Worried about my daughter

My daughter is a 31 year old mother of 5 (4 pregnancies).  She has suffered sleeplessness and migraines all her life and has experienced infrequent unexplained blackouts.  About 3 months ago she went to the doctor because she was experiencing severe dizziness and worse than usual migraines.  She was told that she had suffered a mild stroke brought on by the migraines.  Further testing revealed a cyst on the brain and changes to the white matter.  Her blood pressure is borderline so a prescription was given for a blood pressure medication that also has had good results in controling migraines; this is a low dose medication that is safe for her to take while she is still nursing.  The cyst is being monitored and she was told that sometimes changes in white matter did occur but they did not know why.  I am very concerned about what the future may hold for her healthwise; particularly since she has 5 children depending upon her.  I know I don't have a lot of specifics but is there any information you can provide that might help me better understand her condition and prognosis?

[Neuro Forum]

Thanks for using the forum. I am happy to address your questions, and my answer will be based on the information you provided here. Please make sure you recognize that this forum is for educational purposes only, and it does not substitute for a formal office visit with your doctor.

Without the ability to examine your daughter and obtain a history and review her imaging, I can not tell you what the exact cause of her symptoms is. However I will try to provide you with some useful information.

It sounds like your daughter's headaches are now under good control with medications, this is certainly reassuring.

I am not clear as to whether or not her MRI of the brain showed an acute stroke (when they told her she had a stroke due to migraine); that can happen but is distinctly rare. If there was evidence of an acute stroke on the MRI, investigation for causes of stroke in a young person (of which there are many many causes including blood clots from various areas of the body including heart and legs, various clotting tendencies including the clotting tendency that occurs in all women around pregnancy but also other hereditary or non-hereditary clotting disorders, and some genetic disorders such as CADASIL and mitochondrial disorders).

On the other hand if there was no an acute stroke per se, but rather nonspecific white matter changes, which in general have a more or less nonspecific appearance on MRI and do not appear as acute strokes, these do happen for no clear reason in someone with migraines, and there are no implications for this that are known of.

Regarding the cyst, several types of cysts occur in the brain. Not all cysts are dangerous, and not all cysts need to be removed. It is difficult for me to know which one she has. One common type of cyst is the arachnoid cyst. Our brain is covered by a layer of tissue called the meninges. This layer of tissue is made up of 3 layers, one of which is called the arachnoid. An arachnoid cyst is a developmental cyst that occurs in the arachnoid membrane. They can occur anywhere within the central nervous system (brain or spinal cord) but are most commonly found in the brain.
The exact cause of arachnoid cysts is unclear, but the majority are thought to be developmental: occur as a human develops, present since birth. Secondary arachnoid cysts, cysts occurring from a particular reason, are much less common. Most people don't cause any symptoms or problems. In most people, they are discovered incidentally. Care should be taken when attributing the patient's symptoms to the presence of the cyst. Asymptomatic arachnoid cysts identified incidentally probably should be left alone and are of no consequence.

At this point, the best thing would be for your daughter to be followed up regularly by her neurologist. If there was indeed evidence for an acute stroke on MRI, evaluation by a stroke specialist and/or vascular medicine specialist to further investigate the cause of the stroke (before attributing it to the migraine) would be prudent, as would therapies to help prevent further strokes.


Thank you for this opportunity to answer your questions, I hope you find the information I have provided useful, good luck.

[ConcernedMom908]

Thank you for replying to my question.  The information you provided does give me some piece of mind.  I will also share your comments with my daughter so that she can better participate in her own treatment.

Again, thank you!