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Neurology (Expert Forum)
UBO's, fatigue and headaches
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UBO's, fatigue and headaches
by Chrisbo, Mar 30, 2005 12:00AM
Hi, I am a 44yo male.
About 15 months ago while at work I suddenly became dizzy and somewhat lightheaded, a feeling I had never experienced previously. Following a battery of tests including thyroid, CMV, EBV, general chemistry and a brain MRI. The only significant findings were elevated IGA gliadin antibodies in the blood and a brain MRI which showed 13 scattered lesions which the radiologist said was consistent with demyelination but the neurologist dismissed as UBOs which were non-specific in nature.
Since this original incident I have had frequent headaches (several per month) including migraine with aura and tension type headaches as well as lethargy, eye soreness, yawning and tiredness which is not relieved by sleep. The neurologist believes what I am experiencing is chronic transformed migraine (I have always suffered from migraine with aura but certainly not in the same form or frequency and I am not convinced that this is the correct diagnosis) and has suggested combination prophylactic treatment, namely, a Calcium Channel Blocker with an anti-Convulsant.
My questions are:
Are there any other tests to be considered before accepting the transformed migraine diagnosis?
Is it possible the UBOs are as a result of my initial dizzy spell and are the cause of the symptoms I have been experiencing?
If I take the medication, how long generally speaking before improvement is shown?
How long generally is prophylactic treatment continued for?
Is it usual for 2 medications and in this combination to be tried in the first instance?
Thank you for your time
About 15 months ago while at work I suddenly became dizzy and somewhat lightheaded, a feeling I had never experienced previously. Following a battery of tests including thyroid, CMV, EBV, general chemistry and a brain MRI. The only significant findings were elevated IGA gliadin antibodies in the blood and a brain MRI which showed 13 scattered lesions which the radiologist said was consistent with demyelination but the neurologist dismissed as UBOs which were non-specific in nature.
Since this original incident I have had frequent headaches (several per month) including migraine with aura and tension type headaches as well as lethargy, eye soreness, yawning and tiredness which is not relieved by sleep. The neurologist believes what I am experiencing is chronic transformed migraine (I have always suffered from migraine with aura but certainly not in the same form or frequency and I am not convinced that this is the correct diagnosis) and has suggested combination prophylactic treatment, namely, a Calcium Channel Blocker with an anti-Convulsant.
My questions are:
Are there any other tests to be considered before accepting the transformed migraine diagnosis?
Is it possible the UBOs are as a result of my initial dizzy spell and are the cause of the symptoms I have been experiencing?
If I take the medication, how long generally speaking before improvement is shown?
How long generally is prophylactic treatment continued for?
Is it usual for 2 medications and in this combination to be tried in the first instance?
Thank you for your time
Doctor's Answer
by CCF-Neuro-M.D.-PW, Mar 31, 2005 12:00AM
Unfortunately I cannot give you a clinical diagnosis over the internet, without seeing you or your test results
Other tests to consider would be an evaluation to exclude cerebral vasculitis as a cause - such as blood sedimentation rate, antinuclear antibodies, Behcets disease (a form of vasculitis), and maybe an angiogram
I assume an MR angiogram was done with the MRI to exclude any major vascular narrowings?
While you do not appear to meet criteria for a diagnosis of MS based on the presence of old UBOs and no clinical attacks, other tests such as evoked potentials, and cerebrospinal fluid analysis can help exclude an inflammatory/demyelinating problem
Migraine can certainly cause this MR appearance, and may indeed be the correct diagnosis after the excluding the above diseases. Migraine can change over time as one gets older, and may even cause transient focal neurological deficits with or without headache
A trial of several weeks is necessary to see if you are benefitting from a prophylactic medication, and treatment may continue indefintely based on a good response
There is no standard algorithm for drug treatment - one may argue that tackling the mechanism of the migraine from 2 different angles may produce more benefit, and in shorter space of time
Good luck
Other tests to consider would be an evaluation to exclude cerebral vasculitis as a cause - such as blood sedimentation rate, antinuclear antibodies, Behcets disease (a form of vasculitis), and maybe an angiogram
I assume an MR angiogram was done with the MRI to exclude any major vascular narrowings?
While you do not appear to meet criteria for a diagnosis of MS based on the presence of old UBOs and no clinical attacks, other tests such as evoked potentials, and cerebrospinal fluid analysis can help exclude an inflammatory/demyelinating problem
Migraine can certainly cause this MR appearance, and may indeed be the correct diagnosis after the excluding the above diseases. Migraine can change over time as one gets older, and may even cause transient focal neurological deficits with or without headache
A trial of several weeks is necessary to see if you are benefitting from a prophylactic medication, and treatment may continue indefintely based on a good response
There is no standard algorithm for drug treatment - one may argue that tackling the mechanism of the migraine from 2 different angles may produce more benefit, and in shorter space of time
Good luck
Member Comments (2)
by Chrisbo, Mar 30, 2005 12:00AM
I should also mention that I work with computers a lot under fluorescent lighting (not sure if this could be a trigger or cause) and other symptoms I have are photophobia and what feels like heavy sore eye muscles.
