tia vs. complicated migraine

[Mila]

I recently posted a comment concerning a possible TIA vs. complicated migraine (1/16/02) Given the normal imaging studies on MRA, MRI(diffusion), carotid doppler, cardiac echo, what does all that say about a possible TIA? My cholesterol is very low (total is 100, with HDL of 28)and I exercise every day. My maternal grandfather died at age 50 of a series of strokes in the late 1950's. I do have a history of migraine aura without headache (scintillating light), but I did not get this aura when I had the brief bout of right-sided numbness which came on rather suddenly and left gradually. I had no weakness, just numbness, no other symptoms. Could there still have been some sort of clot from the heart even in the absence of obvious plaque or diseased arteries? I do get PVC's and PAC's at rest and when exercising, but have learned to live with them. Could they have contributed to a blood flow problem? How likely is this sort of episode to happen again given this set of facts? My docs so far are unwilling to call this TIA due to blockage, but I'm anxious about it. I am seeing a local neuro next week. Thank you.

[puppylove]

on may 21, i was rushed to the ER with severe dizziness and weakness. they found my entire left side weak, mouth drooped, left pupil dialated,and hyper tonic when tested for reflexes. i also could not count to 10. My bp also spiked to 190/110, after a negative CT scan and then a negative MRI/MRA scan i started to improve.(about 4-5 HOurs). I still have to have a doppler carotid, and an eccocardiogram next week, to rule out vascular, but since i have had simple migraines around the same time of the month for the past 5 years, they concluded that i had a complex migraine, i was advised to stop taking bc pills,which i have been on for 10 years, and not to take maxalt any more( which worked wonderfully for my simple migraines) I left the hospital that evening exhausted and the next day, i developed my usual simple throbbing migraine which lasted 36 hours. i tried midrin but it was worthless, i then tried decadron for 2 doses 7 hours apart with compazine suppository. nothing really worked.
I am 47 and work full-time as a pharmacist, i cannot imagine not having any options to prevent this form happening again, and i also need to find something to take to stop either of these migraines once they get going.  i was so used to having success with my maxalt.
any suggestions?
karyn

[born2chirp]

I have been diagnosed with complicated migraine with hemiparesis.  The past 21 years have sucked because of unwanted headaches, but I have learned to live with them.  I was 8 years old when the first headaches started, but they were not diagnosed as complicated migraine until shortly after a left temporal lobe brain biopsy had been performed in fear by the doctors it was herpes encephalitis.  I always have had aura that starts in my left peripheral vison as a small, metallic strobelight-like spot, and progressively grows larger as the attack progresses, until my entire vision is then engulfed by this aura. On occasion, the aura starts large, and when that happens, it is generally a headache that requires a visit to the ER.  About halfway through the aura, the nausea sets in (usually never have to barf though, unless it had been caused by something I ate), along with a heavy numbness on the opposite side of my body from where the pain of the headache is (usually pain is on the left and paralysis is on the right, but somtimes it is the opposite, and on occasion paralysis is on both sides).  Aura generally lasts about 20-30 minutes, paralysis lasts a couple of hours, although has lasted longer at times, and the headache is generally gone within 12 hours.  I have been hospitalized for extended periods of time, with the longest in 1989 when I was 16 (1 month in the hospital, 3 months out of school).  Doctors are usually baffled whenever I set foot in their hospitals.  The time in 1989, they thought maybe I had a stroke at first, but when I told them it was a migraine, they sort of had to agree.  The only difference between the two,as far as symptoms go, from what I have heard, is that a stroke is considered "fast" and a migraine is considered "slow", or rather in other terms, maybe "acute" and "chronic" are better descriptive words for the condition.  Either way, both are horrible things to have happen, especially for someone so young.  I do still get them, however the frequency and severity has decreased, and that is good, but they have gone on long enough and would want more in the world for them to never come back again.  I do not like to take pills and would prefer not to have surgery if at all avoidable.  I have had an MRI and lumbar puncture recently and am waiting for the results to come back from my neurologist.  If all appears normal after that, I have had people suggest acupuncture-they said there is a really great actupuncturist in my area that they can't say enough good things about after seeing him about their migraines and not having any since.

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

Anytime someone has a focal neurological event, migraine, TIA, and seizure are always at the top of th list. It doesn't sound like you have any significant stroke risk factors and I'm glad your workup was normal. This does make the diagnosis of TIA less likely,although 30% patients who have stroke have unknown causes. Also, strokes can come from the heart with abnormal rhythms or valves.  But if it is coming from the heart, the symptoms shouldn't manifest itself in the same way clinically every time(you mentioned two episodes of Rt sided face numbness) as clots usually don't travel the same route up to your head each time the heart beats abnormally. You typically would have had different symptoms or different sides would have been affected. A 3 hr seizure would be unlikely too, but possible. Finally, complicated migraine remains a strong possibility. Can't say when and if this will happen again. Your docs so far have done all the right things. An EEG is a consideration, but I shall leave that to your upcoming neuro appointment. Best of luck.

[Suzanne49]

A related discussion, Atypical migraines or panic attack? was started.

[sulayy]

i know this is going to sound strange but the past three  years i have had three major operations.1st band in my bowel 2nd  adhesions and third subachranoid hemoerage.i am 36 years  old and have never had a complaint in my life until then.the problem is since my brain surgery,which was a clip  i have been having wierd things happen . for example the sudden nausea and violent sickness and i also thought my eye popped out its socket one time i  also get very photophobic and i was wondering if this is connected to my surgery or my other medication  (fluoxitine)that i started taking before my first operationn. i have also asked my doctor about pins and needles in my legs and wierd sensations ,lasting seconds of the feeling i got before my anuarysm and he told me it is anxiety.the 3  operations all happened within  1 and half years.  could this all be psychological

[just talking]

Hi
  I had stroke like symptoms also. Went to the hospital and they diagnosed me as TIA. After all the tests and all normal I got released 2 days later. I then went to a neurologist for another opinion. She tells me she thinks its a complicated migraine. Not sure if ones any better than the other! I also get the migraines with the Aura, but not a headache. Use to get the headaches, but guess I grew out of them with age. Am also wondering now how often we have to worry about the headache turning in the bad ones, like those.Also I dont take medications for my migraines so am wondering if that may help with the occurances? Is a Neurologist a specialist in Migraine headaches? I also did not get any Aura before my symptoms either, altho I did have a neck type pounding headache before those symptoms hit me. But I also had my blood pressure go up to 220/110 which at this time we dont know why or what caused it to go up. If any one has an suggestions on this please let me know. I am suppose to do a mri to get more detail of why. Thanks.
                   Char...

[alisultaneh]

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