Complicated Migraines

[hubbardb]

I have a 26 y/o daughter who has been suffering with a complicated migraine for the past 24 days without a break in the cycle. She has a previous history of migraines over the past 3 years with this headache being different in nature. Her headaches have always been in the occipital area radiating into her neck and usually relieved with Midrin and rest. She was placed on Inderal 3 years ago and came off of it when she became pregnant with her 2nd child. He is now one and this is the first headache she has had since his birth. She never returned to her Inderal. 3 weeks ago Saturday she was watching TV and developed a sharp pain behind her left eye with a episode of numbness in her face and neck. She went to bed and went to work the next day with her headache and as the day progressed she became dizzy and lightheaded and her face still remained numb. On Monday am she saw her family dr. and he ordered a CT Head and it was negative and sent her to her neurologist. She ordered a MRI & MRA (both negative). Lumbar puncture negative and placed back on her Inderal. A few days later she developed another sharp pain behind her left eye, numbness in her face with left sided weakness and expressive aphasia which led to hospitalization overnight and a transfer to neurologist (her dr. out of town)where he placed her on Depakote and stopped the Inderal and sent her home. It has now been over another 1 1/2 weeks with the same headache and the other symptoms resolving over 4 days. Today she still remains with the headache 2-3/10.  Any thoughts on where do we go from here.

[CCF-Neuro-M.D.-JT]

Sounds like your daughter may be having status migrainosus which is a migraine headache that lasts over 72hrs. If your daughter is continuing to have a headache (fortunately in the setting of normal testing that failed to reveal serious illnesses such as brain tumor or meningitis) more aggressive treatment measures need to be considered.  Medications that can break the cycle include steroids, IV depakote or magnesium.  A full history evaluating triggers and medications used should be undertaken to remove any possible precipitating or exacerbating factors. ANother test to consider depending  on the degree of suspicion by your doctor is an MRV or MRI of the veins in her brain to make sure there's no blood clot. Finally, routine blood tests may be considered to look for correctable causes such as anemia or electrolte abnormalities. As a side note, unless she's left handed, the combination of aphasia and left sided weakness is unusual.  

Talk to your doctors about trying a short course of steroids. Good luck.

[ozark]

I wonder at times if neck spasms can be a cause of certain migraines...I was told i had migraines after 4 months of constant tense pressure feeling in center of head, with a head bobbing sensation (not actual bobbing)and lightheadedness.....i never actually had pain just the constant pressure like someone trying to push a boulder into my head.  My MRI was neg...i started to do massage therapy especially at the base of my skull which was very tense and tender during the massage (not prior to)....After a few treatments, eventually things relaxed and my symptoms subsided..... i find when i carry anything heavy esp. on my shoulders, or sitting at the computer or turn my head a certain way i tend to get the symptoms back...there are vessells, nerves etc amongst the muscles of the neck that connect into the head that i wonder if a simple solution to a complex migraine is somehow to some degree resolved with proper massage therapy and proper body mechanics?

[hubbardb]

Thanks for your comment. She did see a chiropractic dr. about a month ago and was told that she does not have the proper curve to her cervical spine and gave her exercises to do to help with it.  We had a massage once in the past 2 weeks  and she developed a worse headache with it and now she is not sure she wants to repeat since the headache is at least getting down to  where she can function. I have contacted my close friend who is the director of a massage program at a local college in my area and we are going to start a program for her this week. We are hoping that it will subside with massage. I just know that I sure would like her to get relief so that she may return to her normal activity.

[De-De]

Sorry to hear about your daughter.  I, too, was finally diagnosed with complicated migraines after about a year's worth of testing.  I've had a total work up which included heart/brain caths, numerous spinal taps, bloodwork, MRI/MRA's, CT's. You get the picture. My migraine story began with a mild heart attack at age 42 due to coronary artery spasms.  Testing proved no damage, and normal coronary arteries no disease.  Almost a year passed with reoccuring chest pain until one day I appeared stroke like.  Right sided weakness, facial droop, expressive aphasia, very scary.  The only head discomfort was pressure at the base of the skull.  Testing began to try to find out what's happening.  After all the scary stuff was ruled out, the only explanation was migraine. During the brain cath it was determined that I had smaller than normal arteries at the base of the brain and that this is a common finding in migrainers.  I was under the misconception that migraine was a headache.  Boy, now I understand the mechanism. Okay, now how do I cope?  I'm currently taking preventative medications - verapamil 240mg 2xday, aspirin 325mg 1xday and nortriptyline 75mg day.  This combination appears to be working for me.  So far this year, only 2 episodes. Don't give up, keep looking for what works for her.

