Summary Of Hemiplegic Migraines
Because symptoms of hemiplegic migraine are also symptoms of other conditions such as stroke and epilepsya hemiplegic migraine attack can be quite frightening, both to the migraineur and to those witnessing the attacks. Proper diagnosis and treatment are especially essential with this form of migraine. Imaging studies and other testing should be performed to rule out other causes of the symptoms. It is important that people with hemiplegic migraine understand their migraines as well as possible. With continuing research, especially genetic research, more is being learned about hemiplegic migraine. As this research continues, living with hemiplegic migraine will become easier.
Treatment Options For Hemiplegic Migraine
If you have suspected hemiplegic migraine specialist advice is recommended. This helps to make sure you are given the most appropriate treatments. Triptans, for example, are best avoided during the aura phase of SHM or FHM and a specialist should assess whether it is safe to use during the headache phase.
As with other types of migraine, there isnt a single best treatment. A specialist will consider your medical history, individual symptoms and use their clinical experience to recommend preventive treatments such as flunarizine , topiramate or others.
Comorbidities And Confused Conditions
You may or may not be aware that having migraine with aura increases the risk of stroke. However, it is important to keep in mind that the overall risk is still low. For example, there are about 800,000 strokes annually. Half of these strokes occur among women, and 2,000 to 3,000 of these might be related to migraine, according to Dr. Gretchen Tietjen, the chair of the University of Toledos Department of Neurology. The risk seems to involve patients who experience aura and not necessarily those without aura. This is true whether you have the associated headache or not. Additionally, estrogen-containing hormone treatments are associated with even higher stroke risk in aura patients, especially when taken at higher doses.
Doctors may want to rule out rare presentations of other conditions, like a seizure or other visual patterns associated with migraine. This includes visual snowwhere people see white or black dots in their visual fieldsor other visual symptoms that might not be related to migraine. On a similar note, aura is commonly confused with stroke because they may present similarly. However, one of the most significant differences is that stroke has a sudden onset, whereas aura slowly ramps up.
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What Is A Complex Migraine
A complex migraine isn’t a specific type of migraine, and it’s not an official diagnosis.
“It’s an older term that refers to migraines that present with stroke-like symptoms,” says Lauren R. Natbony, MD, assistant professor of neurology at the Icahn School of Medicine at Mount Sinai in New York City.
You might have slurred speech, numbness or tingling on one side of the body, balance problems, brain fog, or double vision.
Stroke-like symptoms can be a part of a migraine aura, one of the phases of a migraine that can either occur before or during the head pain portion. Sometimes, though, you might not feel any head pain at all.
If these symptoms are part of your migraine, you are not having a stroke. However, since strokes are a medical emergency, you should seek help immediately if you think you might be having one.
Within the umbrella of “complex migraine” are several different types of migraine, says Dr. Natbony.
These include vestibular migraine, hemiplegic migraine, and migraine with brainstem aura.
When To Get Medical Advice
You should see a GP if you have frequent or severe migraine symptoms.
Simple painkillers, such as paracetamol or ibuprofen, can be effective for migraine.
Try not to use the maximum dosage of painkillers on a regular or frequent basis as this could make it harder to treat headaches over time.
You should also make an appointment to see a GP if you have frequent migraines , even if they can be controlled with medicines, as you may benefit from preventative treatment.
You should call 999 for an ambulance immediately if you or someone you’re with experiences:
- paralysis or weakness in 1 or both arms or 1 side of the face
- slurred or garbled speech
- a sudden agonising headache resulting in a severe pain unlike anything experienced before
- headache along with a high temperature , stiff neck, mental confusion, seizures, double vision and a rash
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Migraine And Other Vascular Disease
People who suffer from migraine headaches are more likely to also have cardiovascular or cerebrovascular disease . Reliable evidence comes from the Women’s Health Study, which found that migraine with aura raised the risk of myocardial infarction by 91% and ischemic stroke by 108% and that migraine without aura raised both risks by approximately 25%. Migraines during pregnancy are also linked to stroke and vascular diseases. A 2017 analysis of the Women’s Health Study found that women who experience migraine headaches, particularly migraine without aura, may be at increased risk for hypertension. Compared with women without a history of migraine, those who experienced migraine with aura had about a 9% increased risk for hypertension while those who experienced migraine without aura had about a 21% increased risk.
