The Basics About Hemiplegic Migraine
Migraine can present in a variety of ways. Hemiplegic migraine is a rare form of migraine where people experience weakness on one side of their body in addition to the migraine headache attack. The weakness is a form of migraine aura and occurs with other forms of typical migraine aura like changes in vision, speech or sensation. Hemiplegic migraine is divided into Familial hemiplegic migraine or Sporadic hemiplegic migraine . This is a very rare migraine type so if you ever experience new or never-evaluated weakness with your headache, you should seek immediate medical evaluation and not assume you have hemiplegic migraine.
Both familial and sporadic hemiplegic migraines often begin in childhood. Diagnosing hemiplegic migraine can be difficult, as the symptoms can mimic stroke, seizures or other conditions. A full neurological work up, including obtaining imaging of the brain and vessels in the head, and careful review of medical history and symptoms are necessary to rule out other causes and confirm a diagnosis of hemiplegic migraine. Family medical history is especially helpful in diagnosing familial hemiplegic migraine.
But What About Side Effects Of Verapamil
The same survey reported 36% with no side effects, and another 30% with only slight side effects. As is too often the case, I tend to be a 1%er, if theres a rare side effect I will stumble upon it, and thats what happened with Verapamil.
Id love to tell you that I had no side effects, but thats not the case.
In the last few weeks, Ive noticed an increase in a couple of symptoms, one of which is kind of new.
The first is general joint pain and inflammation. Everything hurts more lately. Initially, I attributed it to the semester and to just being worn out, I needed to eat better, etc. But, now Im not so sure.
The second is something sort of new. Id been waking up feeling like my feet were on fire, just aching and swollen, as if they were beyond dry and Id been walking on them all day in bad shoes. This has progressively gotten worse, and once I established that it was definitely more than just dry feet and really started thinking about how they feel, I realized it was something more.
It took me a minute to stop and ask myself whats changed? Have I started any new meds/ treatments lately that this could be a side effect of?
The only new med is the Verapamil and its been about three months. I did a search to see if this type of thing was a normal side effect and initially I didnt find it in the standard lists, but when I searched for Verapamil and burning feet I found it was connected. Its something called erythromelalgia.
Verapamil For Headaches May Cause Heart Problems
3 Min Read
NEW YORK – When high doses of the drug verapamil are used to prevent cluster headaches, a severely painful type of headache, about one in five patients will develop some form of cardiac irregularity, according to a report by UK researchers.
The benefit of taking verapamil to alleviate the devastating pain of cluster headaches has to be balanced against the risk of causing a heart abnormality that could progress into a more serious problem, senior author Dr. Peter J. Goadsby, from the National Hospital for Neurology and Neurosurgery in London, said in a statement.
The new findings, which appear in the current issue of the journal Neurology, stem from a study of 108 patients who received the calcium-channel blocker verapamil for cluster headache and had ECG results documented in hospital notes. The daily dose of verapamil ranged from 240 to 1200 mg.
Calcium-channel blockers are a class of drugs that decrease heart contractions and dilate the arteries, which may increase the supply of blood to the heart. Some of the trade names that verapamil is sold under include Calan, Verelan or Covera.
Twenty-one patients had an arrhythmia – a disorder of the hearts regular rhythmic beating, according to the report. Thirteen patients developed first-degree heart block, when the hearts electrical impulse moves through the atrioventricular block node more slowly than normal. One of these 13 patients required a permanent pacemaker.
Recommended Reading: Can Migraines Cause Ear Infections
Caffeine And Vestibular Migraine
Interestingly, this same study also tested the effect of caffeine intake on Vestibular Migraine and unexplained dizziness. It found a 14% reduction in vestibular symptoms for those who completely quit caffeine, but 46% of patients found a reduction in dizziness with nortriptyline therapy.
This shows that eliminating caffeine can be a helpful addition, but medication provides the greatest reduction in symptoms of headache and dizziness.
Falling in between caffeine cessation and nortriptyline in terms of efficacy was treatment with topiramate , which resulted in a 25% reduction of dizziness.
