Migraines or MS based on Lesion?

How does a Dr. determine that Migraines are the cause of all your sx even if you
dont suffer with terrible headaches, and not MS even if you are having sx of
weakness, fatigue, numbness/tingling , vision problems as well as cognative issues.
.  Is there a difference in the way the lesions appear on the brain
that explain migraines and not MS. ?  Im asking because after spending time reading
about MS on the forum (which btw is great!) and others as well, I have noticed that
there are many who have been first dx w/migraines even when lesion is present . as is the
case with myself.
Thanks
Cyndi

[slightlybroken]

It sounds like you have been given the DX of an atypical migraine or complex migraine (it goes by many different names). You can have the same symptoms that you mention above with/without a headache. I think the difference (from what I was told by my neuro), the symptoms typically last for hours (not days) and spasms/spasticity is not included as a symptom. (At least this was the case when she was looking into a different DX for me...but migraines got eliminated for the spasms reason.

In my own experience, the doctors say migraines are linked in leaving nonspecific small lesions. That's not to say that if you have nonspecific lesions that this is where you got them. Nonspecific lesions occur more in people of older age, that have high blood pressure, and migraines, etc...but nonspecific lesions can occur in MS as well.  

From what I gathered what nonspecific means is..it occurs in the part of the brain where other causes can not be eliminated, so they aren't sure what cause it or They can be small as well (3mm or smaller).

[PastorDan]

My "punctate to small T2 hyperintensities" (they didn't call them "lesions" in the radiology report) were said to be "of nonspecific etiology," which means, basically, they can't tell what caused them.  DUH!

And I've been suffering balance and visual problems nonstop since October of last year... yet the neuros so far have all said "migraine" because my MRI isn't worse.  They won't do any other testing, either, except to use me as a guinea pig to test their migraine theory with another dangerous medicine that makes my symptoms worse, rather than better.  Okay, done with that rant.  Carry on.

[HVAC]

I have migraines and MS. I have both typical and Atypical Migraines. The difference in symptoms is my Migraine symptoms come and go with the headache. I.e. when my migraine medicine kicks in my blindness in my left eye goes away and my left side is no longer numb.

I had one Neurologist who only wanted to look at head aches because that is what she specializes in. I went to an MS Specialist because another Neurologist thought I had MS. My MRIs over two years, neurological exams, and  positive LP, and negative blood work all pointed to MS.

Alex

[cyndi25]

ok.. they definately said Lesion to me and i believe 5mm.never said non-specific.  This was the first neuro that I had seen... I am seeing a specialist in Oct.  In the last 4 years, since I was told my
issues were due from Migrains, after the first MRI, i have been more frequently having
more symptoms including spasm in my feet(more in the left), leg and also in the
left arm and in my upper back. My eyesight is shot.. i barely can see out of my left eye
and most of the time i have blurry vision,   I f someone were to take my glasses, i wouldn't be able to see at all.. and to think 4 years ago.. i didnt even wear them, just
for reading. so.. Im thinking if migraines can cause all this, then I have been correctly
dx.  just wasnt sure on his lesion theory.  
slightlybroken-thanks for helping to clerify..for me . i think I have a better understanding.
pastordan- sorry your having to suffer so much.. hang in there, ill be hanging with you
until we get the answers to what were looking for .
Take care
Cyndi

[opie74]

I honestly think that dr's use the migraine as an excuse.  I had a ton of lesions with few symptoms at age 27.  At the time I did have bad migraines that would come and go for 14 days at a time.  After time the migraines imporoved, and I ingnored the symptoms of possible MS.  Long story short, after my second baby I had major issues, and yet another neuro said it was allfrommigreaines.  My opthomologist disagreed, the doublevision was he main tip-off.  Ok, so, get multiple second opinions and go armed with research and questions.

Bestof wishes, and welcome!
Opie Ann

[Udkas]

Hi there this is a very interesting discussion and relevant to myself too.  

For interest some time ago I did bring up some very good websites on migraine/headaches so if you do a search on this forum either on Headaches or migraine you might find it.

