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Stroke (Brain Attack) & TIA

A stroke happens when blood flow to part of the brain is blocked or a blood vessel in the brain bursts. It is a medical emergency: call 911 at the first sign, note the time, and never drive yourself. Fast treatment, rehabilitation and controlling blood pressure and other risks can limit damage and help prevent another stroke.

Signs of a stroke — think B.E. F.A.S.T. and call 911 immediately: Balance — sudden dizziness, trouble walking or loss of balance; Eyes — sudden trouble seeing; Face — ask the person to smile and see whether one side droops; Arms — ask them to raise both arms and see whether one drifts down; Speech — ask them to repeat a simple phrase and listen for slurred or strange speech; Time — if you see any of these signs, call 911 (CDC, NHLBI).

Other sudden signs include numbness or weakness of the face, arm or leg (especially on one side of the body); confusion or trouble speaking or understanding speech; trouble seeing in one or both eyes; and a severe headache with no known cause (NINDS, CDC).

Call 911 right away. Do not drive yourself to the hospital, and do not let someone else drive you. An ambulance lets medical staff begin lifesaving treatment on the way (NHLBI, CDC). Note the time the symptoms first started — it helps doctors choose the best treatment (NINDS). NINDS says the best stroke treatments can only be used within four and a half hours of the first symptoms, though some people benefit from treatment up to 24 hours later, which is why even people who wake up with symptoms need to go in at once (NINDS).

Symptoms that go away still count. If stroke symptoms disappear after a few minutes, it may have been a transient ischemic attack (TIA, often called a “mini-stroke”) — a serious warning sign. Tell a health care team right away (CDC, NINDS). There is no immediate way to tell a TIA from a stroke, so call an ambulance; do not try to drive to the hospital (NINDS, MedlinePlus). The NHS in the UK likewise tells people to call for urgent help for stroke signs in the last 24 hours even if they have stopped (NHS), and says a TIA should be treated as urgent or you could be at risk of a full stroke (NHS).

A stroke is a medical emergency just like a heart attack (NINDS). Never wait for a chiropractic, acupuncture or massage appointment, and never try an herb, supplement, magnet or other home remedy first. Nothing on this page is a reason to delay calling 911.

What is a stroke?

A stroke, also called a brain attack, happens when blood flow to the brain is blocked or a blood vessel inside or on the surface of the brain bursts (NINDS). Without oxygen and nutrients from the blood, brain cells begin to die within minutes (NHLBI). A stroke can cause lasting brain damage, long-term disability or death, but recovery depends on how serious it was and how quickly it was treated (NHLBI).

More than 795,000 people in the United States have a stroke every year; about 610,000 of those are first or new strokes, and nearly 1 in 4 happen in people who have had one before (CDC). NINDS calls stroke the fifth leading cause of death in the United States and the most common cause of adult disability (NINDS). Strokes can be prevented and treated (NINDS).

Ischemic, hemorrhagic and TIA

  • Ischemic stroke (a blockage) is by far the most common type — about 80% according to NINDS and MedlinePlus, and about 87% according to NHLBI and CDC (NINDS, MedlinePlus, NHLBI, CDC). It is usually caused by a blood clot or a piece of plaque. A clot can form in a diseased brain artery (thrombosis), travel to the brain from elsewhere such as the heart (embolism), or an artery in the head or neck can narrow from plaque (stenosis) (NINDS).
  • Hemorrhagic stroke (bleeding) happens when a blood vessel in the brain breaks and bleeds. The two kinds are bleeding within the brain (intracerebral hemorrhage) and bleeding between the brain and its covering (subarachnoid hemorrhage), often from a burst aneurysm (MedlinePlus). Other causes include a tangle of abnormal vessels called an arteriovenous malformation (AVM), high blood pressure and, sometimes, blood-thinning medicine (NHLBI). See our aneurysms guide.
  • TIA (transient ischemic attack) is a temporary blockage. The symptoms resemble a stroke but usually go away within an hour, though they can last up to 24 hours (NINDS). A TIA is an important warning sign: about one in three people who have one will have a stroke sometime in the future, most of them within a year (NINDS). CDC reports that as many as 10% to 15% have a major stroke within 3 months (CDC). One kind of TIA causes brief vision loss in one eye, described as “like a shade coming down over the eye” (NINDS).