How To Prevent Vestibular Migraine
There are also several other treatments that might help specifically vestibular migraine.
In an interview at the 2017 Migraine World Summit, the Director of Headache at the Mayo Clinic, Dr. David Dodick shared some of these:
Theres a medication called Acetazolamide. Its an old medication, but we use that for patients with vestibular migraine. Theres another medication called Verapamil. Verapamil is a calcium channel blocker, sometimes used for patients with high blood pressure. But Verapamil, we think, is probably more effective for vestibular migraine and some other unusual migraines that I think we may talk about, than it is for typical migraine.
Another medication which unfortunately we dont have in the United States, but is available in many countries around the world, is a medication called Flunarizine. It too is a calcium channel blocker, but it can be very effective for the vertigo associated with migraines.
The treatments listed above can be helpful if taken regularly to prevent attacks. Hence the classification of prevention treatments. However for someone with a severe case of migraine vertigo it may not be enough. Sometimes Vestibular rehabilitation can be helpful.
Recommended Reading: Can You Get A Sick Note For Migraines
Vestibular Migraine Not As Rare As Once Thought
Vestibular Migraine was once considered rare, but it is increasingly becoming a more widely recognized diagnosis. This type of Migraine is characterized by vertigo and dizziness. It is a common cause of headache with dizziness, but VM can occur with or without head pain.
Migraine-associated vertigo affects between 1-3% of the general population, making Migraine the leading causes of vertigo and dizziness in adults
Only about half of all patients with VM experience pain with their attacks. It can be confusing to get a diagnosis of Migraine if you have no pain, but an accurate diagnosis is key to finding the right treatment and relief.
How Long Does It Last
The duration of attacks is highly variable. Episodes of dizziness can last a few seconds up to a few days . ;
- About 30% of patients have episodes lasting minutes.
- 30% have attacks for hours.
- Another 30% have attacks over several days.
- The remaining 10% have attacks lasting only seconds, which tend to occur repeatedly during head motion, visual stimulation, or after changes of head position.
There is a small percentage of people who have debilitating daily vertigo that can be an extremely disruptive experience.
Also Check: What Is An Abdominal Migraine
Cgrp Monoclonal Antibodies For Vestibular Migraine
People with VM were excluded from the trials of anti-CGRP Migraine treatments so not much is known about their efficacy as a Vestibular Migraine treatment, yet Dr. David Dodick remains “cautiously optimistic” about them for the future.
For Dr. Shin Beh, some initial success is being seen among dizzy patients. He says, “I’m finding that the CGRP monoclonal antibodies are helping Vestibular Migraine patients. I have a handful of patients on them at the moment. With more people using them, I’m sure we will draw a much clearer picture. For the Migraine rescue oral CGRP small-molecule blockers , I am waiting to hear back from the patients on their efficacy. They are still pretty new to the market, and I suspect insurance companies are still figuring out how to deal with them.”
Symptoms And Features Of Vestibular Migraine
Vestibular Migraine can manifest through alarming symptoms like lightheadedness, ataxia, and sensations of moving while sitting still. Because symptoms are not the same for every person, it is incredibly easy to misdiagnose VM.
There are few clinical studies available on VM. Specialists in this field find themselves learning more every day about how to distinguish this diagnosis from other vestibular disorders like Meniere’s disease and benign paroxysmal positional vertigo .
Healthcare providers diagnose VM based on universal criteria set forth by the Barany Society and the International Headache Society. General practitioners receive little education in headache types, including Vestibular Migraine, so many people with symptoms of VM end up seeing several different doctors before they are accurately diagnosed.
Some of the common symptoms of Vestibular Migraine are:
- Memory loss and brain fog
- Positional and/or spontaneous vertigo episodes
- Sensitivity to light and motion
- Nausea and vomiting
Don’t Miss: How To Sleep With Migraine Pain
Use A Multidisciplinary Approach
I also tell my patients they have to take a holistic approach to managing migraine, Cowan says. I believe it takes a village to raze a headache, and this means using a multidisciplinary approach.