Migraine with aura for women in midlife has a statistically significant association with late-life vascular disease in the cerebellum. This association is not seen in migraine without aura.
One Of Our Readers Shared A Harrowing Story About ‘complex Migraine’ That Every Migraine Warrior Should Understand Why It Could Happen To You
Dear Migraine Again,
This past Tuesday, I started my work day as a high school teacher, just like any other day. I noticed I had difficulty finishing a word or two. This continued through the morning, without me thinking much about it. During the last period, I started to feel disoriented and sort of dizzy. I would read from the computer screen. But I forgot what I read immediately.
I told my students I didn’t feel right. I had to sit down for a minute trying to figure out what was going on. Someone called the Nurse’s Office and wheeled me there.
Once there I was slurring most of my words, and could hardly get out of the wheelchair without support. Everything inside and out of my head was spinning. I was taken to the hospital in an ambulance. At the emergency room they diagnosed a stroke, and proceeded to perform CAT scans, MRI, and took blood. In short, they wired me all over. But all the tests came back negative. When the neurologist that treats me for migraines came to see me, she diagnosed a Complex Migraine. I ended up spending two additional days in the hospital.
I would appreciate if you could provide some background information about complex migraines. I would like other migraine sufferers to be aware of the symptoms. It was a very scary experience.
Thank you, Tery
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Migraine With Aura Treatment
When you’re having a migraine with aura, stay in a quiet, dark room. Try putting cold compresses or pressure on the painful areas.
Prescription medications called triptans or ditans — such as almotriptan , eletriptan , frovatriptan , lasmiditan , naratriptan , rizatriptan , and sumatriptan — can help. Ergots may also treat migraine pain.
Other medications can ease related symptoms such as nausea and vomiting.
Some devices are designed to short-circuit a migraine by turning on your brain in a particular way.
SpringTMS and eNeura sTMS use a technique called transcranial magnetic stimulation . Place the device on the back of your head for about a minute to release a pulse of magnetic energy.
A vagus nerve stimulator called gammaCore, when placed over the vagus nerve in your neck, releases mild electrical stimulation to relieve pain.
You’ll need a prescription for any of these devices.
Economic Impact Of Migraine
The economic cost resulting from migraine-related loss of productive time in the US workforce is more than $13 billion per year, most of which is in the form of reduced work productivity. In the American Migraine Study, more than 85% of women and 82% of men with severe migraine had some headache-related disability. Migraineur men required 3.8 bed-rest days per year, whereas women required 5.6 bed-rest days per year.
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Migraine With Aura Diagnosis
Your doctor will give you a physical exam and check your muscles, reflexes, speech, and senses to test the nerves in your head. Theyâll also ask about your health history, such as:
- Do other family members have migraine or other kinds of headaches?
- What medications do you take, including birth control pills or blood pressure drugs?
- Do your headaches start after working hard, coughing, or sneezing?
Blood tests and imaging, such as X-rays, CT scans, or MRIs, can help rule out other causes like an infection and bleeding.
How To Treat A Migraine At Home
“The quickest way to treat a migraine is to take a medication at the first sign of migraine symptoms,” Paul Mathew, MD, DNBPAS, FAAN, FAHS, assistant professor of neurology at Harvard Medical School and a member of the National Headache Foundation, tells POPSUGAR. Dr. Mathew notes that prescription medications that are specific to migraines tend to be far more effective than over-the-counter options but, either way, it’s crucial to take the medication as quickly as possible.