Stroke in women, young adults and children

Women. Some risks apply only to women. Stroke risk is about three times higher during pregnancy than for other women of the same age, and is highest in the last month before delivery and the first 6 weeks after giving birth (NHLBI). Women who take birth control pills or use hormone replacement therapy are also at higher risk, and high blood pressure in pregnancy, such as preeclampsia, raises stroke risk later in life (NHLBI). NINDS notes that hormone replacement pills may raise stroke risk, especially more than 10 years after menopause, while estrogen patches on the skin have not been found to; women should discuss their own risks with a doctor (NINDS). Men are more likely to have a stroke at younger ages, but women live longer, so their lifetime risk is higher (NHLBI). If you are pregnant and at risk, some medicines are changed — ACE inhibitors and ARBs are stopped, warfarin is not used, and statins are paused until delivery — so ask your provider before changing anything (NHLBI). Migraine and the combined contraceptive pill are also listed among the things that can raise risk (NHS); see our migraines guide.

Young adults. Stroke can happen at any age. NINDS reports that the stroke rate is rising in adults under 49 (NINDS), and about one in seven strokes occurs in people ages 15 to 49 (CDC). Tears in the neck arteries (cervical artery dissection) are among the common causes of stroke in young and middle-aged adults (Biller et al., 2014). Using illicit drugs, such as cocaine, or medicines other than as prescribed greatly raises the risk (NINDS, NHLBI). A small opening between the heart’s upper chambers (patent foramen ovale) is one example of a birth-related heart defect that can let clots travel to the brain; closing it may lower the risk of a second ischemic stroke in people between 18 and 60 (NHLBI).

Children and babies. Stroke can even happen before birth. A child’s risk is highest around the time of birth, and boys and Black children have a higher risk (NINDS). Children usually have the same symptoms as adults, but are more likely to have seizures, breathing problems or loss of consciousness, so stroke can be hard to spot in younger children. Risk factors include heart problems present at birth, head trauma (see our head trauma guide), blood-clotting disorders and, especially for Black children, sickle cell disease (NINDS). As many as 40% of children with sickle cell disease have had a silent stroke (NHLBI). Children who have a stroke generally recover better than adults with proper treatment and rehabilitation, though outcomes are worse under age one and when a child loses consciousness or has seizures (NINDS).

Risk factors

NINDS says your risk grows with the number and severity of your risk factors, and that many can be changed (NINDS). NHLBI reports that controllable factors — high blood pressure, obesity, physical inactivity, poor diet and smoking — account for 82% to 90% of all strokes (NHLBI).

How a stroke is diagnosed

Doctors diagnose a stroke from your symptoms, medical history, a physical exam and tests, and try to find the type, the cause and the part of the brain affected (NHLBI). A head CT scan, often done right away, shows whether there is bleeding; an MRI can find changes in brain tissue, and angiography or other imaging looks at blood vessels (NHLBI). The scan matters because doctors must rule out bleeding before giving clot-dissolving medicine, which can worsen a hemorrhagic stroke (NINDS). Blood tests, an electrocardiogram (EKG) to look for atrial fibrillation or a past heart attack, and sometimes a lumbar puncture are also used (NHLBI). MRI cannot be done in people with certain implants such as pacemakers (NINDS); see our pacemakers, pumps and ventilators guide. Providers often rate severity with the NIH Stroke Scale (NINDS).

When to see a doctor: if you were told you had a TIA in the emergency room, follow up as soon as possible with a primary care provider and a neurologist (NHLBI). If you take a blood thinner, call your provider about easy bruising, blood in urine or stool, black tarry stools, vomit that looks like coffee grounds, unexplained gum or nose bleeding, or a severe headache; call 911 for severe bleeding (NHLBI). Any new sign of stroke, at any time after a stroke, means calling 911 (NHLBI). Other guides that may help: balance, fainting and nerve damage.

Side by side

Six approaches compared

For every condition we look at the same six approaches: what each involves, what it typically costs, and what a patient can realistically expect.