One way of doing this is to pay attention to your life. Cowan recommends, Dont let the clutter pile up. If you didnt sleep well one night, avoid wine that day.
He also adds, You cant live in a cave with migraine. You take the precautions you can, and then live your life.
What Should I Know About Storage And Disposal Of This Medication
Keep this medication in the container it came in, tightly closed, and out of reach of children. Store it at room temperature and away from excess heat and moisture .
It is important to keep all medication out of sight and reach of children as many containers are not child-resistant and young children can open them easily. To protect young children from poisoning, always lock safety caps and immediately place the medication in a safe location â one that is up and away and out of their sight and reach.
Unneeded medications should be disposed of in special ways to ensure that pets, children, and other people cannot consume them. However, you should not flush this medication down the toilet. Instead, the best way to dispose of your medication is through a medicine take-back program. Talk to your pharmacist or contact your local garbage/recycling department to learn about take-back programs in your community. See the FDA’s Safe Disposal of Medicines website for more information if you do not have access to a take-back program.
Also Check: Can A 13 Year Old Take Excedrin Migraine
What Are The Symptoms Of Vestibular Migraine
The vestibular system involves the inner ear which contributes towards our sense of balance, spatial orientation and movement. Problems that arise with the vestibular system commonly result in vertigo, dizziness or imbalance.
The ICHD-III outlines the following set of vestibular symptoms associated with vestibular migraine :
- Spontaneous vertigo. Including both internal vertigo; the false feeling that your body is moving, and external vertigo; the false feeling that your external environment is spinning or flowing.
- Positional vertigo. Occurring after a change in head position.
- Visually induced vertigo.; Caused by the movement of something visually complex or large.
- Head motion-induced vertigo. ;Due to movement of the head.
- Head motion-induced dizziness with nausea. Refers to dizziness that feels like spatial disorientation.
Auditory symptoms, including hearing loss, tinnitus, and aural pressure have been reported in up to 38% patients with vestibular migraine.
Devices For Migraine Treatment
In addition to the medications used for prevention, there are now devices being used successfully for both Migraine prevention and to treat Migraine attackss when they occur. Two devices now have FDA approval and are available in the United States with a prescription:
- The Cefaly device is an External Trigeminal Nerve Stimulation device for migraine treatment. A self-adhesive electrode is placed on the forehead and the Cefaly device is magnetically connected to this electrode. Precise micro-impulses are then sent through the electrode to the upper branch of the trigeminal nerve. The Cefaly is also available in Canada.
- eNeuras sTMS Mini device is a portable delivery system for single-pulse transcranial magnetic stimulation . The first generation of this device was called the Spring sTMS. The sTMS Mini works by interrupting cortical spreading depression to stop a migraine attack in progress. Preventively, it works by preventing cortical spreading depression from starting. The sTMS Mini is also available in the United Kingdom, but is not yet available in Canada.
gammaCore Sapphire Vagus nerve stimulator: The Sapphire nVNS device is;a hand-held device about the size of a cell phone that can be carried in a purse or backpack. It is now FDA approved for the acute treatment of both Migraine and Cluster Headache.
You May Like: Does Marijuana Help Ocular Migraines
Tricyclic Antidepressants For Vestibular Migraine
Another popular class of medication used to treat Vestibular Migraine is tricyclic antidepressants. Nortriptyline specifically was found to relieve dizziness in 46% of patients who combined the medication with lifestyle changes that included addressing triggers related to diet, behavior, and sleep hygiene
It seems these medications work well for patients who may also have sleep disturbances or who also experience an anxiety component to their attacks. It also appears that medication is even more effective when supported by other areas of treatment, like keeping a sleep schedule and avoiding potential food triggers.
This High Blood Pressure Drug Sometimes Can Keep Headaches At Bay
Verapamil is a medication sometimes prescribed to prevent migraine headaches. Available as a generic product and under brand names Calan and Verelan, verapamil;is in a class of drugs called calcium channel blockers that primarily are used to treat high blood pressure, angina, irregular heart rate, and other cardiac conditions.