“Many people make the mistake of waiting to see if the migraine will go away, and this delay in taking medication can result in the medication being less effective,” Dr. Mathew says. He adds that taking the medicine at the first sign of a migraine symptom can result in a mild to moderate headache that lasts for one to two hours, while waiting too long often means a moderate to severe headache that can last a day or longer.
Experts typically recommend taking a nonsteroidal anti-inflammatory drug , such as ibuprofen or naproxen, for migraine headaches. Other over-the-counter remedies, such as Excedrin Migraine, combine an NSAID with acetaminophen and caffeine, which you may find to be effective.
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Acute Migraine Headache: Treatment Strategies
LAURA MAYANS, MD, MPH, and ANNE WALLING, MB, ChB, University of Kansas School of Medicine, Wichita, Kansas
Am Fam Physician. 2018 Feb 15 97:243-251.
Patient information: A handout on this topic is available at .
Migraine is a primary headache disorder characterized by recurrent attacks. Acetaminophen, nonsteroidal anti-inflammatory drugs, triptans, antiemetics, ergot alkaloids, and combination analgesics have evidence supporting their effectiveness in the treatment of migraine. Acetaminophen and nonsteroidal anti-inflammatory drugs are first-line treatments for mild to moderate migraines, whereas triptans are first-line treatments for moderate to severe migraines. Although triptans are effective, they may be expensive. Other medications such as dihydroergotamine and antiemetics are recommended for use as second- or third-line therapy for select patients or for those with refractory migraine. The pharmacologic properties, potential adverse effects, cost, and routes of administration vary widely, allowing therapy to be individualized based on the pattern and severity of attacks. Several treatment principles, including taking medication early in an attack and using a stratified treatment approach, can help ensure that migraine treatment is cost-effective.
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What Are Some Migraine Risk Factors And Triggers
Some things make you more likely to get migraine headaches . Other things may bring on a migraine .
Common migraine risk factors include the following:
- Family history: You are much more likely to have migraines if one or both of your parents had migraines.
- Sex: Women are more likely than men to have migraines.
- Age: Most people have their first migraine during adolescence, but migraines can start at any age, usually before age 40.
Common migraine triggers include the following:
- Food and drink: Certain food and drink may cause migraines. Dehydration and dieting or skipping meals may also trigger migraines.
- Hormone changes: Women may experience migraines related to their menstrual cycles, to menopause, or to using hormonal birth control or hormone replacement therapy.
- Stress: Stress may trigger migraines. Stress includes feeling overwhelmed at home or work, but your body can also be stressed if you exercise too much or dont get enough sleep.
- Senses: Loud sounds, bright lights , or strong smells may trigger migraines.
- Medicines: Certain medicines may trigger migraines. If you think your migraines might be related to your medicine, talk to your doctor. Your doctor may be able to prescribe a different medicine.
- Illness: Infections, such as the cold or the flu, may trigger migraines, especially in children.
Foods that may trigger migraines:
- aged, canned, cured, or processed meat
- aged cheese
- soy sauce
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What Is An Aura
An aura is a group of sensory, motor and speech symptoms that usually act like warning signals that a migraine headache is about to begin. Commonly misinterpreted as a seizure or stroke, it typically happens before the headache pain, but can sometimes appear during or even after. An aura can last from 10 to 60 minutes. About 15% to 20% of people who experience migraines have auras.
Aura symptoms are reversible, meaning that they can be stopped/healed. An aura produces symptoms that may include:
- Seeing bright flashing dots, sparkles, or lights.
- Blind spots in your vision.
- Numb or tingling skin.
What Treatment Guidelines And Pain Relief Options Are Available For Complex Migraine
They’re the same as for migraine in general. Some of the symptoms that people might include in a diagnosis of what may be called complex migraine â like language dysfunction or fatigue â may not have any specific symptomatic treatments. Therefore healthcare providers should use the same treatments as they would for migraine with or without aura.