ApproachWhat it involves Estimated costWhat to expect
Conventional medicine (AMA) Emergency care by ambulance and stroke team: brain imaging, clot-dissolving medicine or clot removal for ischemic stroke, bleeding control for hemorrhagic stroke; then rehabilitation (physical, occupational and speech therapy) and long-term medicines and procedures to prevent another stroke. Medicare Part A covers inpatient rehabilitation (days 1-60 are $0 a day after the Part A deductible); outpatient therapy is 20% of the Medicare-approved amount after the Part B deductible. Other costs: being researched. Treatment speed matters most. Recovery can take weeks, months or years; some people recover fully, others have lasting disability. Most people take medicines long term.
Chiropractic No role in emergency care or in treating a stroke. Small studies have looked at chiropractic adjustments added to physical therapy in chronic stroke. About $55 to $100 per follow-up visit paying cash, per The Pricer. Medicare covers only spinal adjustments for a subluxation. Never a substitute for 911. Neck manipulation has been linked to rare tears in neck arteries that can cause a stroke, though experts disagree on whether it causes them. Tell the chiropractor about your stroke and any blood thinner.
Acupuncture Needle treatments added to usual stroke rehabilitation. About $90 to $185 per follow-up visit paying cash, per The Pricer. Medicare covers acupuncture only for chronic low back pain. Cochrane reviews found possible benefits, but the trials were mostly low quality, and the authors found inadequate evidence for routine use. Minor side effects; bleeding risk rises with blood thinners.
Herbal medicine Mostly a question of safety: several herbs and supplements raise bleeding risk or interact with stroke-prevention medicines. No herb has been shown to treat a stroke or replace medicine. Cost estimate being researched. Ginkgo, garlic and feverfew can affect bleeding; St. John’s wort weakens warfarin and some other medicines. Tell your doctor and pharmacist about every product. Magnets and far-infrared products have no stroke evidence.
Massage therapy Gentle, relaxing massage for comfort and muscle tension during recovery, once your care team agrees. One national chain: about $70 to $90 a month on a 12-month membership, per The Pricer. One review found Chinese massage added to physical therapy modestly improved arm movement and lowered spasticity. Don’t massage a swollen, painful, warm leg — it could be a blood clot.
MBHA Wellness Coach Everyday habits that lower the risk of another stroke and support recovery: blood pressure checks, taking medicines as prescribed, food, activity, quitting tobacco, sleep, stress and mood — plus support for caregivers. Cost estimate being researched. Supports — never replaces — emergency care, rehabilitation and medicines. Small, steady changes add up.

Approach 1 of 6

Conventional medicine (AMA)

Stroke treatment falls into three stages: emergency care to limit the damage, treatment to prevent another stroke, and rehabilitation (NINDS). See the sections below for details on Emergency treatment and hospital care, Rehabilitation and recovery and Preventing another stroke. In short:

  • Ischemic stroke: a clot-dissolving medicine (thrombolytic) given by vein, and/or a procedure to remove the clot (thrombectomy), as soon as possible (NHLBI). If neither is possible, an antiplatelet medicine such as aspirin or clopidogrel, or a blood thinner (NHLBI).
  • Hemorrhagic stroke: find and control the cause of bleeding — blood pressure medicine, stopping blood thinners, and sometimes surgery or aneurysm repair (NHLBI).
  • Afterward: physical, occupational and speech therapy; medicines for blood pressure, cholesterol and clots; treating atrial fibrillation or carotid disease; and attention to mood (NHS, NHLBI).

Treatment decisions depend on the type of stroke, how much time has passed since symptoms started and your other medical conditions (NHLBI). We don’t list doses.

Find a medical doctor in our directory

Approach 2 of 6

Chiropractic

Chiropractic care has no role in emergency stroke care or in treating a stroke. If you have any stroke sign, call 911 first.

Neck manipulation and stroke: what the evidence says

NCCIH reports that neck-focused spinal manipulation has been linked to small, potentially dangerous tears in the neck artery walls (cervical artery dissection) that are rare but can lead to a stroke. Any sudden neck movement, such as in sports, whiplash or violent vomiting or coughing, may also raise the risk of tears. NCCIH says the incidence in people getting spinal manipulation appears low, and that there is disagreement about whether manipulation can actually cause a dissection, but that patients should be informed of the possible risk (NCCIH).

  • An American Heart Association/American Stroke Association statement found that case-control studies suggest an association between cervical manipulation and stroke from vertebral artery dissection in young patients, but it is unclear whether manipulation causes the dissection or whether patients with an existing dissection were seeking care for neck pain. It said biomechanical evidence is insufficient to say manipulation causes dissection, the incidence is “probably low,” and patients should be told of the statistical association before neck manipulation (Biller et al., 2014).
  • A large Ontario study of 818 vertebral-basilar strokes found people under 45 were about three times more likely to have visited a chiropractor or a primary care doctor before the stroke. The authors concluded this was likely because neck pain and headache from an artery tear send people to seek care before the stroke, and found no excess risk with chiropractic care compared with primary care (Cassidy et al., 2008).

