

But he stresses, “To be safe, it is still important to get evaluated as soon as possible.”

That “pins and needles” feeling or weakness

This is probably the most famous stroke sign of all: a sudden numbness or weakness, especially when it’s all on one side of your body. It can affect your face, your arm, your leg, or all three. This is the “A” for Arm in the F.A.S.T. test. The check is simple and powerful: ask the person to raise both arms. If one arm starts to drift downward, that’s a huge warning sign.

The one-sided nature of this symptom is the most important clue you have. Our brains are cross-wired; the left side of the brain controls the right side of the body, and vice versa. A stroke is usually a localized event—a blockage in one specific artery feeding one specific part of the brain.

So, a clot in the left motor cortex will cause weakness on the right side of the body. It’s a very clear cause-and-effect relationship. While other things can cause weakness, like a pinched nerve or just being tired, they rarely produce such a sudden, clean, one-sided deficit. This symptom is a powerful predictor.

One study found that one-sided weakness was present in 58% of actual TIA cases, but in only about 29% of cases that turned out to be something else.

Pay attention to asymmetry. It’s not just about feeling weak; it’s about feeling weaker on one side than the other.

A droopy, uneven smile

This is the “F” for Face in F.A.S.T., and it’s another classic, easy-to-spot sign. When a stroke affects the part of the brain that controls facial muscles, one side of the face can suddenly go slack or feel numb.

The test is incredibly simple: ask the person to smile. If the smile is uneven, lopsided, or one side of their mouth droops, that’s a red alert. This is a core component of every major stroke recognition tool for a reason.

The power of the “smile test” lies in its objectivity. A person having a stroke might be confused or even unaware that anything is wrong (a condition called anosognosia). If you ask them, “How do you feel?” they might say, “I’m fine!”

But asking them to perform a simple action like smiling is a functional test. A droopy smile isn’t a feeling; it’s visible, undeniable proof that the brain’s signals aren’t reaching the facial muscles correctly.

This simple command transforms you from a worried bystander into an active data-gatherer. It gives you a piece of hard evidence that empowers you to make the right call—dialing 911—based on what you see, not just what you’re told.

When words get jumbled

This is the “S” for Speech in F.A.S.T., and it can be one of the most frightening symptoms for the person experiencing it.

It can show up in a couple of different ways:

• Slurred or garbled speech (dysarthria): The person knows what they want to say, but the words come out thick and hard to understand, as if their mouth isn’t working properly.
• Trouble with language (aphasia): This is a deeper problem. The person might struggle to find the right words, use the wrong words, or not be able to speak at all. They might also have a hard time understanding what you’re saying to them, even if you speak clearly.

The F.A.S.T. test for this is to ask the person to repeat a simple phrase, like “The sky is blue” or “You can’t teach an old dog new tricks.” If their speech is unusual or they struggle to repeat it correctly, it’s time to seek help.

An abrupt wave of nausea or vomiting

This one is less common and can be easily misinterpreted, but it’s an important warning sign to be aware of. A sudden, unexplained bout of nausea or vomiting that isn’t related to a stomach bug or food poisoning can absolutely be a symptom of a stroke.

This symptom is noted as being more common in women, who sometimes experience more “atypical” stroke signs that are easy to explain away. It’s also a hallmark of those tricky-to-diagnose posterior circulation strokes—the ones affecting the back of the brain. These strokes often present with a cluster of symptoms: vertigo, dizziness, balance problems, and nausea or vomiting.

Dr. Pooja Khatri, a neurology professor, points out that for women, symptoms like nausea often get “explained away to viral illnesses.” Her advice is to focus on “any sudden symptom or loss in function that you can’t explain.”

That out-of-the-blue exhaustion

For busy professionals, “fatigue” is practically a default setting. So how can you tell the difference between normal end-of-the-week burnout and a serious neurological warning sign? The key is the quality and suddenness of the exhaustion.

This isn’t the kind of tired that a good night’s sleep can fix. It’s a sudden, profound, and unexplained wave of fatigue, general weakness, or brain fog. Like nausea, this is another one of those vague, atypical symptoms that women are more likely to experience. It’s so easy to brush off as being overworked or stressed out.

Dr. Pooja Khatri notes that women “more frequently have atypical, vague symptoms. They might start with fatigue, confusion or maybe general weakness, as opposed to weakness on one side of the body.”

This is a neurological “power-down,” not just physical tiredness. It’s a sudden loss of function that feels completely out of character. The question to ask yourself isn’t “Am I tired?” but “Did a switch just flip in my brain?” If the answer is yes, it’s time to pay attention.

A sudden fainting spell or seizure

This is one of the rarer warning signs, but it’s also one of the most critical. A brief loss of consciousness, like fainting (syncope) or having a seizure, can be a sign of a TIA or stroke.

Many things can cause someone to faint, but a seizure is a definitive sign of an electrical storm in the brain. When a seizure happens for the first time in an adult with no previous history of epilepsy, a stroke has to be considered as a possible cause.

When a stroke cuts off oxygen to brain cells, the dying tissue can become electrically irritable, disrupting the brain’s normal circuits and triggering a seizure, as reported by the American Stroke Association.

Think of it this way: a new-onset seizure in an adult is a five-alarm fire. It’s a medical emergency that demands an immediate trip to the ER for brain imaging to figure out what’s going on. While other things can cause seizures, the suddenness of the event fits perfectly with the profile of a stroke.

Key takeaway

If you remember nothing else from this article, remember these four things:

• Your biggest warning is a TIA. If you experience stroke-like symptoms that suddenly disappear, it’s not a “dodged bullet”—it’s a “warning stroke.” Your risk of a major stroke is highest in the hours and days that follow.
• Remember BE FAST. For quick identification in yourself or others, use the BE FAST acronym: Balance loss, Eyesight changes, Face drooping, Arm weakness, Speech difficulty. If you see any of these signs, it’s Time to call 911.
• Time is Brain. This isn’t just a catchy phrase; it’s a biological reality. Every single minute that a stroke goes untreated, the brain loses an average of 1.9 million cells. Getting treatment with clot-busting drugs within 3 to 4.5 hours dramatically improves the odds of a full recovery.
• Call 911. Always. Even if the symptoms go away. Don’t try to drive yourself or have a friend take you. Call an ambulance. Paramedics can initiate life-saving treatment en route to the hospital. It could be the most important phone call you ever make.

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