Migraines and Falling

[whisperwolf]

I have had the classic Migraines since 2001, approx. one every month or so with the aura, which was treated with Imitrex.  After a concussion last summer, I started getting them almost daily, where I would get blurry vision, tremors in my hands, nausea, difficulty speaking, pain in the left temple, and falling.  My doctor started me on Topamax, 100mg, which has helped with the symptoms, although I still fall occassionally.  She was able to rule out epilepsy.  

I was wondering if anyone else has these symptoms when they have a migraine?  If so, what else do you do besides take medication, such as take any fall precautions?  I am supposed to see my Neurologist next month and wonder if I should ask for anything in particular?  

Thanks!

[Dr Santos]

Hi,
It is good that the MRI was normal. Severe migraines can really be devastating. However, with trigger identification, stress reduction, and medical therapy, this can be controlled. The treatment for menstrual headaches is also the same as that of migraine: vasoconstrictors and/or anti-inflammatory drugs before and during menstrual period. Take care always and all the best!  

[whisperwolf]

Dr. Santos;

MRI came back normal.  My neurologist says my symptoms are all pointing to severe migraines.  I have eliminated all nitrates, MSG, cut way back on simple sugars and processed foods.  I am supposed to drink way more water and add magnesium supplements to my diet.  My migraines are much worse around my periods, so I have to take Imitrex during my period, plus limit computer use, which seems to trigger migraines.  

Stress reduction is going to be a big part of migraine reduction for me as well :).  

Thank you for all of your help.  

[whisperwolf]

Hi Dr. Santos.  I saw my neurologist on Dec. 7th and she increased my Topamax and gave me a migraine diary and told me to eliminate certain foods.  She also gave me a prescription for self-administered toradol shots.  A few days later I had a severe migraine and ended up in the ER for IV pain medication(torodol, fenadol) (I didn't have my prescription yet) and had to go back the next day as well. I called my neurologist, who asked them to do a CT scan, which came up normal.  They gave me another round of IV pain medication (Torodol, Benadryl, compozine, morphine).  This worked, but on Sunday and Monday I kept falling and ended up in the ER again because my legs kept giving out on me.  I saw my primary doctor, who did a neuro exam and said it was all normal and can't figure out what my problem is.  But I have bouts of weakness and numbness in my legs and left arm as well as chest pain, palpitations and shortness of breath.  I am scheduled for a brain MRI next week.  All my blood work, EKG, urine tests, heart echo is all normal.  

[whisperwolf]

Dr. Santos:

I am doing ok today. Thanks for asking.

The concussion was after I hit my head on the bottom of a swimming pool when trying to get out of an inner tube.  I hit the back of the left side of my head.  I was dizzy, unable to walk, shaking, hand tremors, unable to speak and had headaches.  

I get all those symptoms you mentioned above plus Nystagmus, nausea, falling down, vertigo, weakness in the legs, flashing lights, hallucinations and numbness on the left side of my face.  

The Topamax helps quite a bit.  

Thank You.  

[Dr Santos]

Hi,
How are you? Can you elaborate on your concussion? It is good that epilepsy was ruled out from the differentials. We can also consider post-traumatic headache since this condition share many clinical symptoms with primary headaches such as your migraine. There is also confusion, headaches, dizziness, ringing in the ears, memory or concentration problems, sensitivity to light and noise, irritability and sleep disturbances. Continue with your medications and do update us with your neuro consult. Take care and best regards.

[whisperwolf]

So far the diagnosis of Migraine has not changed.  However, I am also being treated for BPPV in the hopes that might alleviate some of the falling and vertigo symptoms.

I did some research a while back and thought I might be having either a hemiplegic or a basilar migraine as well.  

I discovered that for a hemiplegic migraine that opiates actually work better than triptans.  But for now Imitrex is what I have.  I take Promethazine for nausea and when I have to take a trip to the ER, they give me a headache cocktail which includes Toradal and some other stuff I can't remember, which works great.  

Thanks for the information!  I will give you an update after I see my new neuro. on Dec. 7th.  

[marileew]

Hi whisperwolf,

I take Topamax 100mg too. :)

Did your doctor's diagnosis after the concussion stay migraine or did it change at all?

Some of the symptoms you are describing sound to me like they could be Basilar migraine, although since these symptoms started after a concussion I think it may confuse things a bit.. although if your doctor is sure that all of the symptoms are directly related to your migraines, then I would ask your doctor if you have Basilar migraine.

Basilar migraine is a case of migraine which includes dysfunction of the brain stem (all migraines include temporary dysfunction of the brain stem, although in the case of Basilar migraine the dysfunction is much more severe). Symptoms of Basilar migraine can include: the usual migraine symptoms + vertigo, visual problems, impaired ability to control movements, poor muscle control, balance problems, speech problems, severe vomiting, fainting, and stroke symptoms.

The fact that you experience blurry vision, difficulty speaking and falling suggests to me that you may suffer from Basilar migraine.

Another possibility would be that you suffer from Hemiplegic migraine which mimics a stroke, although falling is not usually a symptom of Hemiplegic migraine, falling sounds much more like a Basilar migraine.

The reason I mention this all as a possibility is because if this is the case, then triptans such as Imitrex are actually counterindicated, especially in the case of Basilar migraine. Triptans can make basilar migraine much worse in the long run. So, it is possible that your acute treatment plan may need to be changed, so this might be something you want to bring up when you see your neuro next month. Although please don't stop using your triptans until you speak with your doctor.

Antiemetics prescribed specifically for the treatment of migraine headaches may be a good option in your situation. One antiemetic that is often used in hospital and sometimes prescribed in doctor's offices is called Metoclopramide. I often use Metoclopramide myself and find it to be a useful part of my acute treatment plan.

If it does turn out that you should not be using triptans, then analgesics that are less likely to cause rebound headaches may also be a good option for you. Many analgesics cause rebound headaches, although some have a much greater risk of doing so than others. Analgesics that we really want to avoid are often over-the-counter pain killers such as acetaminophen and ibuprofen.

Naproxen is an NSAID that is often prescribed for migraines and it is less likely to cause rebound headaches than other NSAIDS. You could discuss with your doctor if Naproxen was an appropriate medication to add to your acute treatment plan. I use Naproxen and I have never found it to give me a rebound headache.

Also, opiates are not known to cause rebound headaches as often either (it is quite rare for an opiate to cause a rebound headache). They are not a first-line treatment for migraine headaches but if you cannot take triptans, they are something you may want to discuss with your doctor. Morphine is usually something I personally suggest migraineurs avoid just because it can cause nausea and vomiting, and why add more nausea and vomiting to our migraine symptoms... although everyone is unique and some people do find that this medication works for them. Although, usually there are opiates that have a lower side-effect profile and a lower dependency profile than morphine and if possible, I think it's better to go with a medication that has the lowest side-effect profile and lowest dependency profile possible, as long as it works. For example, when I go to the hospital for migraines they give me a medication called hydromorphone and it has an extremely low side-effect profile and a low dependency profile as well. Although I am not suggesting this medication specifically as these sorts of prescribing decisions should only ever be made by you and your doctor, never by anyone else.

I hope that information helps a bit! Let me know how the neuro appointment goes next month! :)

- marilee