Where to find more info?

[Marlies199]

I recently got diagnosed with complicated migraines. I had neurological symptoms (several visual field defecits, numbness in the leg, and buzing in a foot), which lasted for several days, but no headache associated with it. I do get headaches, maybe 2x per year, but these are not associated with the any of the neurological symptoms.
I had several test, including a CT scan and a MRI, after which I was diagnosed by a neurologist as having migraines. This seems to be an "elimination diagnosis"; since it is not something else (a stroke or TIA's), it must be migraines. Is this usually the way migraines are diagnosed?
Where can I find more information about these complicated non-headache migraines? What can I expect for the future? Will I devellop headaches with this? Is this causing any damage to my brain?
How do I stop the neurological symptoms from returning?
The neurologist had 2 answers for me. The first is to return to my home country, which I left 17 years ago. This makes no sense to me, as a move like that would cause a lot of stress, which he says is the cause of the migraines. Or he could put me on Topomax or Celebrex, 2 medications that I rather not take, specially, since it appears that asprin is improving the symptoms as well.
Should I get a second opinion, or visit a migraine specialist? Or should I continue to treat my symptoms with aspirin?

[Vanessa Lacuesta]

Hi,

Good point. Migraines that present with neurological deficits have to be differentiated from a transient ischemic attack (TIA). Any neurologic deficits that appear to progress or are new in onset need immediate consult with a physician.It is better to be on the safe side always.

Migraines and tension headaches may later transform into chronic daily headaches.Some migraines also have a tension headache component.

Migraines have both electrical and vascular components. A genetic or familial component has  also been considered in migraines. Although some studies have shown EEG and MRI changes in migraine patients . These changes are nonspecific and may not be present in all cases.

There is no cause of worry in your case. A close follow up with your physician will help in managing your condition. Migraines are very complex and they have been present for a long long time in medical history. Yet further investigations are yet to give us a clear picture of migraines and associated disorders.


I hope this helps.Good Luck!

[Marlies199]

Are migraines considered vascular problems or electrical?  
You say, that migraines can be transformed later... into what?
Isn't the white matter the cells that protect the dendrites?

I haven't had a major event, that last more than a day, since dec 19. It is three events in the last 2 months.

I do notice that I suddenly am having more frequent headaches (from twice per year to one per week), but they don't seem related to the neurological symptoms. They seem more related to fatique.
Plus an acupuncturist told me to stop drinking coffee, which seems to be my medicine of choice when I have headaches.

Why do you think I may need close supervision, if no damage is done to brain cells during these migraines?

Thank you for your help.

[Vanessa Lacuesta]

Hi,

Migraines are usually diagnosed clinically that is there is no single definite diagnostic tool for a migraine diagnosis. Diagnosis is usually based on patients medical history and complete physical examinations.

Migraines may present with some white matter abnormalities in the MRI but the significance of these are still being further investigated.
Have your physician reclassify your migraines if need be. Some primary headaches that start as migraines may be transformed later on. As in your case, a complicated migraine may require close supervision and follow up.

How frequent is this now?

Keep us posted.

[Marlies199]

Thank you for your response.
There was a carotid ultra sound done (with color something), which showed no stenosis or plaque. A cardiac echo was done which showed that all is normal. EKG's were done, which were normal. On the MRI all arteries to the brain were visible and open. These test however were done when I had no symptoms.

There was no exam of the extremities, most likely because I am only 39 years old. I just had arthroscopic sx done to my knee, 10 days before the first visual field problem. Coagulation tests were done just before the sx, and were normal. My PCP put me on Plavix and aspirin immediatly. The Plavix has been doscontinued now. But I had no symptoms while I was on the Plavix. I did devellop symptoms again after.

Don't get me wrong; I rather have migraines than (mini) strokes, but aren't migraines diagnosed with an EEG?

[Vanessa Lacuesta]

Hi,

Was a carotid duplex scan done to evaluate the arteries that supply blood to the brain?

Were blood vessels in the extremities also evaluated?

Any blood tests done especially coagulation tests?

A transient ischemic attack may not be readily excluded in your case. I suggest you have your scans read by another physician for another opinion. Although a migraine may also present with neurological deficits ( basilar migraines, retinal migraines ) , more serious underlying conditions have to be considered.

Keep us posted.