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Neurology (Expert Forum)
Complicated migraines
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Complicated migraines
by Traciedar, Feb 15, 2003 12:00AM
My neuroligist has diagnosed me with complicated migraines and I have been hospitilized several times and had many test. I take Topomax to help prevent them, but it doesn't seem to help. I don't trust my doctor's,and my attacks are getting worse. If anyone else know about them, they are hemiplegic migraines, causing one side of your body to go numb, and now, I am having several a day and they are slowing down my breathing and I am unconscious for up to five minutes afterwards. My neurologist does nothing but increase my Topomax after every episode. Does anyone else have these type of migraines and what does your doctor do for you?
Doctor's Answer
by CCF-Neuro-M.D.-JT, Feb 18, 2003 12:00AM
Not sure if you are using the right terms as hemiplegic means WEAKNESS not numbness on one side of the body. At any rate, your symptoms sound a bit concerning, especially if you are truly losing consciousness and everything is happening more frequently. It would be extremely important to make sure these are not seizures or TIA's with EEG (need to capture one of these episodes) and MRI/MRA. If they are indeed just complicated migraines, then Topomax certainly does not sound like it's cutting it for you. You may need to have abortive treatment (again assuming this is truly complicated migraine) with an IV medication such as magnesium, depakote, or steroids. Prophylactic therapy with calcium channel blockers rather than topomax may be more helpful. If you don't trust your doctors, then get a second opinion. If you are becoming unconscious several times a day, then consider going to the ER for a more urgent evaluation. As for now, until this is taken care of, you should not be driving or operating heavy machinery for your own safety and that of others. Good luck.
Talk to your neurologist about changing your preventative medication. Topomax doesn't seem to be doing anything for you. However, although I've been on Depakote for several years now, it did take a long time adjusting the dosages until we got to an effective level, and even then it took a long time for me to notice that my migraines were less severe. I stopped passing out reasonably soon after the Depakote dosage got right, and the dizziness disappeared about a year and a half later. Although milder, my headaches can still last a week or more. I don't know how conscientious you are about taking your medications on time, but I definitely noticed that I needed to take mine at the same time every day to keep my blood levels even. Don't miss a dose.
You didn't mention any abortive treatments. Most of them only worked for a month or two at most. I went through the gamut and still haven't found anything that works totally and reliably, but Maxalt seems to be the most effective of the triptans for me (not everyone reacts the same to every medication).
In addition to increasing your magnesium, try adding Vitamins B-2 and B-12. Strangely enough, I also found that although everyone tells you to get off of caffine (and if you haven't, you should--it does make a difference), I found that one of two things would frequently help: either a large amount (1/2 gal.) of orange juice or a 2-ltr bottle of cola (I always drink diet, I don't know if this makes a difference). I don't know why, but if one doesn't help the other frequently does. I usually start with the oj, because it's the healther of the two. The cola does make sense, though, because caffine somehow speeds up the absorption rate of certain medications (ergo the otc migraine relief medications). The baby aspirin (or Feverfew if you can't take aspirin) probably isn't a bad idea, but do make sure you avoid ginko. You might also want to try yoga exercises to get your circulation moving and elongate your spine (don't try to push yourself to do anything that's uncomfortable--and don't do anything that makes the blood rush to your head). And last, but not least, if you suspect that your headaches might be related to a hormonal imbalance (you didn't mention your age), and if you don't have any family history of breast cancer, you can try supplementing your diet with natural estrogens (like soy). This might take a while for you to notice any effect).
In any event, you should definitely get a second opinion. If your unconscious episodes are anything like mine were, they are extremely dangerous (I not only had to stop driving because they would come on with very little notice, but I was afraid to go anywhere by myself--it was terrifying). Your numbness brings this all much too close to stroke symptoms.