migraines and stroke prevention

[Dianne]

Thank you so much for taking the time to answer these questions.  I am a 26 year old female, and I have had complicated migraines for several years now, with symptoms of varying left sided numbness.  My neurologist recently found that I had a small stroke, which must have occured within the past year (as I had a normal MRI a year ago).  Now when I get neurological symptoms they are often more severe, with entire left sided numbness rather than just facial or hand numbness.  My doctor thinks that because of the damaged area, now when I get migraines these more severe symptoms develop.  My questions really relate to prevention of future strokes.  I wonder how much greater risk I am at to have another one with this history?  I have gone of birth control pills and I am taking aspirin every day.  My doctor said the only other option is a calcium channel blocker, which he doesn't want to put me on unless I get symptoms more often than every few months (which I don't).  Is this the only other mode of prevention?  I am not worried about the migraines themselves, just having another stroke.  I am lucky that this one has not really affected me functionally... Thank you for any advice you can provide.

[CCF Neuro[P] MD, RPS]

Dear Dianne:

Sorry to hear about your condition.  The association between migraine and stroke seems to be more prevalent in females with migraines that also have an aura and before the age of 45.  Was the stroke on the opposite side of the brain as your focal neurological deficit when you have your migraine.  Unfortunately, you are at a higher risk of having another stroke compared to the general population.  If you have an aura with your migraine, you at even a higher risk (although the risk is only alittle).  I would make sure that you do not have any other risk factors for stroke, antiphospholipid antibodies, Leiden V factor, prothrombin mutation, abnormal low HDL or high LDL, etc.  I would agree with the aspirin a day.  I hope that you never have another stroke.

CCF Neuro MD

[To Dianne/From Maureen McL]

Dianne:

I would love to chat with you regarding this topic.  I also suffered a complicated migraine at the age of 35.  I am now 39.  I take the one aspirin a day also.  Mine was diagnosed by one of the top neuro-opthamologists in the country, Michael Rosenberg at Northwestern here in Chicago.  

It is very scary.  My vision had improved by a consistent 80%.  However, I still get visual disturbances all day every day esp. before my menses.  Recently I was very sick with double otitis externa (double outer ear infection).  Interestingly enough, this made my eyes "relapse."  I've had many many tests.  Normal MRI and SPECT scan. My father had seizures and his father strokes.  I feel my neurological system is my "weak link."  I am 2nd generation irish.  

I live one day at a time now - I've already told my husband to be prepared that at sometime in the future I might "stroke-out."  This makes me feel very sad for my three children, ages 11, 8 and 5 whom I love so very much.  

I did try a calcium channel blocker verapamil for one month with no change or improvement.  E-mail me if you want:  ***@****

[Dianne]

Thanks for your responses.  Can you give me any more info. on the mechanisms behind the migraine causing the stroke?  I read that the blood vessels constrict to the point of depriving areas of the brain of blood- is this correct?  Obviously if this goes on long enough it can cause permanent damage.  If this is true, wouldn't drugs that prevent the migraines, or the vasoconstriction, then prevent the stroke?  I assume, perhaps wrongly, that prevention of migraine prevents stroke (in my case).  I had luck previously on propanalol, but my doctor now says that won't prevent a stroke.  He says only calcium channel blockers MAY.  Can you give me your opinion on this issue?  Thank you very much.

[CCF Neuro[P] MD, RPS]

Dear Dianne:

I would check if you have any of the hypercoag. risk factors as previously stated.  Theoretically, prevention of migraines should decrease the chance of stroke, but if you had your stroke while not having a migraine then the point is mute.  The stroke in migraines is usually correlated with the aura phase, this is where the vasoconstriction is thought to occur.  The migraine phase is when the vasodilation occurs.  I would try and prevent the migraine headaches, but this is only theoretical.  Treatment is based on personal preference and not a standard of care.

CCF Neuro MD

[Sandra Unrau]

i cant post my question but it is similar to this one so here goes.
    For the last two weeks the right side of my tongue, face, and head have been numb. There is still feeling there but it
     is like after being at the dentist and your freezing is half gone. It's hard to describe. At times I also feel it in my rt
     arm and rt leg. Three years ago I had what we first thought was TIA's, the muscles on the right side of my face
     contracted,my eye was squeezed shut ( I could not open it ) my mouth and cheek push up as high as they could go,
     this lasted for about one minute each time and happened 1-4 times a month for about one year. I was diagnosed with
     epilepsy after ct scans and eeg's. I refused anti-seisure meds as I figured I could live with this. It has not happened
     for two years now. 17 years ago I had two episodes, one of rt side numbness and the other total body numbness,I
     couldn't even talk. I was put on steroids( I cant remember the name) and was told I had swollen optic nerves. I
     recently heard about FACTOR V LEIDEN GENE. Could these things all be related and could factor v be my
     problem? I am going to see a neurologist again but can't get in until august, and I am concerned. Thankyou for your
     time.