The safety take-away: a tear can cause one-sided headache, neck pain, or stroke-like signs (Biller et al., 2014). New severe neck pain or headache, especially with any stroke sign, is a reason to get emergency care — not an adjustment. If you have had a stroke or TIA, take a blood thinner, or have neck artery disease, MBHA suggests telling your chiropractor and asking your doctor whether neck thrust techniques are safe for you; gentler methods may be an option. For neck pain, see our neck guide.

Research on stroke recovery

We found only small studies. In 12 people with chronic stroke, a single chiropractic session increased calf-muscle strength compared with a control, and the authors called for research on longer-term and functional effects (Holt et al., 2019). In a trial of 63 adults with chronic stroke, four weeks of chiropractic adjustments plus physical therapy produced no difference in blood markers compared with sham adjustments plus physical therapy (Haavik et al., 2022). These are early findings; they do not show that chiropractic care helps people regain everyday function after stroke.

What it costs

The Pricer lists about $55 to $100 for a self-pay follow-up visit and $90 to $200 for a first appointment (The Pricer). Medicare covers only spinal adjustments by a chiropractor to correct a subluxation (Medicare.gov).

Find a chiropractor in our directory

Approach 3 of 6

Acupuncture

Acupuncture is sometimes used alongside rehabilitation. The most reliable summaries are two Cochrane reviews, and both urge caution.

  • Recovery phase (subacute and chronic stroke): 31 trials with 2,257 people. Compared with no acupuncture, acupuncture-plus-usual-care showed better daily-living scores, neurological scores and some specific problems, but the quality of evidence was low or very low. Two trials comparing real with sham acupuncture found no difference in movement or quality of life. The authors concluded the evidence was inadequate to support routine use and called for large, well-designed trials (Yang et al., 2016).
  • Acute stroke (started within 30 days): 33 trials with 3,946 people. Apparently better outcomes were confounded by bias from open (unblinded) controls and weren’t confirmed in trials with sham acupuncture. Side effects such as pain, dizziness and fainting were minor (Xu et al., 2018).

So acupuncture may help as an add-on, but the better-controlled trials that used sham needling did not confirm improved movement or neurological scores in either review. It does not replace emergency care or rehabilitation.

Safety

Relatively few complications have been reported, mostly from nonsterile needles or poor technique (NCCIH). In a Taiwanese study of more than 13 million sessions, the anticoagulants warfarin, newer oral anticoagulants and heparin raised the risk of bleeding after acupuncture (Hsieh et al., 2023). If you take a blood thinner, tell your acupuncturist; and because stroke can affect balance and sensation, MBHA suggests telling them where you have numbness or weakness.

What it costs

The Pricer lists about $90 to $185 per follow-up visit and up to about $230 for a first private appointment, with community acupuncture around $50 to $90 (The Pricer). Medicare covers acupuncture only for chronic low back pain (Medicare.gov).

Find an acupuncturist in our directory

Approach 4 of 6

Herbal medicine

No herb or supplement has been shown to treat a stroke or to take the place of stroke medicines. For people who have had a stroke, the main issue is safety. Many people take anticoagulants (“blood thinners”), antiplatelets, blood pressure medicine or statins to prevent another stroke, and some products interact with them. Natural doesn’t always mean safe (NCCIH).

Products that affect bleeding or interact with stroke medicines

  • Ginkgo may increase bleeding risk in people taking anticoagulants such as warfarin (NCCIH). NCCIH says there is no conclusive evidence ginkgo helps any health condition, while noting it “might be helpful” in stroke rehabilitation. A 2005 Cochrane review found no convincing evidence from good-quality trials to support routine use of ginkgo extract for recovery after acute ischemic stroke (Zeng et al., 2005).
  • Garlic supplements may increase bleeding risk, which matters with anticoagulants or aspirin (NCCIH).
  • Feverfew (sometimes used for migraine) may slow blood clotting (NCCIH).
  • St. John’s wort can weaken many medicines, including warfarin and certain statins (NCCIH).
  • MedlinePlus lists coenzyme Q10, echinacea, garlic, ginkgo, ginseng, goldenseal and St. John’s wort as products that may interact with warfarin, and advises eating consistent amounts of vitamin K-containing foods and asking about alcohol (MedlinePlus).
  • Hidden drugs: the FDA has found prescription drugs, including warfarin, in some products sold as dietary supplements. Also tell providers about supplements before any surgery, since some raise bleeding risk (NCCIH).

Chinese herbal products have been studied for stroke, but because many studies were of poor quality, NCCIH says no firm conclusions can be made about their effectiveness (NCCIH).

