As if that weren’t bad enough, it turns out a headache isn’t your only worry: Migraines have been linked to other health issues. Knowing the risks associated with migraines can help you take precautions. Here’s what to watch out for—and what you can do to protect yourself.

Stroke

For roughly one-third of migraine sufferers, a headache is accompanied by aura—visions of flashing lights, patterns, or spots, as well as numbness or tingling in your face or hands. If that sounds familiar, and you’re a woman between 35 and 45, you have a higher risk for ischemic stroke. “There’s some evidence that, for migraine sufferers, blood platelets are activated and clotting risk is increased,” says Richard Kraig, MD, PhD, director of the Migraine Headache Clinic at the University of Chicago. Also, both hormonal birth control pills and smoking up your risk for clotting issues, he says. For that reason, he advises women who suffer from migraines to use a barrier method of birth control, like condoms. And of course, don’t smoke. Studies show older adults who suffer migraines and light up are three times more likely to suffer a stroke.

Heart trouble

While the mechanisms at work aren’t well understood, migraines may boost your risk for heart disease, per research in the European Journal of Neurology. At this point, the study authors say they can’t make any recommendations beyond the ones mentioned above—avoiding smoking and hormonal forms of birth control. Dr. Kraig says migraine sufferers with known cardiac problems also need to be careful when it comes to some popular migraine meds, namely triptans. These meds constrict blood vessels in the brain and in the heart, which can inflict stress on your ticker, he says. More migraines “Migraines beget migraines,” Dr. Kraig says. “That’s why it’s important to try to stop them.” He says migraine sufferers may have a “hyper excitable” brain—meaning even small disruptions can lead to headaches. Stuff like missing a meal, drinking coffee when you normally don’t, or a poor night of sleep can all be triggers. As a result, it’s important for the migraine-afflicted to avoid disruptions to their normal schedule and behaviors.
Another thing to watch out for: over-taxing your noodle at the office. After 90 minutes of work, get up and do something else for a few minutes, Dr. Kraig advises. At the end of your workday, take the rest of the evening off. Also, don’t work on weekends, and take your vacation time. Doing these things will help you “build a brain” that’s better protected from migraine, Dr. Kraig says.

Fibromyalgia

Roughly half of those with this chronic disorder—which causes widespread muscle pain and tenderness—also experience (or used to experience) migraines, finds research in the journal Headache. It’s unclear why, but the two conditions may share similar root causes, including the body’s ability to control pain. Because these two health problems often go hand in hand, it’s important to talk to your doctor if you suffer from either, the Headache study’s authors say.

Depression

“Migraine shows up more often in people who have bipolar disease and depression,” Dr. Kraig says. “With both, there’s a genetic predisposition to having a hyper excitable brain.” The more frequent your headaches, the more likely you are to be depressed, research shows. It’s not clear whether your headaches directly lead to depression. But your lifestyle goes a long way toward elevating your mood and preventing migraines, Dr. Kraig says. He recommends taking a daily 20-minute stroll outdoors and getting lots of sleep at night. Both of these decrease brain excitability, and so help you avoid migraines and their attendant blues.

Anxiety

About 50 percent of people who have chronic migraines struggle with anxiety, according to the American Migraine Foundation. Chronic migraine is defined as 15 or more episodes per month. Experts believe some people develop anxiety as a result of the burden of living with chronic migraines. However, they also believe that the way the brain sends chemical messages from one neuron to another could also play a role.

Bell’s palsy

A 2014 study published in the journal Neurology revealed that people who suffer from migraines are twice as likely to develop Bell’s palsy, a condition that induces facial paralysis. After keeping tabs on more than 100,000 people, half of whom were migraine sufferers, a team of Taiwanese researchers found rates of a nervous system condition called Bell’s palsy nearly doubled among the migraine afflicted. Bell’s palsy affects the nerves that control facial movements and muscles, the authors explain. The study team says it’s not clear how migraines and Bell’s palsy are connected, although they speculate that inflammation, heart issues, or blood flow problems could link the two.

Parkinson’s

If your migraine headaches are accompanied by an aura (flashes of light or visual floaters), your risk of developing Parkinson’s disease more than doubles, shows research from the Uniformed Services University in Bethesda, MD. That’s especially true if you suffer migraines in middle age. While the causes of migraine headaches are still being debated, the study authors say issues with the neurotransmitter dopamine may play a role. The study authors speculate that dopamine is also disrupted in people with Parkinson’s, which may explain the links.

Epilepsy

People with migraines are twice as likely to have epilepsy (and people with epilepsy are twice as likely to have migraines), according to the Epilepsy Foundation.