[De-De]

You might want to be wary of chiropractic manipulations, especially in people with stroke-like manifestations of migraine.  My Neuro says this is a big no no.

Also, I don't know where you're located, but get your daughter to a large hospital where they've seen just about everything.

My community hospital realized that they couldn't help me and referred me to Hopkins.  I'm lucky this institutions is right in my back yard.

Good luck and tell your daughter to hang in there!  I'm proof that there's a light at the end of the tunnel!

[hubbardb]

Her visit to the chiropractor was before all this started and have no intention on pursing her care there. We were in Ann Arbor last week for a visit to a neurologist. We were treated poorly and with no results..just told to take the Depakote and the headache would eventually go away. We are seeing another neurologist next week in Bloomfield Hills and perhaps we might get some where. I am not expecting a definite diagnosis, I am aware that neuro is a difficult area to diagnosis. They usually just rule out the worse and move backwards. Which they have done thus far...everything negative...our biggest concern is her father has a history of an brain aneuysm, clipped in 1989, and his prelimery work up was negative also and with determination it was discovered he had one and they clipped it. He had all the traditional workup and the second arteriogram was positive and they found it.. Although I do believe she is having a complicated migraine this still sits in the back of my mind... why isn't her headache getting better?  And when does Depakote start to work... how long do we wait for answers..... Oh well I will just keep plugging along.....

[justy]

Please check out Chiari 1 Malformation. Sometimes it is very difficult to diagnose. The criteria that most radiologists and neurologists use to diagnose Chiari is a 3-5 mm herniation of the cerebellar tonsils into the spinal canal. I have been diagnosed with Chiari 1 with a 1-2mm herniation after being given a cine MRI and a 3D ct scan by a well know neurosurgeon in Manhasset NY. The cine MRI proved that I had absolutely no csf flow at the back of my head. Occipital headaches and the numbness you describe are symptoms of Chiari. You can find out more information at www.wacma.com

[hubbardb]

Thanks for the comment.. We have used high dose steriods 2500mg over 24 hours, and a loading dose of Depakote 1000 mg. I have asked about the MRV for looking at her veins in her head because of the platlet aggreation could happen with migraines causing a blood clot. I just get blown off... Her electrolytes, hgb, hct, and other test for MS, and Lupus are all normal... I appreciate your thoughts. Magnesium (have to think about that). I have been an Emergency Room Nurse for 12 years and never have I experienced symptoms with migraines as severe.. she indeed had left sided weakness, asphia, and I did not mention tremors in her left arm.. all those symptoms have slowly resolved but it was scary..I have taken her off her Birth control pills and told her no more artifical sweetners.... Once again Thanks... I will keep on keeping on.......

[snowgoer]

I want to tell your daughter that I understand what she is going through and hope a cause can be identified soon! I too endured several months of headaches that could never be treated or prevented. They finally labeled it as migraines after MRI's and bone conduction studies proved that there was no physical cause for them. Even though they never truly went away, they did ease to where I could almost forget they were there and then BOOM! for no reason they would begin again. How miserable! I tried countless medications but none ever worked but you know how it is, I still carried them around and tried them, hoping.....
I had had a hysterectomy years ago and had gone off my HRT because of the side effects they had, and the recent studies saying they really didn't do any good, but when a physician encouraged me to try the bioidenticle hormones I did, and within days my headaches vanished! I then began reading about how many women suffer from hormonal related migraines and the pieces fit. Please have your daughter tested for her hormonal levels, it just may be the trigger for her.

[hubbardb]

I do believe it could be hormone related.. when she was pregnant with her 2nd baby she was told by a neo-natel dr that her levels of progrestrone and estrogen where low for her age and because of this her AFP scores were severly low... Her son was not a Downs baby as the test could of indicated so I have always thought her migraines could be hormone related... Have a dr appointment this am out of town.. hope to get some answers..