Never stop or skip a stroke-prevention medicine to take a supplement, and show every product to your doctor or pharmacist. Do not try an herb during a suspected stroke — call 911. We don’t list doses.

Magnets, far-infrared devices and “miracle” products

NCCIH’s page on magnets covers pain, not stroke: it says research does not conclusively support static magnets for pain relief, while some electromagnetic therapies may help certain pain conditions (NCCIH). We found no NCCIH or other government page showing that magnets help stroke recovery. A 2015 review of far-infrared therapy looked at heart disease, diabetes and kidney disease and mainly discussed how it might work, not stroke recovery (Shui et al., 2015). Ask your rehabilitation team about devices that have been FDA-approved to support stroke rehab; NINDS names a few (NINDS).

What it costs

Cost estimate being researched.

Approach 5 of 6

Massage therapy

Massage won’t treat a stroke, but gentle massage may ease tension and stiffness during recovery.

What studies found

A 2021 review of 18 randomized trials (1,989 people) found that Chinese massage (tuina) added to physical therapy modestly improved arm movement in the subacute stage and reduced arm and leg spasticity compared with physical therapy alone; the authors concluded that therapeutic massage, especially tuina, is effective alongside conventional therapy (Cabanas-Valdés et al., 2021). The result is an add-on benefit, not a replacement for therapy.

Safety first

Don’t massage a swollen, painful, warm or red leg — get it checked the same day. After a stroke, being unable to move around raises the risk of blood clots in the deep veins of the legs, which can break loose and travel to the lungs (NHLBI). About half of people with a leg clot have no symptoms; common signs are swelling, pain or tenderness, warmth and redness, and trouble breathing, chest pain, a fast heartbeat or fainting mean seeking help immediately (CDC). A published case report describes a pregnant woman with an unrecognized leg clot who suffered a massive pulmonary embolism after leg massage; the authors concluded that leg massage in people with a deep vein clot can dislodge it (case report, BMC Pregnancy and Childbirth, 2020).

  • NCCIH says massage risk appears low, but rare serious problems — a blood clot, nerve injury or bone fracture — have been reported, some after vigorous deep-tissue work or in older people (NCCIH). Stroke can reduce bone density, usually on the affected side (NHLBI), so MBHA suggests asking for light pressure.
  • Bruising and bleeding are more likely if you take a blood thinner (MedlinePlus); tell the therapist.
  • If you have lost feeling in an arm or leg, or have a painful shoulder, MBHA suggests asking your therapist or doctor first, since you may not feel when pressure is too much.
  • MBHA suggests checking with your doctor before starting massage after a stroke.

What it costs

One national chain’s membership runs about $70 to $90 a month on a 12-month term (The Pricer).

Find a massage therapist in our directory

Approach 6 of 6

MBHA Wellness Coach

An MBHA Wellness Coach can help you build the habits that lower the risk of another stroke and support recovery — alongside, never instead of, emergency care, rehabilitation and your medicines.

Know your numbers and take your medicines

NINDS advises making a plan with your doctor to keep blood pressure, blood sugar and cholesterol at healthy levels, taking medicines as directed, knowing your target numbers, and sharing home blood pressure readings with your doctor (NINDS). Never change a dose or skip a medicine without talking to your provider (NHLBI, CDC). A coach can help with pill organizers, reminders and a blood pressure log. See our medication safety guide.

Eat well

NINDS suggests a variety of fruits, vegetables, whole grains and healthy proteins and fats, with less salt and plenty of potassium (NINDS). CDC adds foods low in saturated fat, trans fat and cholesterol, high-fiber foods and limiting sodium (CDC). In a large Spanish trial of people at high heart risk, a Mediterranean diet with extra-virgin olive oil or nuts had fewer major cardiovascular events (heart attack, stroke or cardiovascular death) than a low-fat diet; it enrolled people who had not already had a cardiovascular event (Estruch et al., 2018).

Move more

NINDS suggests about 30 minutes of moderate activity most days; short walks are a start (NINDS). After a stroke, ask your team what is safe. A Cochrane review found that walking-based fitness training improved fitness, balance and walking speed and reduced disability after stroke, with no evidence of serious harm (the review is being replaced by newer ones) (Saunders et al., 2020). A coach can help you keep up the home exercises your therapists assign. Falls are a real risk; see our balance guide.

Quit tobacco, limit alcohol, sleep

Quitting smoking lowers risk, no matter how long you have smoked (NINDS). CDC advises no more than two drinks a day for men and one for women, and not starting smoking (CDC). NHLBI lists getting enough good-quality sleep among heart-healthy changes that help recovery and may help prevent another stroke (NHLBI).

