Panic Attack vs Stroke: How to Tell the Difference and When to Seek Help

A Note from The Center • A Place of HOPE

This article was written by our founder, Dr. Gregory Jantz, in the weeks before his unexpected passing on July 4th, 2025. Dr. Jantz was deeply committed to helping people find lasting healing through a whole-person approach to mental health. His insights, compassion, and dedication shaped everything we do at The Center, and this piece reflects the wisdom and care he brought to every aspect of his work. As one of the final articles he wrote, we are honored to share it in his memory and continue his mission of providing hope to those who need it most.

The sudden onset of chest pain, difficulty breathing, dizziness, and an overwhelming sense of doom can be terrifying. Your mind races: “Am I having a heart attack? A stroke? Or is this a panic attack?” Understanding the crucial differences between these conditions can quite literally save your life.

If you’ve ever experienced sudden, intense physical symptoms that made you fear the worst, you’re not alone. There were an estimated 1,247,000 anxiety-related emergency department visits annually in the United States, representing 0.93% of all ED visits ^[3], while stroke remains a leading cause of death and disability. The similarities between panic attack and stroke symptoms can make it incredibly difficult to distinguish between a medical emergency and an anxiety response.

Understanding Panic Attacks: When Your Body’s Alarm System Goes Into Overdrive

A panic attack is when your body’s fight-or-flight response is activated. According to DSM-5 criteria, a panic attack is an abrupt surge of intense fear or discomfort that reaches a peak within minutes, during which time four or more specific symptoms occur ^[1].

The experience can be overwhelming. Imagine your internal alarm system suddenly blaring at maximum volume when there’s no danger. Your heart pounds, your breathing becomes rapid and shallow, you may feel dizzy or nauseous, and an intense fear of losing control or dying can wash over you.

Common Panic Attack Symptoms

The symptoms of a panic attack are very real and can include:

• Cardiovascular symptoms: Racing heart, palpitations, chest pain or tightness
• Respiratory symptoms: Shortness of breath, feeling like you can’t breathe, hyperventilation
• Neurological symptoms: Dizziness, lightheadedness, feeling faint, numbness or tingling
• Gastrointestinal symptoms: Nausea, stomach upset, feeling like you might vomit
• Psychological symptoms: Intense fear of dying, losing control, or “going crazy”
• Physical sensations: Sweating, trembling, hot or cold flashes, feeling detached from reality

A panic attack typically lasts 5-30 minutes, with symptoms usually reaching peak intensity within about 10 minutes. While the experience is incredibly frightening, panic attacks themselves are not physically dangerous or life-threatening.

Who Experiences Panic Attacks?

Research suggests that around 13.2% of people experience panic attacks at least once, with 66.5% of those experiencing them recurrently ^[2]. However, only a small percentage of people who have panic attacks develop panic disorder. Panic disorder affects 2 to 3% of the population in a 12-month period and usually begins in late adolescence or early adulthood, affecting women about 2 times more often than men.

Stroke: A Medical Emergency That Demands Immediate Action

A stroke occurs when blood flow to part of the brain is blocked (ischemic stroke) or when a blood vessel in the brain bursts (hemorrhagic stroke). On average, 1.9 million brain cells die every minute that a stroke goes untreated ^[4], making rapid medical intervention absolutely critical.

Unlike panic attacks, strokes represent actual damage occurring in the brain and require immediate emergency medical care. The sooner treatment begins, the better the chances of recovery and reducing long-term disability.

Recognizing Stroke: The F.A.S.T. Test

The F.A.S.T. acronym was derived from the Cincinnati Prehospital Stroke Scale and was adopted by the American Heart Association as the primary mnemonic tool to educate about stroke symptoms ^[4]:

• F – Face Drooping: Does one side of the face droop, or is it numb? Ask the person to smile. Is the smile uneven or lopsided?
• A – Arm Weakness: Is one arm weak or numb? Ask the person to raise both arms. Does one arm drift downward?
• S – Speech Difficulty: Is speech slurred, garbled, or strange? Ask the person to repeat a simple phrase.
• T – Time to Call 911: If you observe any of these signs, call 911 immediately and note when symptoms first appeared.

