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Atypical Migraine Headaches
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Atypical Migraine Headaches

My 16 year old daughter began having episodes of stroke-like symptoms (droopy eye, face, arm, dragging foot, speech a little slurred - left side) which are preceeded by upset stomach and irritability and irrational behavior and speech (not her normal personality) in early May 2009. She has had mri, mra, ct scan of the brain as well as an ekg. Her symptoms lasted several hours and were followed with fatigue for several days. The tests were all normal. The neurologist believed her to be having atypical migraines. She was symptom free until May when similar symptoms occurred on the way home from a school field trip. Saw neurologist and had EEG. Placed her on proponolanol. The medication caused her to be lethargic and way worse. He advised to discontinue. The EEG was normal and he advised that we should call if we needed him. Otherwise, he didn't see anything abnormal. Thought that maybe she had a virus. September 8 another similar episode began at school. The day prior (Labor Day) she had complained of stomach pain, was extremely grouchy and exhausted. She slept the 8th after the episode and the 9th. Fairly normal for a week. Yesterday same symptoms and slept the rest of the day. Today she is at school but not feeling much better, tired, cloudy head. Not sure where to turn or what to try next. Thinking of trying a no preservative diet to see if that could be the cause. Wondering if there is something we are missing or if it is indeed atypical migraine and she will just need to learn triggers and coping strategies. Thanks for your consideration and help. Melissa
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768044_tn?1294227036
Hi there, it is possible to have stroke-like symptoms with migraines. I have had stroke-like symptoms with two of my migraines before. It is very scary, but... it can happen. If you are still worried that it could be something more and you are not happy with your current neurologist, you could always ask your family doctor for a referral to a new neurologist, but, it sounds like your neurologist is doing an okay job, as there isn't much they can do for migraines other then try out different medications to try and prevent them... also, the next time it happens, you can always go to an Urgent Care Center to make sure that it really is a migraine, even if the symptoms are similar to before... and always go back to the ER or an Urgent Care Center if there are ever any NEW stroke-like symptoms that you have not seen in your daughter before. If there are NEW stroke-like symptoms, the ER will be happy that you came back, they will not mind at all.

Propranolol is a beta-blocker. Beta-blockers are one type of daily preventative medication used to treat migraines. I take a beta-blocker called Nadolol to treat my migraines. I also take a different class of daily preventative migraine medication too, it is an anti-convulsant called topamax, it is a VERY popular migraine medication and MANY people on the forums take it. I do not know how often it is prescribed for teens though... you will have to ask your doctor about this. The first daily preventative medication I was prescribed, while I was a teen, was in the class of daily preventative medication that are anti-depressants and it was called amitriptyline... it is probably the most used antidepressant for migraines. So, propranolol is not your only option, you have 3 other possible options for your daughter that you can discuss with your daughters doctor:

- Other beta-blockers instead of the propranolol
- Antidepressants, amitriptyline is usually the only one prescribed.
- Anticonvulsants. The most popular one being topamax. The second most popular being Valproic acid... and, as long as this is safe for teens and children, this should be safe for your female daughter since she probably is not planning to get pregnant... as it is NOT safe for women who are sexually active and not on birth control... as it can seriously damage unborn children. So, if there is ANY chance that your daughter could even remotely become pregnant WHILE taking valproic acid, then valproic acid would not be a safe medication for her.... and something like topamax MIXED with folic acid (to protect a possible unborn child... as any anticonvulsant carries some minor risk) would be better) ... this is something that all women should know, and just something that is good for her to know for later when it would become an issue if she had to stay on the preventative medication later into her childbearing years.
- Non-daily options such as Botox or surgery. I just had botox done. It works really well for some people... your daughter would have to get it every 3 months though. I have no idea if it's worked for me yet. I can let you know in a week or two what I think of it.