My neurologist believes that some of my symptoms are caused by migraine and some are caused by my Transverse Myelitis.  

I have no lesions, no blemishes absolutely nothing to report at all on MRI, so nothing to confuse the issue.

When I asked my neuro why he didn't think all my problems weren't just migraine he said that I showed abnormalities on exam that indicated spinal cord. He also told me that migraines and headaches are more common with MS/TM depending on where the lesions are and he thought that my headache was just worsening my symptoms just like any virus or illness would. He believed that my lesions that he thinks are in my spinal cord are the cause of my migraines.

For me I can see a pattern with my headaches and some of my symptoms but this just confuses me.  I asked my GP about migraine as well and he said that normally the symptoms are before the headache and then disappear and are usually one side of the body, but my symptoms usually peak then gradually go away but it takes mths.. for me to recover.

Slightly broken, what a good explanation about the lesions.

I think the neuro's make their decisions on migraine based on how the symptoms present, how long they last etc. etc., what type of abnormalities they can find and then obviously the type of lesions or lack of lesions found on the MRI.

See I am the opposite to everyone here, I have no lesions at all but have been given a diagnosis  other than migraine and then I am the one that questions it all the time and wonders if it is just some complex type of migraine that causes my symptoms.
My husband reckons I am in denial.

Take care,
Udkas.
Sorry for my rant too.

[wadeheather]

Uh! The migraine dx.....(deep breath).  

[PastorDan]

Just read this on the Topamax site:

"Approximately 30 million Americans suffer from migraines, and less than half are properly diagnosed with the condition. Migraines most commonly occur between the ages of 30 and 49, a time when people are actively involved in the workforce."

If I'm too old for MS, I am also too old for migraine!

[opie74]

Don't take "dope-a-max". I could not carry on a decent conversation while on that stuff. It was asit someone multiplied all of the symptoms that I now know are ms by a factor of 10.

[PastorDan]

Thanks, op.  After reading the warnings on the last drug that neuro gave me (Imitrex), I decided I wouldn't try anything else that he suggested.  Having subsequently read enough about that Topamax stuff, I am glad I'd made that decision beforehand.  I've moved on to neuro #4, and am pursuing a formal complaint against #3 through the hospital and university where he is employed.  Imitrex, with my family and clinical history and with my other meds, was a dangerous choice for me.  Topamax wasn't a lot better.

I've been prescribed meclizine, Xanax, scopolamine, Depakote, Klonopin, amitriptyline (did I get the "y" in the right syllable this time?), Imitrex, Topamax, Neurontin, and I'm pretty sure I've left out one or two things from the list.  Neurontin has significantly reduced my eye pain, most of the time.  Everything else did more harm than good.  Balance and vision have not improved, cognitive uncertainty has not improved, tremor has increased a lot.  Did I mention that I have almost no headaches, and haven't since about March?  It simply must be migraine, though, because the doctor is always right, right?

[supermum_ms]

I find the concept of a migraine with out pain very ilogical, how is it possible to get a dx of migraine if you dont have the head ache or hammer banging pain part, i cant find any explanitary information of how this occurs but i still see the one liner of "usually with or without headache."  I tried understanding how migraine could mimic MS and migraines can include sx of pins and needles, nausia and or vomiting, eye pain (ususally cluster headache), blind spots, blindness, flashes of light, fatigue, diorea, difficulty speaking, vertigo and heavy limbs etc. so there is a lot of sx that correspond so it would be theoretically possible for migraine to be confused with early stage RRMS.

No where have i found tremor, spasticity, spasms or a distinctive walk or gait like MS can have and not many of all the other wonderful things that you find commonly through out MS literature such as bladder incontinence. Migraine may or maynot show lesions on MRI's, aura or no aura, the list is very long and contradictory which almost makes them meaningless to a dx of migraine.

One thing for sure is its very hard to argue against, i'd say its just as bad as being told its physco sematic (stress or depression) symptoms, its very difficult to prove other wise. There would be an expectation for any perscribed medications to bring some relief, but in my humble opinion, if they dont i would expect there needs to be an alternate explanation.

Cheers....JJ