Additional Stroke Warning Signs

Beyond F.A.S.T., other stroke symptoms can include:

• Sudden confusion or trouble understanding
• Sudden severe headache with no known cause
• Sudden trouble seeing in one or both eyes
• Sudden trouble walking, loss of balance, or lack of coordination
• Sudden numbness of the face, arm, or leg, especially on one side

The Challenge: When Symptoms Overlap

The difficulty in distinguishing between panic attacks and strokes lies in their overlapping symptoms. Both conditions can cause:

• Sudden onset of symptoms
• Dizziness and feeling faint
• Difficulty speaking or thinking clearly
• Numbness or tingling sensations
• Feeling of impending doom
• Nausea

This overlap is why 34.5% of emergency department patients with non-cardiac chest pain reported at least one panic attack in the past 6 months, and 77.1% of patients who reported panic attacks had visited the emergency department with non-cardiac chest pain following a panic attack ^[8].

Key Differences: How to Tell Panic Attacks and Strokes Apart

Timing and Onset

Panic Attacks: Panic attacks typically reach peak intensity around 10 minutes and then slowly fade. The buildup may be gradual, and symptoms usually resolve within 20-30 minutes.

Strokes: Strokes are almost always instant, with symptoms occurring almost immediately. The effects are typically sudden and persistent, often worsening rather than improving.

Movement and Motor Function

Panic Attacks: While you may feel weak or shaky during a panic attack, you typically retain the ability to move. You might feel like you can’t move certain muscles due to anxiety, but actual paralysis is extremely rare.

Strokes: One thing that anxiety rarely causes is paralysis. With anxiety, even though sensations can still occur, the ability to move or act is still generally present. Facial paralysis, where your face starts to “fall” and you drool or choke because you cannot move, is a stroke symptom.

Associated Symptoms

Panic Attacks: Often accompanied by other anxiety symptoms like rapid heartbeat, sweating, trembling, and psychological symptoms such as fear of losing control.

Strokes: Strokes are a loss of brain function. Though they can cause anxiety, they do not generally occur concurrently with other anxiety symptoms.

Age and Risk Factors

Panic Attacks: Can occur at any age but often begin in young adulthood. Strokes are uncommon in those under 55, those without a family history, and those without high blood pressure or high cholesterol.

Strokes: More common in older adults and those with cardiovascular risk factors.

Understanding Transient Ischemic Attacks (TIAs): The “Warning Strokes”

Transient ischemic attacks (TIAs) are often incorrectly called “mini-strokes,” but they’re every bit as serious as a proper stroke. TIAs cause stroke-like symptoms that resolve within 24 hours, often much sooner.

The danger of TIAs is that they’re often dismissed as “just anxiety” because symptoms disappear. However, up to 20% of people who have a TIA have a stroke within 90 days, and half of those strokes happen within the first two days after a TIA ^[7].

Critical point: Even if stroke-like symptoms resolve quickly, seek immediate medical attention. TIAs are warning signs that a major stroke may be imminent.

When to Seek Emergency Medical Care

Call 911 immediately if you experience:

• Sudden onset of severe headache, unlike any you’ve had before
• Sudden weakness or numbness in the face, arm, or leg, especially on one side
• Sudden confusion, trouble speaking, or difficulty understanding
• Sudden trouble seeing in one or both eyes
• Sudden trouble walking, dizziness, loss of balance, or coordination
• Any combination of symptoms that come on suddenly and severely

Consider emergency care for panic attacks if:

• It’s your first time experiencing these symptoms
• Symptoms are more severe than usual panic attacks
• You have chest pain with shortness of breath
• You lose consciousness or feel like you might
• Symptoms last longer than 30 minutes

If you’ve never had a panic attack before and you experience the symptoms, get medical help right away. Only medical professionals can definitively rule out severe conditions.

