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Autonomic dysfunction and vertebrobasilar migraine?
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Autonomic dysfunction and vertebrobasilar migraine?


  since May I have had escalating symptoms, the preliminary diagnoses is basilar artery migraine with autonomic dysfunction.
  I will feel like I will have an attack in the early morning, sometimes I am woken from sleep with this. I feel dizzy (presyncopal), a feeling of iminent death, parasthesias usually in hands or just certain fingers, but sometimes in both hands and legs, also from my eyes down to my chin and my scalp. I will feel the pounding begin, I check my bp, it ranges anywhere from 150-210/120-140 I feel palpitations, my heart rate increases anywhere from 120-180(highest documented) these spells last for about an hour or so, sometimes more. I was admitted into the hospital last week for just this with Twave  changes in the anterior leads (inversion), I had chest, throat, and jaw pressure and a feeling of not being able to breath. along with visual disturbances, a feeling of presyncope. The episode subsided in the ER, but with the twave changes they admitted me, where I developed orthostatic hypotension and was given iv fluids. my bp remained 120's/80-90 during my stay and heart rate in normal range. I was discharged on Friday and on Sunday had the same episode. and returned to the ER. Oh yeah, I have a headache like I have never felt before. I have suffered migraine since puberty, and on a 1-10 scale these are a 20.I have had every test known to man, R/O pheochromocytoma, renal artery stenosis, hyperthyroidism, had MRI, MRA, CT all=nothing....they can't find anything wrong with me. I have days where my BP on waking is 180/120, 30 min later 100/60 and up and down like this for days, also 110/100 and other very narrow pulse pressure readings. the peaks of these attacks are always right before menstruation. ( I am a34 y/o female,100lbs,5'1") I now have visual disturbances every day, all day since the end of July, the other symptoms come and go except of feeling of general malaise. sometimes I have tinnitus so loud that I become confused if there are more than 1 sound or conversation. sometimes noise is painful, or things sound as though they are on speaker phone. my vision will shake violently, the earth will sway back and forth like a boat, the symptoms are too numerous to mention. I have been prescribed neurontin, which I stopped taking because each time I increased it I ended up in the ER. I was just put on Norvasc 5 mg after insisting on a calcium channel blocker to hopefully reduce blood pressure at this time and prevent vasospasm. I have taken corgard 40 mg for 5 years as migraine prophylaxis which was stopped 3 weeks ago and restarted after the 180 hr episode. I have d/c'd all caffeine and pain medication. thoughts from the consultants. My neurologist does not think that this is the correct diagnosis, she is fairly young and is not experinced in this area admittedly, but my internist insists, she has done a lot of research and has found somewhere that this can cause autonomic dysfunction. I have made an appointment at the Cleveland Clinic with Dr Stillman on Nov 20, I am just very worried about making it that long, these episodes have become more and more frightening. Have you ever heard of anyting like this? btw, my baseline bp is 90/60 and will return to normal between these "attacks" but the attacks are more and more frequent although shorter in duration. Thank you in advance for your time.
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Dear Cherie:
Seeing Dr. Stillman at the Clevelnd Clinic is a wise decision. I am sure he will be able to address all diagnosic questions, and even put you through a comprehensive autonomic work-up. Pain and autonomic troubles are probably the most treatable of neurological problems, and you should consider yourself fortunate in this regard. Although your acute symptoms must be most alarming, it is reassuring that you have survived several events without suffering any permanent harm. So long as you are careful, stay well-hydrated, and stay within easy reach of competent medical attention, I am positive that you will be alright.
We look forward to seeing you. Good luck!




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