Migraine Syndrome, Complicated Migraine or Atypical Migraine?

[nzscientist]

Thank you for running this website.  It is the only one I’ve found that seems trustworthy and also addresses my concerns.  However, I still have a number of questions that I hope you will answer; this is my first post.

I am a 43-year old female, in excellent health except for my recent problem of tingling in my hands and feet and a numb face, that has lasted two months so far. It started out in my left foot and over the course of about a week it spread up the left side of my body and over to the right side. For a period of several weeks, the left face almost always felt numb or tight, except when I was touching it, when it felt normal. The face is now fine, but my chin always feels like my hat’s chinstrap is still on; this started when I started wearing my hat more frequently.  The symptoms in my extremities are worst when I’m lying down (and strongest then in my hands), somewhat better when I am sitting or standing (strongest in my foot), and best when I am using my whole body.  During this time, I have had about 15 headaches in the top left of my head that were strong enough to need aspirin. But most of the time the head is fine, or if I have a headache it is very mild, and it doesn’t get worse when I bend over or cough. One headache didn’t respond to aspirin and was also associated with nausea.  I’ve had numerous blood tests and an MRI, which were all normal.  My GP thought it was “atypical migraine” and my neurologist just said it was part of my “migraine syndrome”, mostly based on my symptoms and the following history.

My father gets migraine aura without headache, and his mother and sister had full-blown classical migraines which would incapacitate them for days at a time.  In 1998 my GP diagnosed me as having migraines, because I had had two brief periods (separated by 6 years) of about ˝ hour – 1 hour each when I felt as if I had forgotten how to read, and I had trouble remembering simple words and names (I forgot my husband’s and parents names).  Since then I’ve had milder migraines with zigzagging lights in my eyes, followed by very mild headaches that are hardly noticeable unless I bend over or cough. I also remembered having similar visual auras when I was younger, but I had never associated them with headaches. I also had two episodes (when I was about 10 and 20) that lasted several weeks in which I felt that sparkling lights sent me into a weird state in which I felt like I was looking at myself from outside myself. I sometimes get mild chest pains or faint for no apparent reason, all of which my neurologist tells me is part of my “migraine syndrome”.  The only consistent element in my migraines is that bright lights bring them on.

My neurologist suggested that some migraine preventatives might help the symptoms, but the side effects he discussed all seemed worse than the migraine, so I’m not taking any medication except aspirin when my headaches are painful.  

My problem is that I like to deal with my problems by reading all I can about them, yet I can’t seem to find much information on such “migraine syndromes”.  I found Oliver Sack’s book on migraine helpful in detailing the auras and in its attitude that the auras are important, but he doesn’t really talk about lengthy auras.  My neurologist recommended James Lance’s book, which I read in another town’s library while I was on holiday and then took out a later edition from my own library.  The earlier edition mentioned “complicated migraine”, which sounds like what I have, and said that people with it should not have the vasoconstrictors that are used for the migraine headaches.  But his most recent edition doesn’t mention complicated migraines at all.  I’ve searched the web for “complicated migraine” and “atypical migraine” without much luck. I would like most to get a reference to an article or book that would be helpful, in a medical review article if there’s nothing for the general public.  But failing that, I would at least like to know these things:

1) Are the tingling/numbness symptoms merely the brain’s misunderstandings of the sensations, or does the brain mis-control the blood supply to the extremities?  In practical terms, if I neglect to stamp out my numbness, are my feet and hands in danger of gangrene or other problems due to lack of circulation?

2) I’ve read that some over-the-counter drugs for headaches and colds contain vasoconstrictors that are not supposed to be taken by people with complicated migraines.  Can you tell me what they are so I can avoid them?  Should I always avoid them, or could I take them again if these symptoms ever go away?  Right now I’m afraid to take anything except aspirin.

3) I am still debating about whether I should try any of the migraine preventatives. Although my present symptoms don’t seem to warrant them, I am concerned about the future, and whether my past short-term symptoms of flashing lights, dyslexia and dysphasia could last longer than a few hours at a time. The dyslexia worries me the most, as my whole life is based around reading. If I had an attack of the dyslexia for a long time, could it be stopped with these same drugs?  If not, would it be worth while to take drugs to prevent such an attack?
  
4) What is the distribution of people with my kind of migraine versus other kinds in the general population? What is the distribution of lengths of migraines?    Does it vary by type?  (e.g., could it be said that the paresthesia type that I have now often lasts long, but the dyslexia and loss of words always or usually ends more quickly?)  For people who get these long migraines, how often do they happen?

Thanks again for your help.