Verapamil is rarely among the first drugs prescribed to prevent migraines, and it has not been approved by the U.S. Food and Drug Administration for this use. However, it may be prescribed off-label when other medications don’t work. It is also used off-label for the prevention of cluster headaches, If your doctor suggests you try verapamil, here’s what you should know.
Also Check: What Is An Ocular Migraine
Vestibular Migraine Is A Common Cause Of Headaches And Dizziness But It Can Occur Without Pain Discover The Evidence Behind Vestibular Migraine Treatments
When I began to experience the strange sensations that come with Vestibular Migraine, I thought I was losing my mind. Some days I felt as though the car would be moving forward and I had to slam on my brakes, even though it was still in park.
Other days I would have daily background dizziness that made it hard to walk or think clearly. The worst days included a terrifying spinning sensation, and that’s when I knew I needed to pursue a diagnosis.
After seeing 7 different physicians who got it all wrong, I was finally diagnosed with Vestibular Migraine . I sat there in disbelief. How on earth could these symptoms be Migraine?
Snris For Vestibular Migraine
Dr. Michael Teixido’s inaugural talk on Vestibular Migraine at the 2019 Migraine World Summit included his positive experience using SNRIs to treat patients with Vestibular Migraine
Recent studies have shown they are an effective and safe treatment, particularly for those who also have anxiety that accompanies their Migraine attacks.
Anxiety is a common trait of Vestibular Migraine attacks, which makes sense considering how frightening some of the symptoms can be.
A meta-analysis of 6 controlled trials testing 418 patients revealed that those taking SNRIs had fewer Migraine days than those taking placebo
You May Like: Can You Take Excedrin Migraine And Tylenol Together
Are There Any Other Disorders Associated With Vestibular Migraine
Those with VM are more likely to suffer from motion sickness.
There is also link between anxiety and VM. This may not be a surprise as constant vertigo, light-headedness or dizziness is an unsettling reminder that something is wrong. Without effective treatment it is not difficult to imagine how this may cause some level of worry or anxiety.
Menieres Disease which is an inner ear disorder characterized by tinnitus , hearing loss, dizziness and ear pressure may also be linked with VM. ;These two conditions have very similar symptoms. The key difference is the hearing loss in Menieres Disease is severe whilst in VM is it generally temporary.
Let me know in the comments below,;have you ever had some kind of lightheadedness, dizziness or vertigo with your migraine attacks?
NATURAL ALTERNATIVES PROVEN TO HELP PREVENT MIGRAINE
Get a list of 11 natural and proven treatments from medically published studies sent to you.
What Else Should I Know About Verapamil
What preparations of verapamil are available?
Immediate release tablets: 40, 80, and 120 mg; sustained release caplets: 120, 180, 240,and 360 mg; extended release tablets: 100, 120, 180, 200, 240, and 300 mg; Injection: 2.5 mg/mL
How should I keep verapamil stored?
Verapamil should be stored at room temperature 15 C – 30 C in a tight, light- resistant container.
You May Like: Can Caffeine Help A Migraine
Before Taking This Medicine
You should not use verapamil if you are allergic to it, or if you have a serious heart condition such as:
“sick sinus syndrome” or “AV block” ;
very low blood pressure; or
if your heart cannot pump blood properly.
You may not be able to use verapamil if you have:
severe congestive heart failure;
certain heart rhythm disorders ;
a heart condition that causes you to have very rapid heartbeats; or
if you are receiving an intravenous beta-blocker .
To make sure verapamil is safe for you, tell your doctor if you have ever had:
congestive heart failure;
liver disease; or
a nerve-muscle disorder such as myasthenia gravis or muscular dystrophy.
It is not known whether verapamil will harm an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant.
You should not breastfeed while using this medicine.
Verapamil oral is not approved for use by anyone younger than 18 years old.