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Prevention/treatment For Complex Migraine
- If you have complex migraines, the best course of action is prevention. Avoiding getting these migraines is the most effective intervention. This entails having the physician educate you in what the common triggers are and what to stay away from. The foods mentioned above need to be cut out of your diet as well as products containing nitrates. There are many foods or spices that affect people with migraines, depending on the individual. You may have triggers that have not been mentioned.
- Getting enough sleep is important in preventing complex migraines. Sleep is needed to reduce stress levels and help the body rejuvenate enough to handle stress when it comes your way. To facilitate better sleep, keep lights at a minimum before bedtime. Go to bed at the same time every night.
- You may want to switch out your light bulbs if they are more than 60 watt. Bright lights may trigger a migraine, so opt for 40 watt. If you feel a migraine coming on, rest in a cool, dark room to try to stave it off.
- Relaxation techniques are great for stress reduction and should be used. Meditation, yoga, and tai chi are good options as well as bio feedback.
What Are The Symptoms
Complex migraine symptoms can vary from person to person. However, this migraine type usually has two phases.
The first phase is an aura episode. The aura is like a precursor to migraine, but it doesnt mean its symptoms are any less severe.
The aura phase typically begins shortly before migraine occurs. Symptoms of complex migraine aura might include the following:
- vision changes, including blind spots, bright flashes of light, or double vision
- changes in your ability to think clearly
- difficulty speaking or difficulty speaking clearly
- weakness on one side of your body that ranges from mild to severe
The most significant aura symptoms usually last about an hour but may have lingering effects for up to a week, according to the National Organization for Rare Disorders .
Following an aura comes migraine. Migraine causes symptoms such as:
- sensitivity to light and sound
- throbbing, intense headache pain
NORD also emphasizes that migraine can last for several days in some people. But whats important to know about complex migraine symptoms is that they are reversible.
A person who has complex migraine will ultimately have symptoms that go away. It may take a little longer due to the nature of complex migraine.
But its important to know that the experience of complex migraine is different from a person who experiences a stroke, which may have lasting effects.
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Treatment For Pregnant And Breastfeeding Women
In general, migraine treatment with medicines should be limited as much as possible when you’re pregnant or breastfeeding.
Instead, trying to identify and avoid potential migraine triggers is often recommended.
If medicine is essential, your GP may prescribe you a low-dose painkiller, such as paracetamol.
In some cases, anti-inflammatory medicine or triptans may be prescribed.
Speak to a GP or your midwife before taking medicine when you’re pregnant or breastfeeding.
Page last reviewed: 10 May 2019 Next review due: 10 May 2022
Diagnosis And Patient Assessment
Migraine has well-established diagnostic criteria4 . Good evidence supports the use of the POUND mnemonic for migraine diagnosis6 . Assessment aims to confirm diagnostic criteria, evaluate for alternative explanations, identify comorbidities that could complicate management ,8 and document the baseline pattern and severity of episodes. A variety of conditions can present as headache, most of which can be identified by the history and physical examination .6 The only indications for ancillary testing are to identify causes of secondary headaches or comorbid conditions.9,10 Table 4 lists red flag symptoms that indicate the need for neuroimaging and/or urgent referral.9,10
International Headache Society Diagnostic Criteria for Migraine Headache With and Without Aura
Migraine without aura
*Recurrent disorder manifesting in headaches with reversible focal neurologic symptoms that usually develop gradually over 5 to 20 minutes before onset of the headache and last for less than 60 minutes. Headache with the features of migraine without aura usually follows the aura symptoms. Less commonly, headache lacks migrainous features or is completely absent .
Adapted with permission from Gilmore B, Michael M. Treatment of acute migraine headache . Am Fam Physician. 2011 83:272.
International Headache Society Diagnostic Criteria for Migraine Headache With and Without Aura
Migraine without aura
POUND Mnemonic for Diagnosis of Migraine
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