Mood and support

Stroke can make people feel scared, anxious and depressed; a support group, support from family and friends and, when needed, medicine can help (NHLBI). Involving family and friends can also help recovery (NHS). A coach can help you set goals and keep up routines. See our depression and anxiety guides.

What it costs

Cost estimate being researched.

Another approach

Emergency treatment and hospital care

A stroke requires emergency care, ideally in a specialized stroke unit with a team of specialists. What you receive depends on whether the stroke was ischemic or hemorrhagic, how much time has passed, and your other conditions (NHLBI).

Ischemic stroke: dissolving or removing the clot

  • Clot-dissolving medicine (thrombolytics). The main treatment is tissue plasminogen activator (tPA), given by vein, which breaks up the clot (NHLBI). Two medicines in this class carry FDA stroke labeling: the labels for alteplase (Activase) and tenecteplase (TNKase) both list acute ischemic stroke as an indication and say to begin treatment as soon as possible and within 3 hours of symptom onset (FDA label, Activase, FDA label, TNKase). In NINDS-funded research, people given tPA by vein within three hours were 30% more likely to have minimal or no disability after three months (NINDS).
  • Time windows differ by source. CDC says the most effective treatments are available when a stroke is recognized within 3 hours (CDC); MedlinePlus says 4 hours (MedlinePlus). NHLBI says tPA is given within 3 hours, and that providers may give it up to 4.5 hours after symptoms begin, or if you woke up with symptoms less than 4.5 hours earlier (NHLBI). NINDS says most clinicians now treat within a four-and-a-half hour window (NINDS). The stroke team decides what applies to you — the point is the sooner the better.
  • Safety. The label warns that these medicines can cause significant, sometimes fatal bleeding, and that the risk of bleeding in the brain is higher in stroke patients, so treatment should be limited to facilities that can manage it; bleeding in the brain must be excluded first, and it is not used with current brain bleeding, recent serious head trauma or current severe uncontrolled high blood pressure, among other situations (FDA label, Activase). This is why the CT scan comes first.
  • Thrombectomy (clot removal). A surgeon threads a catheter from the upper thigh to the blocked artery in the neck or brain and pulls the clot out with a stent retriever or opens the artery with angioplasty and stenting (NHLBI). NINDS says tPA does not work well for large clots in larger arteries, several large studies show benefit from clot-retrieval devices in severe strokes, and special imaging can identify some patients who still benefit from clot removal up to 24 hours after symptoms start (NINDS). The NHS says treatment in the first 24 hours may include thrombolysis or thrombectomy (NHS).
  • If clot-busting medicine isn’t possible, a provider may give an antiplatelet medicine such as aspirin or clopidogrel, or a blood thinner, to stop clots forming or growing; the main side effect is bleeding (NHLBI).
  • Neck artery procedures. If carotid artery disease caused the stroke, carotid endarterectomy removes plaque from the artery (NHLBI). In NINDS-funded research, carotid surgery and stenting had largely similar safety and effectiveness; for severe narrowing of an artery inside the head, medicine alone prevented a second stroke better than adding a stent (NINDS).

Hemorrhagic stroke: stopping the bleeding

Treatment depends on where and how much the brain is bleeding. It may include medicine to lower blood pressure, stopping any blood thinner (sometimes with vitamin K), and procedures: aneurysm clipping, coil embolization, draining excess fluid, surgery to relieve pressure or to remove pooled blood, and surgery or radiation for an AVM (NHLBI). Clot-dissolving medicines make this type worse, so the type must be known before treatment (NINDS). A ruptured aneurysm is critical to treat because repeat bleeding is almost always fatal, and in the two weeks after it brain arteries can narrow (vasospasm) (NINDS). See our aneurysms guide.

Other hospital care

The team may also provide breathing support, leg-compression sleeves to lower the risk of clots, a feeding tube if swallowing is unsafe, fluids, medicine to lower a fever, skin care, and tests of speaking, swallowing and walking before discharge to plan rehabilitation (NHLBI). Complications can include leg clots, bladder or bowel problems, seizures, brain swelling, swallowing trouble and pneumonia, muscle weakness and spasms, and loss of bone strength (NHLBI). Palliative care can help some people have fewer symptoms and a better quality of life (NHLBI). During pregnancy, NHLBI notes thrombectomy may be less risky for the baby than clot-dissolving medicine (NHLBI).

