Preventing Another Stroke: What Stroke Survivors Need to Know

After you’ve had a stroke, the idea of having another one can be terrifying.

I know that fear. Every headache, strange sensation or moment when something just feels “off” can make you wonder: Is it happening again?

Unfortunately, having one stroke does increase your risk of another. But that doesn’t mean another stroke is inevitable.

There are risk factors we can identify, conditions we can treat and everyday choices that may help lower our risk. And while we can’t control everything, understanding what we can control can help us feel a little less powerless.

One thing I want to say upfront: having a stroke does not mean you did something wrong.

Some strokes happen in people who seem to do everything “right.” Some have causes we can’t change. Others remain unexplained even after extensive testing.

Why Preventing Another Stroke Matters

If you’ve already had a stroke or transient ischemic attack (TIA), preventing another one is known as secondary stroke prevention.

Your prevention plan should be based on what caused your first stroke, your medical history and your individual risk factors.

That last part is important.

There isn’t one universal checklist every stroke survivor should follow. Someone whose stroke was related to atrial fibrillation may need a very different prevention strategy than someone whose stroke was caused by narrowing of an artery, uncontrolled high blood pressure or another condition.

The American Stroke Association’s secondary stroke prevention guidance emphasizes working with your healthcare team to identify and manage your individual risk factors.

Know What Caused Your Stroke

This is one of the most important conversations you can have with your neurologist.

“Do we know why I had my stroke?”

Depending on the type of stroke and your individual circumstances, your medical team may evaluate factors such as:

• High blood pressure
• High cholesterol
• Diabetes
• Atrial fibrillation or other heart conditions
• Narrowing or disease of blood vessels
• Smoking
• Sleep apnea
• Certain blood-clotting disorders
• Medications
• Other underlying medical conditions

Sometimes, despite extensive testing, doctors still can’t determine exactly what caused a stroke. An ischemic stroke without an identified cause may be described as cryptogenic.

If the cause of your stroke isn’t clear, ask your neurologist what has been ruled out, whether additional testing is appropriate and what your prevention plan should look like based on what is known.

Blood Pressure Is a Big One

High blood pressure, or hypertension, is one of the most important modifiable risk factors for stroke.

And here’s what makes it tricky: you can have high blood pressure and feel completely fine. The Centers for Disease Control and Prevention notes that high blood pressure often has no signs or symptoms.

That’s why knowing your numbers matters.

If you have high blood pressure, your healthcare provider may recommend a combination of medication and lifestyle changes. If you monitor your blood pressure at home, ask your healthcare team what range they want you to aim for and what readings should prompt a phone call or medical attention.

And don’t stop taking blood pressure medication simply because your numbers improve. The medication may be one of the reasons they’re better.

Keep an Eye on Cholesterol

Cholesterol is another piece of the prevention puzzle. Too much LDL cholesterol can contribute to plaque buildup in arteries, which can increase cardiovascular and stroke risk.

Depending on your stroke history and overall cardiovascular risk, your doctor may recommend lifestyle changes, medication such as a statin, or both.

The CDC explains how cholesterol affects stroke and heart disease risk and why blood testing is important, since high cholesterol typically doesn’t cause symptoms.

If you’re taking cholesterol medication and have concerns about side effects, talk with your healthcare provider rather than stopping it on your own.

Diabetes and Blood Sugar Matter Too

Diabetes can damage blood vessels over time and increases the risk of cardiovascular disease and stroke. If you have diabetes, managing your blood sugar is an important part of protecting your overall health.

That may include:

• Taking prescribed medication
• Monitoring blood glucose as recommended
• Making dietary changes
• Staying physically active
• Attending regular medical appointments

Your appropriate blood sugar goals are individual, so work with your healthcare team rather than comparing your numbers to someone else’s. You can learn more about the connection between diabetes and stroke from the CDC.

Don’t Ignore Your Heart

The heart and brain are more connected than we sometimes realize.

One condition stroke survivors should know about is atrial fibrillation (AFib), an irregular heart rhythm that can allow blood to pool in the heart and form clots. If a clot travels to the brain, it can cause an ischemic stroke.

Some people experience obvious AFib symptoms, while others may not know they have it. The National Heart, Lung, and Blood Institute provides information about AFib symptoms, diagnosis and treatment.

If your stroke was unexplained, ask your healthcare team whether your heart rhythm was evaluated and whether any additional monitoring is appropriate for you.

Treatment for AFib sometimes includes anticoagulant medication to reduce the risk of blood clots and stroke. These medications should only be started, stopped or adjusted with medical guidance.

Women Have Some Additional Stroke Risk Factors

This is particularly important for Stroke Sisters.

Women share many of the same stroke risk factors as men, but we also have some additional considerations.

According to the U.S. Office on Women’s Health, factors that can affect stroke risk in women include pregnancy, high blood pressure during pregnancy, certain types of birth control and hormone therapy.

Migraine with aura has also been associated with an increased risk of ischemic stroke, particularly when combined with other risk factors such as smoking and estrogen-containing contraceptives.

That does not mean every woman with migraine with aura is going to have a stroke. The absolute risk for an individual woman can still be low, and personal risk depends on multiple factors.

But if you have migraine with aura, a history of pregnancy complications, use hormonal contraception or take hormone therapy, those are worth discussing with your healthcare provider as part of your overall stroke risk assessment.

If You Smoke, Getting Help to Quit Matters

Smoking damages blood vessels and significantly increases cardiovascular and stroke risk.

Quitting isn’t always as simple as deciding one morning that you’re done. If you smoke and want to quit, you don’t have to do it through willpower alone. Counseling, quit-smoking programs and medications may help.

The CDC’s quit-smoking resources provide evidence-based information and support.