[CCF Neuro[P] MD, RPS]

Dear Jane:

Thanks for the kind words concerning the service, and I am sorry that your illness is such that you have to use it.  I am not sure what I told you before.  I think that you have migraine without headache syndrome, which is a form of migraine.  The family history would also indicate this possibility.  Usually, with atypical types of migraine we rule out other possibilities initially, so I will assume that all other testing has come out negative and you indeed have atypical migraine.  As far as information, I would tap into the National Headache Foundation (www.headaches.org).  My reading of the literature suggests that the symptoms are benign and do not lead to lasting deficits (Levy, Neurology (1988) 38:831).  Your symptoms are in the CNS, due to the migraine, and therefore you shouldn't have pronounced loss of blood flow etc in the peripheral system.  Although the pathophysiology of migraine is progressing, the exact mechanism remains unclear.  The medication of phenylpropanolamine found in antihistimines has been implicated in stroke, not headache.  However, MSG, caffeine, food preservatives etc have been known to be triggers of migraine.  Although you type of migraine is uncommon, it is not rare.  I am not aware of the exact figures.  Whether to take a preventative medication is a personal decision.  Much depends on how bad the symptoms are and how you feel about them.  There are many types, from elavil to beta blockers.  10-20 percent are disorders of mitochondrial function and by taking 400 mg of riboflavin, some patients are helped.  But, whether this will work for you is unknown.  

I hope that I have helped alittle.

Sincerely,

CCF Neuro MD

[to jane]

just after i read this i went to look up something else at webmd.com and the first thing that came up was a big ad that said something like, find out the newest thinking in ways to help migraines, just wanted to let you know in case you want to check it out

[CCF Neuro[P] MD, RPS]

Dear nzscientist:

Please forgive me for naming you jane.  I was just finishing up with a patient named jane and transposed her name for yours.  I apologize.

Sincerely,

CCF Neuro MD

[Joe Stallard]

nzscientist or Jane, I have been under going treatment for identical symptoms + having complete right-side numbness for the past 13 months. After much web researching, I have come to the conclusion that there is no cure but IF you are one of the lucky ones there is medication that lessens the frequency and severity of these episodes. However, there can be difficulity in finding the correct medication. I've tried 5 different medication with no positive results. My Neurologists says he has seen people that do not respond to any medications. I continue to take Aggranox (Anti-stroke) as a safe guard. I was concerned about the loss of blood flow causing the numbness. The Neuro explained it this way: blood flow is not altered but the neutron field is broken in the brain, the message from the nerve sensors in the back of the brain is not reaching the nerve control center in the front of the brain. I have several links if you need more to look at, e-mail ***@****

[COMPLICATED MIGRAINE..I had that also.]

I would like to comment regarding this phenomenon.  I experienced this also when I was 35.  I am now 40.  My neuro-opthalmalogist who is very well respected nationwide felt it was a complicated migraine or "acute cortical insult."  He explained this as a migraine like event except the vasoconstriction phase lasts longer.  That is why you would not want to take any vasoconstrictors.  I have had constant low-grade visual problems since this episode which have greatly improved over time.  This is because  the cortical-occipital region of my brain suffered from an "insult" during the vasoconstriction phase (no blood flow to that area).  This is almost like a stroke.  Hence he has recommended I be on one enteric coated aspirin daily.  He also did a lot of testing to rule out autoimmune disease which can predispose one to this type of event.  I also had an EKG to make sure the heart did not throw a clot to the brain.  I have been fine since then.  I think calcium channel blockers are the way to go for prevention but obviously check with your doctor.  Maureen or ***@****

[nzscientist]

Thanks to all of you for your replies.  I don't mind if you call me Jane or whatever, as long as you answered my question, which you did very nicely, thanks.  It even makes me feel better that I'm not the only one who has problems getting names straight.

I was pleasantly surprised to find that despite all the rhetoric on the front page of the national headache forum page, it did cover the comlicated migraine without headache problem.  I'll try to also get a copy of that Neuro journal.  So thanks for all your help.

[Elex Valdez]

My wife suffers migraine headaches, sometimes so severly that it makes her cry. We have been to many doctors and nothing successfully had been accomplished. What do you recomend. My wife is 33 years old.

[tracy]

Thank you for this notes on complicated migranies I though I was going crazy. I'm 38 and the Dr thought I was havin TIA's Neur stated  Com.Migr.  Now the S&S effecting my feet. Dr started me on topamax to see if would help, we will see.  Thanks nice to know I'm not alone.

[cryco61]

I am a 48 year old male. Lets call me John.I just stumbled onto this site in desperation. I have been off work for 3 years, seeing different doctors and recieving many diagnosis. Symotoms started with intervals of short term memory loss. Minor things like peoples names, what car I was driving or which way a letter or number would face etc. Also started having dissy spells accompanied by nausea when working on the computer for more than 1/2 an hour. This would also occure when driving in a city at night. It seems to be brought on by the moving lights or things moving on the compuiter screen. I also get swelling in my right hand and arm. At times I have unexplained pain in my arms, legs and other parts of my body. Also get severe, but short (15 to 30 sec.) head-achs. Usually folloued by impared vision in 1 eye. I also have problems with mood swings and anxiety attachs.  I would appreciate any comments or suggestions you might have.  Thank-you.....  John

[sliknick]

A related discussion, Unusual headache was started.