What it costs

Medicare Part A covers inpatient rehabilitation facility care. In 2026, days 1–60 cost $0 a day after the Part A deductible of $1,736, days 61–90 are $434 a day, and days 91–150 are $868 a day (using lifetime reserve days) (Medicare.gov). Other costs: cost estimate being researched.

Another approach

Rehabilitation and recovery

It can take weeks, months or even years to recover from a stroke. Some people recover fully; others have lasting disabilities (NHLBI). Most people who take part in a treatment program recover better than those who don’t, and the sooner it begins the better; it usually starts in the hospital within 24 to 48 hours (MedlinePlus, NINDS); CDC says it often begins within a day or two and lists physical, occupational and speech therapy among the main types (CDC).

The team and settings. Physical, occupational and speech-language therapists work with physicians, rehabilitation nurses, psychologists, social workers and others; care may be given in an inpatient rehabilitation unit, outpatient clinic, skilled nursing facility or at home (NINDS). The NHS says rehabilitation can be done in person or online (telerehabilitation), with a review of progress after about six months (NHS). Rehabilitation uses repetitive practice to relearn skills, and teaches ways to compensate, such as using one hand or assistive devices (NINDS).

A 2025 Cochrane review of 267 studies concluded that physical rehabilitation using a mix of components likely improves function and mobility after stroke, and that functional task training may be useful, although the evidence is of limited certainty (Todhunter-Brown et al., 2025).

Common problems and what helps

  • Movement, weakness and spasticity: physical and occupational therapists help strengthen and stretch muscles and relearn dressing, eating and bathing (NHLBI). Muscles can become weak, stiff or spasm (NHLBI). A 2024 VA/DoD guideline summary lists task-specific practice, mirror therapy, electrical stimulation and botulinum toxin for spasticity among the motor therapies with the strongest support (VA/DoD guideline synopsis, 2025).
  • Shoulder pain: a 2022 meta-analysis of 12 trials (723 people) found that adding certain techniques — botulinum toxin injection, a nerve block at the shoulder, or dry needling — to usual rehabilitation reduced hemiplegic shoulder pain more than usual rehabilitation alone (de Sire et al., 2022). NINDS also describes a rarer central stroke pain, for which most pain medicines give little relief (NINDS).
  • Speech and language (aphasia): about one-third of people who have a stroke have aphasia (Brady et al., 2016). A Cochrane review of 57 trials found speech and language therapy improved functional communication, reading, writing and expressive language compared with no therapy, and that high-intensity, high-dose or longer therapy may help more, though some people may not tolerate it (Brady et al., 2016). Slurred speech from weak muscles (dysarthria) is a different, physical problem (NINDS).
  • Swallowing: a speech therapist can suggest changes such as chopping food or thickened liquids; choking and inhaling food can lead to pneumonia (NHLBI, NHLBI).
  • Thinking and memory: speech and language therapists can help with memory and thinking (NHLBI); cognitive therapy targets learning, planning and decisions (MedlinePlus). Some people have a lasting decline called vascular cognitive impairment (NINDS).
  • Depression: common after stroke, serious, and treatable with medicine and psychotherapy (NINDS). A Cochrane review found SSRI antidepressants did not improve disability or independence after stroke but reduced depression slightly; they also probably increased seizures and increased bone fractures (Legg et al., 2021). Talk to your provider about the best choice. If you are thinking about harming yourself, call or text 988 for the 988 Suicide & Crisis Lifeline, free and available 24/7 (988 Lifeline); call 911 if life is in immediate danger. See our depression guide.
  • Fatigue: a 2015 Cochrane review found insufficient evidence on any treatment for post-stroke fatigue (Wu et al., 2015); the NHS says cognitive behavioural therapy can be part of a plan for tiredness, anxiety and depression (NHS).
  • Bladder and bowel problems can be treated with medicines, exercises and specialists (NHLBI, NHS).
  • Driving: a Cochrane review found insufficient evidence that any training improves on-road driving after stroke (George et al., 2014). Stroke can affect vision, thinking, movement and sensation, so MBHA suggests asking your stroke team about a formal driving evaluation before you drive again, and checking your state’s rules.

Home and equipment

Canes, braces, grab bars, special eating utensils and wheelchairs can make it easier to keep doing daily activities (NHLBI); recovery may also mean adapting your home to make it easier to move around (NHS). See our balance guide for fall prevention.