The Psychological Impact: Health Anxiety After Panic Attacks

Experiencing symptoms that mimic severe medical conditions can create lasting anxiety about your health. Those with severe anxiety are rarely satisfied with a panic attack diagnosis. Because the symptoms are so similar and can have so much in common, it becomes too hard to believe that they are caused by something non-physical.

This health anxiety can become a cycle: fear of having another panic attack can trigger more panic attacks. Understanding this pattern is crucial for breaking free from it.

Treatment Approaches: A Whole-Person Perspective

Understanding the Mind-Body Connection

Panic attacks demonstrate the powerful connection between our mental and physical states. The most important thing to understand is that anxiety is not just a problem with the way you think. It also affects the way you feel. It can cause chain reactions that lead to symptoms so pronounced that they feel like you are suffering from a stroke.

Evidence-Based Treatment Options

Cognitive Behavioral Therapy (CBT): Effective therapies for panic disorder include cognitive behavioral therapy and antidepressants ^[2]. CBT helps you understand the relationship between thoughts, feelings, and physical sensations, providing tools to manage panic attacks when they occur.

Group Therapy Benefits: Group therapy settings offer unique advantages for panic disorder treatment. In group sessions, you can:

• Learn from others who understand your experience
• Practice coping strategies in a supportive environment
• Reduce isolation and shame often associated with panic attacks
• Gain perspective on your own recovery journey

Exposure Therapy: The efficacy of exposure techniques alone, in which the patient repeatedly confronts the anxiety-provoking stimulus through imagery or in vivo (directly facing what is feared), is well established in patients with panic disorder.

Holistic Treatment Considerations

A comprehensive approach to panic disorder treatment often includes:

• Stress management techniques: Deep breathing exercises, progressive muscle relaxation, mindfulness practices
• Lifestyle modifications: Regular exercise, adequate sleep, reduced caffeine intake
• Nutritional support: Maintaining stable blood sugar levels, avoiding anxiety-triggering substances
• Social support: Building strong relationships and community connections

Moving Beyond Medication-Only Approaches

While medications can be helpful for some individuals, focusing solely on pharmaceutical interventions misses the opportunity for lasting change. A whole-person approach addresses the underlying patterns that contribute to panic attacks, helping you build resilience and coping skills that extend far beyond symptom management.

Building Your Support Network

Recovery from panic disorder often happens best in a community with others. Consider:

• Support groups: Whether in-person or online, connecting with others who understand your experience
• Family involvement: Educating loved ones about panic disorder helps them provide appropriate support
• Professional team: Working with mental health professionals who understand trauma-informed, holistic care

The Connection Between Anxiety and Stroke Risk

Interestingly, research suggests a connection between long-term anxiety and stroke risk. Higher anxiety symptom levels were associated prospectively with increased risk for incident stroke, independent of other risk factors, including depression ^[5]. However, patients with panic disorder had an increased risk of stroke ^[6], though further experimental studies are needed to identify the underlying mechanisms.

This doesn’t mean panic attacks cause strokes, but it highlights the importance of addressing anxiety for overall health and well-being.

Practical Strategies for Managing Panic Attacks

During a Panic Attack

1. Remember it’s temporary: Remind yourself what’s happening. You’ve been through this before. It’s scary, but it’s temporary. There’s no real danger
2. Focus on breathing: Try slow, deep breathing through your nose
3. Ground yourself: Use the 5-4-3-2-1 technique (five things you can see, four you can touch, three you can hear, two you can smell, one you can taste)
4. Use positive self-talk: Remind yourself that this will pass

Building Long-Term Resilience

• Regular exercise: Physical activity can reduce overall anxiety levels
• Stress management: Develop healthy coping strategies for daily stressors
• Sleep hygiene: Maintain consistent sleep patterns
• Limit stimulants: Reduce caffeine and alcohol consumption
• Mindfulness practice: Regular meditation or mindfulness exercises

