Friday, March 17, 2023

Complicated Migraine With Stroke-like Symptoms

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What Is A Migraine

Symptoms of Stroke and Migraine | Cedars-Sinai

Migraine is a disease that causes recurrent attacks of head pain together with other symptoms such as a bad headache that often comes with nausea, vomiting, and sensitivity to light, sound, smell, or touch. The pain may throb or pulse, and you usually feel it on one side of your head around your eye or temple.

A migraine with aura is the kind that can be confused with a stroke. An aura affects your senses and usually happens before the headache. You may see light flashes, zig-zagged lines, or blind spots, or you might feel tingling or numbness in your arms, legs, or face. You might have ringing in your ears or trouble speaking. Sometimes, you’ll have those symptoms but never get a headache. That tends to happen more often as you get older.

What To Do Once You Recognize The Symptoms:

While atypical migraines are common, it is always best to visit the doctor immediately and seek an informed opinion. The doctor can give you tips, tricks, and strategies to minimize the discomfort you are experiencing. They will also help you identify why you get the migraine episodes and help mitigate those. Learning why you get a migraine or what factors are most likely to affect you can reduce the frequency of your migraine episodes.

In addition, the doctor is likely to evaluate your health history. This means that the doctor can also pinpoint if your symptoms align with the onset of other diseases and disorders. They will administer the treatment plan accordingly to treat underlying conditions.

On the other hand, if your symptoms align with a hemiplegic migraine or a migraine with brainstem aura, you should see a headache specialist who has dealt with the complex migraine before. They will be better equipped to treat you and provide you with an effective and safe treatment plan. Sometimes the doctor may recommend seeing a neurologist to treat complex migraines because its a little tricky to deal with them. Neurologists can conduct exams and prescribe treatments more effectively.

While the term complex migraine isnt commonly used, it is useful to keep the symptoms and types in mind to address any issues that may occur.

About Dr.Watson

Name Two Common Conditions That Mimic Stroke Symptoms

Seizure and complicated migraine. Although at times difficult to distinguish, the clinician can often differentiate between these conditions on the basis of the temporal nature of symptom onset. Strokes generally produce a deficit that is sudden and maximal at onset. Seizures progress rapidly over a few seconds and may be associated with stereotyped motor movements and often impairment or loss of consciousness. Migraines can produce stereotypical visual, sensory, motor, or language symptoms in a predictable fashion because of the presumed mechanism of cortical spreading depression occurring over minutes. Spreading depression is an extracellular wave of neuronal depolarization thought to be related to rising levels of potassium concentration in the extracellular space that produces migratory symptoms as it spreads across the surface of the cortex.

Joanna C. Jen, Jijun Wan, in, 2018

Recommended Reading: What Causes Headaches And Nausea

Whats The Outlook For People With Complex Migraine

Doctors diagnose an estimated 2 percent of all patients with stroke-like symptoms with migraine, according to a 2019 research review.

When it comes to complex migraine, it can be difficult to differentiate between the two. However, if you have a history of complex migraine, you may recognize the aura symptoms more easily.

Your doctor may recommend seeing a specialist called a neurologist to treat complex migraine as their treatment is more complex.

A neurologist can conduct examinations and prescribe treatments when indicated to address complex migraine symptoms.

Although doctors dont use the term complex migraine as often, the symptoms this migraine type can cause are alarming. They include:

  • weakness on one side

Migraines Begin Gradually While Strokes Happen Quickly

Pin by Ericka on Hemiplegic Migraine

Both conditions can cause debilitating headaches, vision disturbances, and sensory changes, so its important to pay attention to how quickly these all appear. Typically, migraine headaches come on slowly and become more painful with time, sometimes lasting for several days, whereas a stroke-related headache usually reaches its intensity within a few minutes. Additionally, other migraine symptoms appear in phases too, according to Carrie Oakley Dougherty, M.D., associate professor of neurology at Georgetown University Medical Center. In the situation of migraine with aura, its generally a progression of symptoms over time, she tells SELF.

Read Also: How To Relieve Tension Headache Naturally

Whats A Migraine Journal

  • Keeping a migraine journal is not only beneficial to you, but it helps your healthcare provider with the diagnosis process. Your journal should be detailed and updated as much as possible before, during and after a migraine attack. Consider keeping track of the following:
  • The date and time of when the migraine began specifically when the prodrome started, if youre able to tell its happening. Track time passing. When did the aura phase begin? The headache? The postdrome? Do your best to tell what stage youre in and how long it lasts. If theres a pattern, that may help you anticipate what will happen in the future.
  • What are your symptoms? Be specific.
  • Note how many hours of sleep you got the night before it happened and your stress level. Whats causing your stress?
  • Note the weather.
  • Log your food and water intake. Did you eat something that triggered the migraine? Did you miss a meal?
  • Describe the type of pain and rate it on a one to 10 scale with 10 being the worst pain youve ever experienced.
  • Where is the pain located? One side of your head? Your jaw? Your eye?
  • List all of the medications you took. This includes any daily prescriptions, any supplements and any pain medication you took.
  • How did you try to treat your migraine, and did it work? What medicine did you take, at what dosage, at what time?
  • Consider other triggers. Maybe you played basketball in the sunlight? Maybe you watched a movie that had flashing lights? If youre a woman, are you on your period?

