My periodic headache is accompanied by visual disturbance nowadays. What is the reason?

Hello doctor,

I have had periodic headaches that I thought were tension headaches throughout my adult life. Sometimes they are every day for two weeks and sometimes I go a few weeks with nothing. I always seem to have some type of tension in my upper back, shoulders and neck which I felt was the cause of my headaches.

About four and a half years ago, I had my first ocular migraine, it seemed like the shadows of a ceiling fan blinking and it disrupted my vision. I did not have pain, which I thought was odd.

One or two years ago, I had my second ocular migraine, it was different like flashbulbs in my eyes and then zig-zags that spread across my field of vision. Again no pain.

Two days ago, I had my third episode followed by a headache (but I have had what I thought was a tension headache for almost two weeks so maybe they were unrelated?). The visual disturbance was more similar to the one I had a couple of years ago, flashbulbs and zig zags, except it was only the right field of vision.

I have been doing some research and found that women in my age group with migraine and aura have a higher stroke risk, which is scaring me. I am a 40-year-old woman, no smoking, no oral contraceptives, borderline high cholesterol since my 20s, with normal to low blood pressure.

I am honestly looking to ease my mind at this point if there is any good news, but I also need to know the truth about my risk. If my aura symptoms are infrequent, even if these headaches I am having are migraine instead of tension, am I still at high risk?

Thank you doctor,

Would you say visual aura with no pain at all is also associated with increased stroke risk? That was my first two experiences. Also, if the headaches are usually without aura, is that associated with increased stroke risk, or is any aura ever the risk? Is the frequency of either of the above associated with increased stroke risk?