A no preservative diet is totally something you could try. A diet free of MSG is a place to start. Also, make sure she eats 3 meals a day, without ever missing a meal or being late for a meal, with small healthy snacks so her blood sugar doesn't drop. Drops in blood sugar can trigger migraines. No chocolate and no caffeine are good things to try too... so no coke or pepsi or rootbeer or dr. pepper or any sort of cola that you can't see-through as that will usually have caffeine in it. Other foods that can trigger migraines for some people include cheese, especially fermented cheese or hard cheese. I can eat soft cheese without problem... such as mozzarella for example.. but most hard cheeses will trigger a migraine for me! Your daughter probably doesn't drink anything like alcohol... but, the things in alcohol that triggers migraines are things like sulfites, which can be in foods like dried coconut and some granola bars... so check ingredients. But, if your daughter eats these things a lot and doesn't get headaches after eating them, they are likely not triggers and cutting out foods that make her happy can depress a young girl and stress and depression can trigger migraines just as much as foods can... so if after a trial of cutting these things out doesn't show improvement, let her eat the things she loves again, so that her life doesn't seem sad or stressful... unless there is a major improvement, then cutting it out will be worth it and she will understand that it is worth it if you and her doctor explain it to her and make the decisions with her.

Also, has her doctor given her triptans at all to use at the first signs of these symtoms (symptoms)? Sometimes triptans can be counterindicated in some migraines, such as atypical migraines... and this might be why the doctor did not give her triptans if she does not have a prescription. But... if she does not have a prescription and is not using triptans and the doctor did not discuss triptan use with you at all... it might be a good idea to ask about triptan use next time you talk to your daughter's doctor. Triptans are acute migraine medication as opposed to daily migraine medication and they can stop a migraine from progressing, as they interrupt the physiology of the migraine. So, it would be worth asking your daughter's doctor about. I have noticed that many of the pediatric patients on the forums do not mention triptans... maybe there is a reason for this as well... like, young patients are not prescribed triptans? I would be curious to learn about this if your daughter's doctor has an answer.

You could also try giving your daughter the following natural remedies that have been proven effective in scientific clinical trials. Please ask your daughters doctor about these too though as I do NOT know if these dosages are safe for children. Your daughters doctor will be able to give you information on if these are safe for your daughter and will be able to confirm that they are effective in migraine patients:

- 400 mg of magnesium a day (please check with your daughters doctor or pharmacist first to see if this dose is safe for a 16 year old)
- 400 mg of B2 a day (please check with your daughters doctor or pharmacist first to see if this dose is safe for a 16 year old)
- 300 mg of CoQ10 a day (please check with your daughters doctor or pharmacist first to see if this dose is safe for a 16 year old)
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764912_tn?1322715443
Thank you both, for the question and the answer.  I have always had migraines but about a month ago I went to the ER three days in a row at my family Dr's suggestion.  They thought it could be a stroke, which all of my Mom's side have passed away from by 47yrs.  Then they tried DHE which worked, I regained my balance, and the fog, nausea, sensitivity to light & noise ect all gone.  However, since then I have no memory of these days and I only remember details for a couple days at a time then I have forgotten.  My family and friends say my personality has even changed.  So we don't know either, a stroke, MS or complicated migraine???  

I really hope you find help for your daughter!  What a great avenue you are using and searching to find her help, just don't give up. :)  

My MRI/MRA were normal except for higher T2 signal, one lesion or infarction on the left side, and white matter on the frontal lobe.  So I too keep going back for a solution.  Hang in there.
Tracy
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Avatar_n_tn
Thanks for the return post. It is reassuring to know that indeed migraines can in fact cause these types of symptoms. We have been focusing intently on making sure she is well hydrated and eating something every couple of hours. Also watching for certain preservatives. Not going too crazy with every artificial color. Prior to her most recent migraine episodes, she had eaten cheeze crackers and packaged cookies (usually don't buy) and both contained the preservative TBHQ. Really trying to watch that and MSG especially for right now. So far, so good. Thanks again.
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Avatar_f_tn
OM goodness! Melissa you have just explained my son's experience like they are the same kid. He is 13 and has had the same experience with an atypical migraines.  They started two years ago. I got a phone call from the school that he was having a stroke they were sending him to the ER.  He had all the tests and everything was normal!! If you can call any of what we just went through NORMAL!! After that experience he had several small ones that we were able to stop with acetaminophen and ibuprofen. Last month he started in again with  the stroke like symptoms. We have been to three doctors I am currently waiting a phone call as I write this. I am so worried about him and his ability to live a normal life of a typical teenager.  He has had one for almost a month now and I am not having any luck with the medical world. It stared Nov. 21 2003 and has not left yet. He will get better for a few days then boom another one strikes!! He had one so bad yesterday, Christmas day we had to leave the family gathering and hurry home before the ear busting screaming started.  I feel so bad for my son and the roads all seem to be ????
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