Complex Migraines With Brainstem Aura Symptoms

Migraines with BrainStem Aura are also known as basilar migraines. These headaches originate in the lower part of the brain, known as the brainstem. The aura changes can occur about ten to forty-five minutes before the head starts hurting. The migraine and headache pain starts on one side of the head, spreading gradually and becoming stronger with time. It can last for four to seventy-two hours. Patients need time to recover from it, and they can feel drained up until a day after it subsides.

The symptoms can occur for a few hours or last for a few days. These symptoms can occur in addition to typical migraine symptoms.

Read Also: Vitamins For Headaches And Dizziness

Important Clinical Features And Considerations

Migraine is a condition that warrants specific consideration. Complicated migraines in which the patient presents with focal neurologic abnormalities may initially be diagnosed as stroke. A classic history with aura or other migraine-associated symptoms is frequently absent in children with migrane headaches.29 The neurologic deficit may last from hours to days and can vary from subtle abnormalities to dense hemiplegia. In cases in which this is suspected, early neuroimaging is still required to exclude a central nervous system vascular event or other intracranial pathology before expectant management may be safely pursued. Further complicating this entity is the possibility of migraine actually causing an ischemic stroke. While accepted in the adult population,30,31 the development of cerebral infarction as a consequence of migraine in childhood has not been definitively described. Several small studies, however, support the concept.29,32

K. Sivakumar, … M.C. Leary, in, 2017

What Are The Symptoms

Complex Migraine – Mayo Clinic

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.

Also Check: Ophthalmic Migraine Vs Ocular Migraine

Enhancing Healthcare Team Outcomes

A hemiplegic migraine is a very rare migraine headache accompanied by unilateral weakness. It can be very upsetting to the patient and their family. Typically an interprofessional approach involving the family clinician , a pharmacist, and a clinical headache specialist working with a nurse experienced in headache education to educate the patient and family will result in the best outcome. All team members must document their observations, interactions, and interventions in the patient’s medical record and, when necessary, be able to communicate with other team members about the case.

When You Have Stroke

If it is your first time experiencing these symptoms, especially if you have weakness on one side or double vision or impaired sight, dont assume youre having a migraine.

If you have new headache symptoms or ones that are getting progressively worse, you should seek medical attention, says Dr. Silberstein.

What you dont want to do is miss a stroke, as recovery from a stroke relies on prompt treatment.

Also Check: What Is An Intractable Migraine

Causes Of Complex Migraines

Complex migraines may occur because of a range of reasons. They can be linked either to one cause which makes it easier to prevent, or the cause isnt clear, which makes it harder to prevent.

Examples of common migraine triggers include the following:

  • Smelling strong odors or smells

However, a typical migraine with aura is caused by cortical spreading depression or CSD. CSD refers to waves of changed or altered brain activity spread throughout the brain, leading to nerve cell responses and blood flow alterations.

Related: Migraine & Memory loss

Hemiplegic Migraines occur because of CSD in the cortex. They have also been linked to genetic mutations. Depending on how the genetic mutations have occurred, the hemiplegic migraine can be divided further into two categories:

  • Familial hemiplegic migraine: this is inherited the genetic mutations are passed down in members of the same family
  • Sporadic hemiplegic migraine: these are less common and are not inherited. The genetic mutations occur randomly in this case.

On the other hand, migraines with brain stem auras have at least two symptoms that originate in the brain stemfor example, vertigo, tinnitus, and double vision.

Diagnosing Familial Hemiplegic Migraine

Do These Complicated Migraine Symptoms Scare You?

Familial hemiplegic migraine has a genetic component that is part of the diagnosis. To determine FHM, the physician looks for the following:

  • Aura with fully reversible motor weakness and one or more symptoms of visual, sensory, or dysphasic speech disturbances.
  • Two or more of these symptoms:
  • At least one aura symptom developing gradually over five or more minutes and/or different aura symptoms occurring in succession over five or more minutes.
  • Aura symptoms lasting more than five minutes and less than 24 hours
  • A headache lasting between four and 72 hours with pulsating quality, unilateral location, or moderate to severe pain intensity, along with nausea or vomiting, photophobia, or phonophobia.
  • The patient must have at least one first or second-degree relative who has the same type of attacks.
  • Basilar- type migraines are diagnosed when a patient has at least two attacks with the following symptoms:

    • Fully reversible sensory, visual, or speech aura without motor weakness
    • Two or more fully reversible symptoms of dysarthria, vertigo, tinnitus, decreased hearing, double vision, ataxia, decreased consciousness, bilateral symptoms, and simultaneous bilateral paresthesia
    • An aura lasting more than five minutes and up to 60 minutes, or the aura symptoms develop gradually over five minutes or change over five minutes
    • A headache lasting four to 24 72 hours with many of the same symptoms of FHM

    In all cases, the symptoms and pain cannot be attributed to another disorder.

