atypical migraine or something more like MS???

[packermama]

I am a 30 year old female who has been having "spells" over the past 9-10 months.  These typically last around 5-6 days and will fluctuate in the severity of the symptoms w/in that time frame.  I'll be fine for 3-6 weeks before another spell hits.  HUGE family history of aneurysm and autoimmune disorders.

My spells have included things like dizziness, memory loss, slurred speech, numbness and pins and needles (in face, legs, feet, hands), inability to speak, eye twitch, unsteadiness, disorientation, shaking hands, difficulty urinating, insomnia and most recently a shooting, lightening-like bolt feeling down the back of my right leg.  I am unsure if this is coincidental or even relevant.

I experience 1-3 of these symptoms at a time...never altogeher!  And, often once I have a symptom it may not recur from spell to spell.  These symptoms seem to be constantly evolving, w/ the leg numbness and pins and needles in it, as well as the shooting pain, being the "spells" I've had most recently.  

CT and MRI were essentially clear.  I had an initial evaluation w/ a neurologist but my exam was done by a family practice resident who seemed very unsure what he was doing.  The neurologist suspected atypical migraines and put me on nortriptylene as well as removing me from birth control.  There has been a worsening if anything.  I do not get headache, nausea or aura.

Do these symptoms sound like simple atypical migraine or would it seem there is more to going on here?  If atypical migraine, other than birth control, what other things should I avoid?

Thanks for any input!

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

Anytime a young woman presents with multiple and sometimes vague neurological complaints, we think of MS as a possibility. Glad that your MRI was normal, which is somewhat reassuring (although 10% MS patients do have normal MRIs). The neuro exam is also very important and may need to be repeated down the line by a neurologist rather than an FP resident. Other blood tests may be helpful such as checking for lupus/autoimmune diseases, B12, sed rate, routine chemistry, and white count. Otherwise the need for further invasive (spinal tap) and noninvasive testing (evoked potentials) really depends on the suspicion of your doctor for MS despite a normal exam and MRI. Followup may be done later on or if symptoms persist/worsen.

As for atypical migraine, it is a possibility. Birth control pills can bring out headaches due to the hormonal content. But you should also be careful about taking them if you have a strong family history of autoimmune diseases that have caused strokes in relatives at young ages. THe pills can make your blood clot abnormally if you smoke or have some kinds of underlying autoimmune disorders. Things to avoid would be sleep deprivation, foods such as chocolate, red wine, rich cheeses, and nitrites (seen in preserved foods like hot dogs). Stress can also bring it out. Exercise has helped many of our patients and nortryptiline is a good start. Best of luck.

[ozzsome]

A related discussion, migraine syndrome was started.