And if you’ve tried before and started smoking again, that doesn’t mean you failed. Talk with your healthcare provider about trying another approach.

Move Your Body in Ways That Work for You

“Exercise more” can be frustrating advice after a stroke.

Some of us aren’t physically capable of doing what we did before. Balance problems, weakness, spasticity, pain and post-stroke fatigue can make conventional exercise difficult.

So let’s make this more realistic.

Movement counts. Depending on your abilities, that might mean:

• Walking
• Using a stationary bike
• Swimming or water exercise
• Adaptive exercise
• Strength training
• Chair exercises
• Physical therapy exercises
• Dancing
• Gardening
• Simply moving more throughout the day

The goal isn’t to suddenly become an athlete. Regular physical activity can help manage several stroke risk factors, including blood pressure, cholesterol, blood sugar and cardiovascular health.

The CDC offers physical activity guidance for adults with chronic health conditions and disabilities, but your own capabilities and medical situation come first. If you aren’t sure what’s safe after your stroke, ask your physician, physical therapist or rehabilitation team.

Eat for Your Health, Not for Perfection

You don’t need a “perfect” diet. And you don’t need to eliminate everything you enjoy.

Eating patterns that emphasize vegetables, fruits, whole grains, legumes, nuts, fish and other nutritious protein sources while limiting excess sodium, added sugars and heavily processed foods can support cardiovascular health.

The National Heart, Lung, and Blood Institute’s DASH eating plan is one evidence-based approach originally developed to help lower blood pressure.

But sustainable changes are generally more useful than an extreme diet you hate and abandon after two weeks. Work with your healthcare provider or a registered dietitian if you need help developing an eating plan that works with your medical needs, medications, budget and lifestyle.

Sleep Deserves More Attention

Sleep often gets overlooked in conversations about stroke prevention.

One condition worth knowing about is sleep apnea, in which breathing repeatedly stops and starts during sleep.

If you:

• Snore loudly
• Wake up gasping or choking
• Have witnessed pauses in breathing while sleeping
• Regularly wake up exhausted
• Experience significant daytime sleepiness

Talk with your healthcare provider. The National Heart, Lung, and Blood Institute has more information about sleep apnea, its symptoms and treatment.

Take Your Medications as Prescribed

Depending on why you had your stroke and your other health conditions, your prevention plan may include medication for:

• Blood pressure
• Cholesterol
• Diabetes
• Atrial fibrillation
• Prevention of blood clots
• Other medical conditions

One of the most important things you can do is understand why you’re taking each medication. Ask:

Understanding the purpose can make a long medication list feel less arbitrary. And don’t stop taking a medication, change your dose or add something new without discussing it with your healthcare provider.

That includes over-the-counter medications and supplements, which can interact with prescription drugs. The FDA offers guidance on taking medications safely and avoiding potentially harmful drug interactions.

What About Alcohol?

Alcohol and stroke risk aren’t as simple as “a glass of wine is good for your heart.” Drinking too much alcohol can raise blood pressure and contribute to other health problems.

Alcohol can also interact with medications, and some stroke survivors may be advised not to drink at all. If you drink, ask your healthcare provider what’s appropriate based on your health history and medications rather than relying on generalized advice.

Stress and the Fear of Another Stroke

This deserves attention too.

After a stroke, being told to “reduce your stress” can almost feel insulting. Stroke itself is stressful. Recovery is stressful. Appointments, medications, financial concerns, work, relationships, disability and worrying about another stroke are stressful.

The goal isn’t to somehow eliminate stress from your life. It’s to find ways to manage it that support your physical and emotional health.

That might include:

• Walking or other movement
• Meditation or breathing exercises
• Journaling
• Spending time with people who make you feel safe
• Hobbies
• Therapy
• Support groups
• Setting boundaries
• Simply allowing yourself to rest

Mental health is part of stroke recovery too.

Know Your Own Risk Factors

Instead of trying to fix everything at once, sit down with your healthcare provider and ask:

Your list may include:

• High blood pressure
• High cholesterol
• Diabetes
• AFib or another heart condition
• Smoking
• Physical inactivity
• Sleep apnea
• Certain vascular conditions
• Family history
• Age
• Previous stroke or TIA
• Women-specific risk factors
• Other medical conditions specific to you

Then ask which of those risks you can actually do something about. That’s a much more useful prevention strategy than trying to follow every piece of health advice you see online.

And Please Know the Warning Signs

Even when we do everything we can to reduce our risk, no prevention strategy can guarantee another stroke won’t happen. That’s why knowing the warning signs still matters.

The CDC recommends acting immediately when stroke symptoms appear. Remember F.A.S.T.:

A Final Thought About Stroke Prevention

There can be a lot of guilt wrapped up in conversations about stroke prevention.

• Was it something I ate?
• Was I too stressed?
• Should I have exercised more?
• Could I have prevented this?

Sometimes there are clear risk factors. Sometimes there aren’t.

You can’t go backward and rewrite what happened.

What you can do is learn as much as possible about why your stroke happened, understand your individual risks and work with your medical team to protect yourself going forward.

You don’t have to overhaul your entire life tomorrow.

Take your medications. Know your numbers. Keep your appointments. Move your body in whatever ways you safely can. Ask questions. And make the changes that are realistic for your life and your recovery.

That’s prevention too.

Frequently Asked Questions About Preventing Another Stroke

More Stroke Sisters Resources

You may also find these Stroke Sisters articles helpful:

• Living With the Fear of Another Stroke
• Signs of Stroke
• Nutrition Tips for Female Stroke Survivors
• Sleep Problems After Stroke
• Medication Management After Stroke

Trusted Stroke Prevention Resources