Emergency Action Plan: What to Do When Symptoms Strike

If You’re Experiencing Symptoms:

1. Assess the situation: Are symptoms sudden and severe, or building gradually?
2. Try the F.A.S.T. test: Check for facial drooping, arm weakness, speech difficulties
3. Consider your history: Have you experienced similar symptoms before?
4. When in doubt, call 911: It’s better to be safe than sorry

If You’re Helping Someone Else:

1. Stay calm: Your calm presence can help reduce their anxiety
2. Perform F.A.S.T. assessment: Check for stroke warning signs
3. Don’t hesitate to call emergency services: Time is critical for stroke treatment
4. Stay with them: Provide reassurance while waiting for help

Statistical Overview: Understanding the Numbers

The Path Forward: Recovery and Hope

If you’re struggling with panic attacks or health anxiety related to stroke fears, remember that effective treatment is available. Recovery is not just about managing symptoms—it’s about reclaiming your life and building resilience for the future.

A Whole-Person Approach to Healing

At The Center • A Place of HOPE, we understand that panic attacks affect every aspect of your life, not just your mental health. Our Whole-Person Care approach addresses the complete you: emotional, physical, psychological, nutritional, and spiritual aspects of wellness.

This comprehensive approach recognizes that lasting healing occurs when we address the root causes, not just the symptoms. Through evidence-based therapies, nutritional support, stress management techniques, and community connection, you can develop the tools and resilience needed to overcome panic attacks and reduce anxiety about stroke and other health concerns.

Take the First Step

If you’re experiencing panic attacks or health anxiety, consider taking our mental health assessment to understand your symptoms better and explore treatment options. Our compassionate team is here to help you navigate this challenging time and find your path to healing.

Remember: You don’t have to face this alone. With the right support, understanding, and treatment approach, you can overcome panic attacks and build a life of greater peace and confidence.

Frequently Asked Questions

Can panic attacks cause stroke-like symptoms?

Yes, panic attacks can mimic many stroke symptoms, including dizziness, numbness, difficulty speaking, and feelings of doom. However, panic attacks typically don’t cause true paralysis or facial drooping like strokes do. The key difference is that panic attack symptoms usually peak within 10 minutes and then gradually subside, while stroke symptoms are sudden, persistent, and often worsen over time.

How long do panic attacks last compared to stroke symptoms?

Panic attacks typically last 5-30 minutes, with symptoms peaking around 10 minutes and gradually improving. Stroke symptoms, on the other hand, are sudden in onset and persist or worsen over time. If you’re experiencing symptoms lasting longer than 30 minutes or worsening, seek immediate medical attention.

When should I go to the emergency room for panic attack symptoms?

You should seek emergency care if this is your first time experiencing these symptoms, the symptoms are more severe than usual panic attacks, you have chest pain with shortness of breath, you lose consciousness, or the symptoms last longer than 30 minutes. When in doubt, it’s always better to err on the side of caution and seek medical evaluation.

Can anxiety disorders increase my risk of having a stroke?

Research suggests that chronic anxiety may be associated with a slightly increased risk of stroke, though more research is needed to understand this connection. However, having panic attacks doesn’t directly cause strokes. The more immediate concern is ensuring you receive proper treatment for anxiety disorders to improve your overall quality of life and health.

What’s the difference between a panic attack and a TIA (mini-stroke)?

A TIA (transient ischemic attack) involves actual temporary blockage of blood flow to the brain, while a panic attack is an anxiety response. TIA symptoms are typically sudden and include clear neurological signs like facial drooping, arm weakness, or speech problems. Panic attacks often include multiple anxiety symptoms like a racing heart, sweating, and fear of dying. Importantly, TIAs require immediate medical attention as they often precede major strokes.

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