[CCF Neuro[P] MD, RPS]

Dear Sandra:

I do not thing having the Leiden mutation would cause your symptoms.  One associates Leiden mutation with a hypercoaguable state.  Your symptoms do not sound vascular in nature as this would be a loss in function as counter to your symptoms of spasm or dystonic muscle contracture.  TIA's are only transitory and would not have last several days.

Sincerely,

CCF Neuro MD

[Sandra]

thankyou for responding.  i know a person diagnosed with Leiden mutation and we have discussed what we have experienced and our symptoms are quite similar. you commented only on my so called TIA's, which only lasted approximately 1 minute not several days. What about the right side numbness i am having now and the numbness i had 17 years ago(total body and partial). could that not be caused by a hypercoaguable state? if not then what do you suggest it could be?

[CCF Neuro[P] MD, RPS]

Dear Sandra:

Again, stroke usually causes loss of function and not a gain of function such as muscle contraction.  The right sided numbness might be an indication of a TIA as it was a loss of function or sensation.  Leiden V mutations usually cause embolic strokes or venous infarctions.  There is usually a family history of DVTs or other clotting problems.  However, one never knows and if your neurologist or stroke physician thinks that it is warranted, running the test for the Leiden mutation might help resolve the issue in your mind.

CCF Neuro MD

[To Neuro/From Maureen]

Dr.:

Is the hypercoagulation indicated by PT and PTT tests?  I've had them and they were fortunately negative.  Thanks, Maureen

Dianne:

I want to add that another very intelligent neuro told me he thought there was a very good chance a lot of the migrainous activity would settle down after menopause!  Which for me, will probably be in about 10 years if I follow my Mom's pattern (menopause at 50).

[CCF Neuro[P] MD, RPS]

Dear Maureen:

When the PTT is within normal limits, there is usually no circulating antiphosholipid antibodies.  There may be low levels of anticardiolipin antibodies but low levels are likely not significant in producing a hypercoaguable state.  Circulating antiphospholipid antibodies are associated with a increased chance of a hypercoaguable state.

CCF Neuro MD

[Joy E.]

I have been diagnosed with complicated migraine syndrome which is chronic for the past two and a half years.  It began with a minor ischmic incident (RIND) after which the complicated migraine syndrome started.  At first I was on a channel blocker which helped for a time, then a beta blocker which helped for a time, then I went through a series of medications which did not help much and made me sick and now I am on Zanaflex which helps some times but is difficult to function when taking it.  I have speech deficit with my complicated migraines as well as loss of mobilility during an episode.  The speech deficit last longer and longer (now lasting up to 20 hours).  The only thing I don't understand is my muscular weekness that happens periodically even when I do not have an episode.  My legs give out or they feel like led.  I have been on the net trying to learn more about this disease.  I have episodes up to four times a week.  My neurologist says they will stop in my 50's.  He says there should not be permanent damage.  Any information related to this problem would be appreciated.  I did hear of some shot that was suppose to prevent these episodes but it is not covered by insurance.  Any information on this would be helpful too.  Thanks.

[CCF Neuro[P] MD, RPS]

Dear Joy E.

The muscle weakness is from the zanaflex.  We usually do not use it to treat migraines, but I guess it works for you.  You might want to see if another medication might help.  I would ask your physician if there is another medication that you haven't tried.  There are many types of migraine medications, so the likelihood of not trying a different one that might work is high.

Sincerely,

CCF Neuro MD

[Joy E]

Thank you very much to responding to my post. I have had the muscle weakness long before I started taking the Zanaflex.  I have had that particular problem for about two years. I used to be walking at work and my legs would just buckle suddenly or I would be walking and my legs would just be harder and harder to move.  At one time I thought that may have to do with my degenerative spine disorder but I am not sure.  I really don't like the Zanaflex because it knocks me out or leaves me really groggy but my neurologist says there is nothing more I can do unless I want that shot that costs $800.  I have been on about 10 different medications since the onset of this disease.

