Triptans and complicated migraine

[fringepod]

Hi,

First, my history:  33 yo female, epilepsy since age 19, progressively worse migraines since age 20(?), on valproic acid, was 500mg/day until being bumped back up to 1000mg/day due to having two seizures last month (2nd occurring before regaining consciousness from the first) although I had not had enough sleep the night before, and I have only had maybe 15 gm seizures total since they began.

My migraines have always involved severe unilateral weakness and numbness that begins before the headache. This is a gradual loss of sensation and 'heaviness/discomfort' that begins on one side of my head and face and finally encompasses that entire side of my body all the way to my toes. Along with this I experience loss of balance and difficulty concentrating (especially evident while engaging in conversation) nausea and sometimes vomiting.  I have never had issues with slurred speech (just lack of finding the right word and then forgetting what I'm talking about) or major visual disturbances.  During the attacks and for a period of time after they have subsided, fatigue is an issue.  I am otherwise healthy.

My question is this:  my doctors (I have moved on average every 2 years since I was 19, so have had quite a number of neurologists) have never 'officially' diagnosed me with complicated migraine, just always agreeing with the previous dr that I have migraines and writing me an Imitrex prescription and not saying much more about it.  Although in my research of late, as I am really trying to get to the bottom of this most annoying condition, I have found that the description for complicated migraines seems to fit my symptoms rather well and I am concerned as I have come to rely very much on triptans to help lessen the severity of the attacks (I get no less than 6 migraines per month) and after reading about complicated and hemiplegic migraines and the risk of stroke triptans may present in this type, I am concerned.

Should I be worried about taking triptans?  I have noticed that over the past few years the side effects I experience have become worse with them--feeling really weird and out of it and generally uncomfortable--but this is nothing compared to the migraine in full force.  I don't like taking them, but I shudder to think how I will get through the next year and half of grad school, let alone the rest of my life, without having something to lessen the blows!

Thank you very much for your help and appreciate any insights you can offer!

[fringepod]

By unilateral weakness I mean weakness not paralysis.  I can move that side of my body, but it is tiring and very much desensitized--ie you could hit my arm with a cat-o-nine tails and I wouldn't know the difference from a being caressed by a feather. Well, I would feel it if hit with the weapon, but I certainly wouldn't feel a feather and have actually given myself bruises accidentally in trying to massage some sensation back into my arm and leg. This sensation usually begins a good 20-60 minutes prior to a full-on raging headache, and continues throughout the headache which, if I do not take triptans, usually last between 6 and 12 hours.  If I take a triptan early enough I can knock out the worst of it, although I do remain fatigued, weak, easily confused and generally out of it.  

But yes, as I stated, I do have a seizure disorder, and yes, both epilepsy and migraine have been separately diagnosed by the same physician.  I have had numerous EEG's, most normal but a few with 3spike/sec blips, but never a 24 hour EEG--I am doubtful my doctor would recommend this and if so, I doubt my health insurance would cover it (I am studying abroad in Germany and thus have the bare minimum of coverage)...

What I really want to know is, do I need to be concerned about taking triptans, and if so, what is the risk (ie numbers) of stroke, and are there alternatives besides midrin (so does not work!) and anticonvulsants (which of course I am already on with no effect decreasing the number of migraines I experience.)

Thanks for the help.

[Vanessa Lacuesta]

Hi,


You have mentioned of severe unilateral weakness. How would you describe this ? Does this mean you can not move an extremity or a part of the body? When this happens , for how long do these symptoms last? Do they last for less than an hour? Do they last for days? Also, do these symtoms always accompany the headache or do they always occur on their own?

Based on your post ,this sounds like a hemiplegic migraine if severe unilateral weakness is involved. However, it is important to delineate this weakness from a seizure disorder. Some seizure disorders may present with weakness ,numbness or even confusion during an attack. Have you had a 24 hour video EEG done? Migraines and seizures may occur together.It s important to ascertain that these neurologic symptoms are actually migraine auras and not part of a seizure attack.

Has your physician discussed this with you?

Have you been diagnosed with a separate migraine condition aside from the seizure?