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Complex/Complicated Migraine?

A week and a half ago I had an excruciating headache (none like I've ever experienced before), with severe nausea, dizziness, blurry vision, hearing changes and numbness in my left arm and face.  I went to the ER where they did an MRI, which was normal.  I saw a neurologist the next day who diagnosed me with a "complex" or "complicated" migraine, started me on a preventative medication and gave me pain medication.  The headache (which feels like my head is in a vice) has yet to go away and 3 days ago was worse.  I was taking pain pills around the clock with almost no relief.  So, I was started on a 6 day course of steroids.  The last 2 days there seemed to be an improvement in the severity of the headache and the dizziness was going away.  Now today, the headache is excruciating again, the dizziness is back (the numbness in my left arm and face gets better and worse - it's back and forth) and the pain medication is barely helping.  The neurologist said she has seen it take 3-4 weeks for the "cycle" to break and the headache to go away.  The pain and dizziness is debilitating and I'm looking for any advice that may help. - Thank you!
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Avatar universal
hi, i have just come out of hospital after 8 days, i to did not no what was happening to me, till the doctor told me i had a mini stroke brought on by a complex migraine, i had never heard of this, im am still very frightened and worried by the way im feeling. i am on topamax,asprin. and metoprolol, ,
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Avatar universal
One more thing Dolly1978, another med I have been on with the complicated/complex migraine since I had the stroke was 2 low dose aspirin everyday... 162 mg, now I'm down to 1 aspirin...81 mg.  The high dose magnesium I spoke of before is 400 mg. TWICE a day, but that is a prescription dose.

I totally understand all you are going through and the things you feel when you are going through this horrible affliction.  It took awhile for me to understand what was going on and to find the help I needed,  it it a very scary time and something you don't wish on anybody.  Don't stop with the first dr. if you aren't satisfied. We live in small rural community and it took me a few drs. This type of migraine is not well understood.  I actually got a lot of help on this forum.

Please whatever you do, don't take abortive drugs...Triptans.

Dr. Noopur directed me to websites and through him I found this Diamond Headache Clinic in Chicago, 5 hours 1 way for us to drive, but well worth the drive.  They are tremendous!!  

I wish you the best!  Keep us posted!
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Avatar universal
I have been having complicated/complex migraines for a few years now and have 1 went to point of having a mild stroke 20 mos. ago. I was in the hospital 3 days and recovered, since then I have had another episode, it was not a stroke or TIA, the only way to tell was by an MRI. I had multiple tests each time.  I am on preventative meds...verelan pm, topamax and the latest a high dose of magnesium.  I am doing well.  My drs. have have told me NEVER take triptans for complicated/complex migraines, they constrict blood vessels, which would indeed make the outcome MUCH worse.  Complicated/complex migraines do exactly that... constrict the blood vessels, which in turn is what caused the stroke I had and shut off the blood supply to my brain, only briefly, but long enough to cause the stroke.  So you can only imagine what a Triptan would do.  I did have the auras, the head pain, then mostly the neuro symptoms and then finally went to The Diamond Headache Clinic in Chicago, IL. and was diagnosed with Hemiplegic Migraines along with the complicated/complex, because I was paralyzed during the last migraine I had.  I came through with no last ill effects, but I now give myself a shot of Toradol for pain, PRN, it takes the pain away and does not make me feel drugged or loopy, like most pain meds, at least it works for me.  I would suggest asking your neurologist about preventative meds, maybe adding magnesium, and NOT taking Triptans.  If you want to talk to the experts go online and checkout diamondheadacheclinic.com!
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Avatar universal
I suffer from comlicated migraines, have for the past year. No medication really works for me but over time that constant headache did lesson. I had a migraine for 2 weeks straight right after I got sick and it was awful nothing helped so I feel your pain. I was on the same medication as you at one point but it gave me chest pains and rapid heart rate so I stopped taking it. I was also on topamax which worked in the beginning but stopped doing anything in about december. I have tried cutting this out of my diet and I still got headaches I have tried excersising and I still get headaches. Complex migraines are a pain to treat and get under control. It is all about finding the right daily preventative and just finding ways to deal with it which *****. I find drinking HUGE amounts of water is about the only thing that really helps me, but even that doesn't always keep them at bay. Anyway I know I haven't been much help but you aren't alone in this!!
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Avatar universal
Even though you had no sign of stroke on your MRI,it might also be good to have an ECG of your heart and a heart echo. Complicated migraine and transient ishchemic attack (TIA) can mimic each other,but TIA symptoms usually only last a day,but then can recur. These tests may be unnecessary,but I know it would help put my mind at ease. Let us know how your doing.  
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Avatar universal
Hi Dolly1978,

I was wrong complicated actually means aura symptoms that don't go away when the migraine pain begins,so I would also stick with your doctors plan for now,it may be this will dissappear as mysteriously as they appeared.