[CCF Neuro[P] MD, RPS]

Dear Joy:

Since you have had muscle weakness before starting zanaflex, and it is not correlated with your migraine, I am unsure of why you should have weakness in you legs intermittently. You do not indicate that a brain MRI has shown strokes, not do you indicate any seizure activity, nor is there any history of dystonia.  These are the only things I can think of that would cause intermittent weakness in your case.  Sorry, I am not much help.

CCF Neuro MD

[Lynne Goodwin]

First, this is an excellent forum, very informative and professional.  I am 29 with a history of migraines since early adolecence (sp?).  They had become very infrequent until last spring.  I saw my gp who started a beta blocker, which worked for a time, then stopped.  He also prescribed midrin which sometimes helped me sleep, but ibuprofen helped the pain more.  Anyway, I am experiecing numbness, really all over.  In my legs and hips (for 6 years) and most recently in the soles of both feet and palms of both hands upon waking, regardless of daily activity.  Also some numbness along my spine.  And, most recently, tingling in my arms, face, mouth (wierd feeling), neck, and abdomen.  My gp prescribed oralprednisone yesterday, for nerve stem pain, and I have an initial visit with a neurologist in 1.5 weeks.  Some days are worse than others.  A friend of mine who is a gp suggested most of this could be related to the migraines (other than the legs).  I had no idea this was possible.  The most frightening part has been not knowing what's going on, of course, and the fact that I am losing some ability to concentrate.  (It has taken me a long time just to type this post).  I know this isn't the proper place to post questions, but any information you could give would be appreciated.  The numbness in my hips and legs extends just below the knee and is painful (mostly w/standing but recently increased with sitting as well.)  Thank you so much for your time.

[CCF Neuro[P] MD, RPS]

Dear Lynn Goodwin:

Usually when there are associated findings together with migraine, they occur together.  So, when you have a migraine headache, you have muscle weakness, numbness, loss of vision, or dizziness before, during, or just after the migraine.  It sounds like your symptoms are not associated with your migraine headaches.  If, this is the case, I would suggest looking for other reasons for your numbness and weird feelings.  I am sure that your neurological visit will include a thorough exam and some lab work.  Make sure you take any information that might help her/him with your condition, such as labs etc.

Sincerely,

CCF Neuro MD

[Joy E.]

I pulled up information on dystonia and found it very interesting and very familiar.  My right leg has a tendency to drag especially after walking for a while.  I never thought of it as anything, but I also have weird jerking of my head and neck area periodically.  Is there a test to determine if this is a problem for me?  I believe my problem with getting to the bottom of what is wrong is that other conditions may complicate a diagnosis. Thanks for your help.

[CCF Neuro[P] MD, RPS]

Dear Joy E:

If you have a camcorder, record the events and then show your neurologist.  This will allow him/her to make a judgement if this is a dystonic movement or not.

Sincerely,

CCF Neuro MD

[Kimberly Thomas]

Hi,to everyone!  I am 27 yrs old and I have been having migraines about3-4yrs now, every since I had a accident at a work place that left me with a head concussion for about 2 wks or longer. Now, about a month ago I started to have migraines every week sometimes 2 in a weeks time, and the problem is they are getting worse in every episode I have of them. Now the last one I had was the beginning of last week, and it was so severe that I lost some of my memory for about 4 days. I really don't know what is going on, and to be honest it is scarring me and my husband to death. I didn't even know some of my family members, and when I did get back to myself I didn't even know what had happened to me for the last few days.
  I have read some of the other peoples problems and I was hopping that you could possibly help me, or maybe someone has had the same type problems I am now having. Please help!!!!!
I go for an MRI in a few days, but the doctor I have now don't seem like it will show up anything, because I had one 4 yrs ago when I had that accident at work. But I have had a car accident since then and taken another lick on the head. What do you think????
                Please help me!!!!
  Anyone that can, you can e-mail me at Cookie_26_40033***@****       or just answer me here, please,I need some help I am scared for my life and for my husband and children that I have.( 9,7,and 4 yr old)
  Thank you, Kimberly Thomas
                     Lebanon,Kentucky

[CCF Neuro[P] MD, RPS]

Dear Kimberly:

Post traumatic headache is common, and with multiple head traumas it can be worsened.  See what the MRI shows, and if that is normal then the worrisome things are likely ruled out.  I would talk with your neurologist to see what medications can help with your pain.  

Sincerely,

CCF Neuro MD