[bwlk]

I hope you get some answers about your daughters headaches.  I had bad migranes for years. I had 25 migranes out of a month Then finally had a MRI with the dye through viens.  It showed magor migranes so I got put on preventive meds - Topamax and Sansert. I also figure they probably are hormonal. The meds worked for about a year or 2 then the migranes came back with a vengences.  Twice as bad.  I had another MRI with dye and seen my Neruoligist again and he increase my preventitive meds and put me on DHE shots(dihydroergotamine) when I have an attack.  I took these shots through the emergency for about 1 year and this is a miracle drug for anyone that has migranes.  It works right away on a severve attack.  

I read that your daughter had the headaches after she saw the chiropractor.  Did they start after she saw the chiro?  And has she ever been checked for a pinched nerve in the neck?  

Just keep being persistant and telling the doctors that you are not satisfied with it will get better in time.  You need to get answers now.

The meds she was on at beginning of May I think takes about a month or so to get in system.  I have been told this.

I am not a dr. I have been through alot of tests also and
I understand the frustration you are going through but hang in there as you will get the answers soon.  Good luck.
bwlk

[mintdove]

My mother is 63 years old and for the last 6 weeks has had constant pain in her head and an aching in her neck.  the first dr. she went to said it was a sinus infection and put her on antibiotics.  This went on for 3 weeks and she did not feel any better.  So she went to a ears, nose throat dr.  he did a cat scan on her sinuses and found that they are clear.  he's now sending her for a cat scan of her neck...  in the mean time she's got numbness in her mouth and it is swollen... there are also white postules growing on her cheeks.  she's going to see an oral surgeon about it in a week.  she also complains that her ears feel..."raw"... the dr. looked in her ears and saw nothing wrong...  she went to the eye dr. this morning and he found what looks to be tissue behind her left eye...she's going to call an eye specialist.  she's currently taking advil...she says it takes the edge off, but the pain never goes away...  the ear, nose throat dr put her on steroids for a short time and she felt noticeably better.  i'm so concerned and so is she...  has anyone heard of this?   before this happened she was active, felt fine and had no head pain at all...

[mary migraine]

Oh, I am so sorry to hear about your daughter.  Let me tell you my story and hope someone can benefit.  Although there is a terribly strong family history of migraine, I thought I had escaped that inheritance, and didn't have a migraine until 10/01 at the age of 38.  It began the same day I had awakened with a horrible hot flash, and it was 2 days before my period.  Then another migraine 3 weeks later, and another 3 weeks later (with spotting).  Since 1999 I had come to the point of self-treatment with progesterone cream for hormonal problems after trying a variety of ineffective prescriptions.  The progesterone had regulated an erratic cycle, reduced a heavy flow, eliminated hot flashes, decreased insomnia, eliminated painful menstrual cramps and greatly dimished PMS moodiness.  After the third migraine that seemed so connected with menstruation, I followed my doctor's advice to discontine the progesterone, as he thought that "if the migraines are related to hormones, then you need estrogen".  Five days after stopping the progesterone, I entered migraine hell:  indescribable, unbearable pain that I thought would kill me.  The migraines lasted for weeks and menstrual bleeding also lasted for weeks.  I was hospitalized and run through it all.  The only thing that stopped the pain was morphine, and nothing stopped the migraines.  After the relief from the morphine, I was able to think again, and I got out of the hospital and my gynecologist prescribed Combipatch (estrogen and progesterone).  The day after the patch was applied, was the first day without a migraine in 7 weeks.  By the third post-patch day, the migraine was back.  But then a new patch, and again in 12 hours, no migraine for the next couple of days.  This went on until I realized that I needed only progesterone, no estrogen.  I also finally have been diagnosed with a thyroid problem (Hashimoto's hypothyroidism) and the thyroid hormone helps a great deal.  I still struggle with migraines and erratic menstrual problems, but not at all to the degree I sufferred last year.  Try to find a physician knowledgeable about bioidentical hormone replacement. Best wishes to you.

[ballinalass]

A related discussion, migraine relief was started.