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Avatar universal

migraines and stroke prevention

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.
20 Responses
Avatar universal
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
Avatar universal
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:  ***@****
Avatar universal
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.
Avatar universal
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
Avatar universal
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.
Avatar universal
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
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