I had chronic migraine,with chronic tension headaches,with transformed migraine(from analgesic overuse)for about three years. But I never really had migraines with aura. I had chronic paresthesia but that turned out to be from an underlying disease.

In my experience preventatives did nothing for me,I thought analgesics were helping,but their only helpful in the short term,and personally I hated triptans,they made me feel worse. The only thing that ever helped me was quitting caffeine,and stopping all analgesic use simultaneously.  But it also turned out later that my headaches weren't primary,they were caused by an inflammatory disease called sarcoidosis,and I also sometimes get intracranial hypertension,but the same things that made people with primary headache worse would also antagonize mine.

My headaches were pretty much gone last summer and fall when the sarcoid was in remission but now that it's flaring again I have a headache everyday again but their way less severe than they would be if I was popping pills and drinking a bunch of caffeine.

So if yours doesn't get better in a month,although withdrawing from the Fioricet could even make you feel sick for up to a week. I would look more for a secondary cause,your blood pressure sounds almost borderline hypotensive,it might be worth finding out why. I trust they took blood and checked your thyroid,kidneys,liver,blood sugar,blood count and so on.

But everyone is different,I just wanted to share my experience,I hope you find what works for you.

PS: Nortriptyline inhibits the reuptake of norepinephrine and to a lesser extent serotonin,it may be safe to take with a triptan but you'll have to ask your doctor. Triptans are strong vascular constrictors so it could be dangerous to take them if you have aura symptoms because aura means there's already a part of the brain not getting enough blood flow,so creating more constriction could put you at more of a risk for stroke. Again you should ask your doctor.

Take Care
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Avatar universal
Thank you all for your feedback.  I really appreciate it.  This is a very scary experience for me as I have never had a migraine before let alone the other symptoms I've had that made me go to the ER thinking I was having a stroke.  The preventative medication I am taking is Nortriptyline (an antidepressant - my doctor decided on this verses an antihypertensive as my normal blood pressure is only about 95/65 and she said I'd probably be fainting a lot if she prescribed that).  The pain medication I am taking (which I've been taking around the clock currently because the pain is so intense and will not go away) is Fioricet, which is also what I am suppose to take in the future as soon as I feel a migraine coming on.

I know my doctor told me and as you DrNoopurMD also confirmed, it can take 3-4 weeks to break the headache cycle, I am just really freaked out that I've had an excruciating headache for 2 weeks now that has never gone away and has completely debilitated me.  Sleeping doesn't help, the cool cloth doesn't help, lying in a dark cool room doesn't help... I am just feeling at my wits end of what to do to get some relief and it also scares me to think that it can't be a good thing to have this bad of a headache for this long.

Corvin, you mentioned Triptans are typically the abortive medication prescribed but it can't be taken with some antidepressants.  I don't know if Nortriptyline is one of them - but I also read somewhere on the internet that sometimes with "complex" or "complicated" migraines that sometimes Triptans are not prescribed as there is less known about these types of migraines verses what I guess you would call a "regular" migraine. ???

Again, thank you all for your feedback as this is all new to me and any input is very much appreciated.
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Avatar universal
Hi,

Your doctor is right, it takes 3-4 weeks to break the headache cycle. Preventive medications also take some time to act. So I would suggest you to continue with your prescribed medications. Supplemental magnesium has been known to provide relief and reduce frequency of migraines.
You an discuss this with your treating doctor. Keep us posted.
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Avatar universal
I forgot also that some antidepressants and Triptans shouldn't be taken together,because you can develop serotonin shock. So discuss this with your physician.
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Avatar universal
Hi Dolly1978,

Complex means you have signs of tension headache(vise feeling)and migraine with aura. I'm not sure what pain medication your referring to,but narcotics or even otc's used everyday will create transformed headache,basically making the headaches worse. Narcotics also increase intracranial(csf)pressure,that's also why their not usually used for headaches.

Preventative medication like antideppressants,blood pressure medication can be used,along with a triptan medication. Triptans are an abortive medication,taken as soon as possible WHEN YOU NOTICE A MIGRAINE STARTING, Triptans can only be taken up to once or sometimes twice a day. Otc's and even narcotics can be used but limit their usage to two or three days a week.

If despite medication a headache gets severe,laying down in a dark quiet room with a ice pack on your head,and try and rest,or if you can falling asleep usually helps. Although I know this is hard to do when you have work/kids.

I won't expect them to give you anymore Prednisone,that sort of tells them the cause is inflammatory,but taking Prednisone everyday for more than a few weeks can create more unwanted complications.

  Also most important is to avoid anything addictive,that creates a withdrawal and/or vascular restriction. The most common being caffeine,and cigarettes. Remember chocolate contains caffeine also,and if your already addicted to caffeine when you stop you will get a severe headache for a few days,but even if you have to take some time off work to stop caffeine I would highly recommend it. It is extremely important to also follow all of these things at the same time,not try one and then another one later.

There are other "triggers" for migraine such as: lack of sleep,stress,and menstruation.

Take Care
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