What it costs

Medicare covers outpatient physical, occupational and speech-language therapy when your doctor certifies you need it, with no limit on how much it pays for medically necessary outpatient therapy in a calendar year; you generally pay 20% of the Medicare-approved amount after the Part B deductible (Medicare.gov, physical therapy, occupational therapy, speech-language pathology). Without Medicare: cost estimate being researched.

Another approach

Preventing another stroke

People who have had a stroke or TIA are at higher risk of another (NHS), and nearly 1 in 4 strokes happen in people who have had one before (CDC). The plan depends on what caused the first one (NHLBI).

Medicines (by class — no doses)

  • Antiplatelet medicines (such as aspirin or clopidogrel) help prevent dangerous clotting (NHLBI). The label for clopidogrel (Plavix) says it reduces the rate of heart attack and stroke in people with a recent stroke, and carries a boxed warning that it has a diminished effect in people with two nonfunctional copies of a gene called CYP2C19 (“poor metabolizers”); tests are available (FDA label, Plavix). For people who have had a stroke but do not have atrial fibrillation, two NINDS-sponsored trials found aspirin equal to warfarin for reducing stroke risk (NINDS).
  • Anticoagulants (blood thinners) for atrial fibrillation. Blood thinners such as warfarin or direct-acting oral anticoagulants (apixaban, dabigatran, rivaroxaban, edoxaban) prevent clots and lower stroke risk, and carry a bleeding risk (NHLBI). NINDS notes the newer ones don’t need regular blood test monitoring and may be less likely to cause bleeding (NINDS). Boxed warnings from the FDA labels: apixaban (Eliquis), indicated to reduce stroke risk in nonvalvular atrial fibrillation, warns that stopping it early raises the risk of clots and that spinal or epidural bleeding can occur with spinal procedures (FDA label, Eliquis); warfarin warns it can cause major or fatal bleeding, needs regular blood (INR) monitoring, and is affected by other drugs and dietary changes (FDA label, warfarin). Never stop an anticoagulant on your own.
  • Blood pressure medicines and statins are commonly given long term (NHS); statin therapy has been found protective against stroke but is not used during pregnancy (NHLBI).

Do not change the amount of a medicine or skip a dose without talking to your provider (NHLBI). Know the warning signs of bleeding from blood thinners (see the When to see a doctor box above), and see our medication safety guide.

Procedures and treating the cause

Carotid endarterectomy for carotid artery disease; medicine or surgery for a heart condition; and, for a hole between the heart’s upper chambers (patent foramen ovale), closing it in people age 18 to 60 (NHLBI).

Daily habits

Keep blood pressure, blood sugar and cholesterol under control, manage any heart condition, eat well, quit smoking and stay active (NINDS). See our blood pressure, cholesterol and diabetes guides, and the MBHA Wellness Coach section above.

What it costs

Cost estimate being researched.

Another approach

For family and caregivers

Looking after someone who has had a stroke can be difficult, frustrating and lonely. The NHS urges caregivers to get all the support and help they need (NHS).

  • Learn the warning signs. A person having a stroke may not realize it, may ignore the signs, or may be unable to call for help, and bystanders may think they just look confused. Someone nearby who recognizes the signs and acts fast gives them the best chance of recovery (NINDS). Know the signs of another stroke (NHLBI).
  • Get clear information. A Cochrane review found that actively giving information may improve stroke survivors’ knowledge and quality of life and slightly reduce anxiety and depression, while passive information may slightly worsen them; evidence for carers is uncertain, and the evidence is better for approaches that involve survivors and carers and include planned follow-up (Crocker et al., 2021). Ask the team to explain the plan, and write down the medicines.
  • Be part of recovery. Getting family and friends involved can help the person get better (NHS). Respect swallowing and fall-prevention advice from therapists (NHLBI).
  • Look after yourself. A 2022 review of 18 studies of caregiver and caregiver-plus-survivor programs found that 11 reported significant caregiver outcomes, most commonly caregiver burden, but the studies were few, small and sometimes conflicting, so firm conclusions were difficult (Bakas et al., 2022). Support groups can also help; ask the care team or a local medical center (NHLBI).
  • Plan for the long term. Palliative care can improve quality of life for some people with a serious stroke (NHLBI).

What it costs

Cost estimate being researched.

Member stories

Living with Stroke (Brain Attack) & TIA? Share your experience

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Sources

This page is for education only and is not medical advice. Costs are typical U.S. ranges and estimates; yours will depend on your provider, location and insurance. Talk with your doctor before starting, stopping or combining any treatment. In an emergency, call 911. See our disclaimer.

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