Is it a migraine or heart problem?

[Lori__0__0]

  About a year ago I began to have moments of extreme nausea and disorientation
  when waking.  I often feel a tingling in the back off my throat and eye. Usually, my heart
  rate is increase also.  My doctor diagnosed this as occular miagraines, and gave me
  nausea and pain medication for it.  However, the nausea if very brief usually only ten to twenty minutes,
   and there is no pain so I never bothered to take it because they only make me drowsy after the fact.
   I have had migraines since the age of twelve and these episodes have no similar symptoms, i.e. Headache, sensitivty to sound
  and light, pain on one side of head.  I have tried to link them to triggers like "regular"
  migrains but have been unable to do so as of yet.  I only have them in the morning when waking
  or soon after, or when I get very upset.  This lead me to believe it may have something to
  do with my heart.  I had open heart surgery at 3yrs. and still have a septal defect.
  Please give me any iformation, I feel like my doctor isn't listening.
Dear Lori:
I am sorry to hear of your problem.  First let me describe the usual ophthalmoplegic migraine, usual jpresents with acute attacks of third nerve palsy (which for the person with the migraine would be blurry or double vision), dilated pupil (go to the mirror and see if one pupil is larger than the other).  The pain is usually unilaterl, and is migrainous in quality.  The duration of symptoms is usually hours to days.  Now with that said, I have seen variation in this.  The pain in some patients is present but not migrainous.  Some of my patients have a duration of only 40-90 minutes.  Given that, with each of these patients I did a full work-up to eliminate those entities that can mimic this disease.  I would do a MRI to rule out aneurysm, do some blood work to rule out infection, and EEG to rule possible epilepsy.  The things that are atypical need to be worked up, in my opinion.  Given what I have said, your symptoms have alot of qualities that sound like ocular migraine.  The only symptoms that really don't fit are the lack of pain, and the duration.  It doesn't sound like it is related to your heart.  The symptoms are too numerous and completely resolve, with no fixed deficit.  This might occur, although very rare, if you septal defect allowed right to left blood flow during a valsva condition.  On usually get bradycardia with maybe a rebound increase in heart rate.  This might send emboli into the opthal. artery and cause stroke.  So, enough said, I think your physician is likely correct, but, if he/she hasn't tested for the possible other diseases that can cause these events, I might suggest just getting a second opinion.  Let us know how things turn out.
Sincerely,
CCF Neuro[P] MD, RPS