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    What Are The Symptoms Of Migraines

    The primary symptom of migraine is a headache. Pain is sometimes described as pounding or throbbing. It can begin as a dull ache that develops into pulsing pain that is mild, moderate or severe. If left untreated, your headache pain will become moderate to severe. Pain can shift from one side of your head to the other, or it can affect the front of your head, the back of your head or feel like its affecting your whole head. Some people feel pain around their eye or temple, and sometimes in their face, sinuses, jaw or neck.

    Other symptoms of migraine headaches include:

    • Sensitivity to light, noise and odors.
    • Nausea and vomiting, upset stomach and abdominal pain.
    • Loss of appetite.
    • Feeling very warm or cold .
    • Pale skin color .

    Complicated Migraine Symptoms To Be Alarmed About

    Aneurysms can be dismissed as severe migraines. If an aneurysm is ruptured and leaking it can produce a headache like nothing youve experienced before. Its difficult to tell the difference between this and intensely disabling complicated migraine symptoms.

    Dont go rushing off to the hospital… but if your regular routine and abortives are not helping, it could be something else… like an aneurysm.

    I dont want to scare you but this is a reality. So lets look at some more details to clear things up

    Approximately 15 percent of people that have migraines suffer from migraines with aura. These migraines used to be called classic, classical migraine or complicated migraine.

    Now complicated migraine is more a descriptive term. The International Headache Societystarted categorizing headaches into different groups by their characteristics.

    The other 85 percent of migraineurs have migraine without aura. But there is also a small percentage that has characteristics unlike these two categories.

    These people have the more scary complicated migraine symptoms.

    I find symptoms like paralysis, or difficulty using one side of the body or difficulty forming a sentence and talking… very scary.

    I don’t get the paralysis often, thank goodness, but I do get the speech and cognition problems regularly.

    These are the symptoms that can often be misdiagnosed as stroke symptoms.

    • numbness, weakness, or tingling only on one side of your body
    • changes in your vision
    • difficulty forming words

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    What Is The Prognosis For People With Migraines

    Migraines are unique to each individual. Likewise, how migraines are managed is also unique. The best outcomes are usually achieved by learning and avoiding personal migraine triggers, managing symptoms, practicing preventive methods, following the advice of your healthcare provider and reporting any significant changes as soon as they occur.

    Do These Complicated Migraine Symptoms Scare You

    Migraines 101: Symptoms

    Written and verified by Holly Hazen

    Migraines are a chronic problem and complicated migraine symptoms can often be worse than the pain phase itself. One of the problems with diagnosing these symptoms is that they often mimic other serious medical problems. So, you get tested for a brain tumour, stroke and MS to rule them out.

    They can definitely be scary and debilitating.

    This makes it difficult for doctors and for us as patients.

    If you have these debilitating symptoms, then I suggest becoming familiar with your own early warning signals, and some of the more serious signs below.

    I used to hate those subtle sensations because I knew what was in store. That was until a hairdresser said…

    “how lucky are you to have an early warning like that!”

    I was just starting to panic and tell her that I was triggered by the perfumed shampoo she was using. I could feel my heart rate increase and my breathing when I thought… hang on a minute, she’s right. I can use this to help.

    Now I am thankful for that inner awareness… that subtle clue and I can take immediate action to stop the attack from escalating.

    Also Check: Is It Normal To Have Headaches During Pregnancy

    Migraine And Hormone Replacement Therapy

    There are insufficient data to support a further increased risk of ischaemic stroke in women with any type of migraine who are using hormone replacement therapy.

    Clinical implication

    After menopause, MA in itself is not a contraindication for the use of hormone-replacement therapy, but stroke risk related to the therapy itself should be considered.

    Migraine Stroke And Special Concerns In Women

    Migraine is a predominantly female disorder, affecting women with a ratio of approximately 3:1 to men. The highest 1-year prevalence of migraine is between ages of 25 and 55 years, and it is estimated that 22%37% of women will experience migraine during their reproductive years. As the association between migraine and ischaemic stroke is particularly strong in women with MA under the age of 45, certain aspects during a womans life need to be considered.

    Read Also: Can You Get Migraines From Stress

    What Is A Migraine Headache

    A migraine is a group of neurological symptoms that typically include a severe throbbing headache, usually on one side of the head. Researchers and doctors do fully understand the causes of migraine headaches however, most think that they may be caused by changes in the chemicals in the brain, which causes inflammation, or the condition may be genetic .

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