Hello XXXXXXX

Thanks for the query,

It seems that you may be having a classic case of migraine.

A migraine is a common type of headache that may occur with symptoms such as nausea, vomiting, or sensitivity to light. In many people, a throbbing pain is felt only on one side of the head.

Some people who get migraines have warning symptoms, called an XXXXXXX before the actual headache begins. An XXXXXXX is a group of symptoms, including vision disturbances, that are a warning sign that a bad headache is coming.

A migraine is caused by abnormal brain activity, which is triggered by stress, certain foods, environmental factors, or something else.

Migraine attacks may be triggered by:
Alcohol
Allergic reactions
Bright lights
Certain odors or perfumes
Changes in sleep patterns
Exercise
Loud noises
Missed meals
Physical or emotional stress
Smoking or exposure to smoke

Based on the medications you have been prescribed you are on adequate treatment for migraine.

Divalproex has been prescribed as a form of prophylaxis to such attacks. Domperidone and naproxen have been prescribed to treat any possible symptoms due to migraine.

You might continue to take the treatment as prescribed by your doctor. This will be very helpful.

In addition developing proper sleep habits and a healthy lifestyle is very essential.

I hope this helps.

In case any more doubts, I am available for the follow ups.

Regards,

Dr Anvekar.

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Hello XXXXXXX

Before I can answer your questions I would like you to answer a small questionaire for me and provide a Score to each of the question - mentioned below:-

Method of Scoring :- Assign a value of 0 to 4 to each question.

SYMPTOM DETECTED :-
Not At All ...................... 0

A Little ...................... 1

Moderately ...................... 2

Quite a Bit ...................... 3

Extremely ...................... 4

Please Score the questions below - as mentioned above:-

1. Difficulty in getting your breath, smothering, or over breathing.

2. Choking sensation or a lump in the throat

3. Skipping, racing, or pounding of your heart

4. Chest Pain, pressure, or discomfort

5. Bouts of excessive sweating

6. Faintness, light-headedness, or dizzy spells

7. Sensation of rubbery or "jelly" legs

8. Feeling off balance or unsteady like you might fall

9. Nausea or stomach problems

10. Feeling that things around you are strange, unreal, foggy, or detached from you

11. Feeling outside or detached from part or all of your body, or a floating freely

12. Tingling or numbness in parts of your body

13. Hot flashes or cold chills

14. Shaking or trembling

15. Having a fear that you are dying or that something terrible is about to happen

16. Feeling you are loosing control or going insane

17. Sudden anxiety attacks with three or more of the symptoms listed above that occur when you are in or are about to go into a situation that is likely, from your experience, to bring on an attack

18. Sudden unexpected anxiety attacks with three or more symptoms listed above that occur with little or no provocation (i.e. when you are NOT in a situation that is likely, from your experience to bring on an attack)

19. Sudden unexpected spells with only one or two symptoms (listed above) that occur with little or no provocation (i.e. when you are NOT in a situation that is likely , from your experience, to bring on an attack)

20. Anxiety episodes that build up as you anticipate doing something that is likely, from your experience, to bring on anxiety that is more intense than most people experience in such situations

21. Avoiding situations because they frighten you

22. Being dependent on others

23. Tension and inability to relax

24. Anxiety, nervousness, restlessness

25. Spells of increased sensitivity to sound, light, or touch

26. Attacks of diarrhea

27. Worrying about your health too much

28. Feeling tired, weak, and exhausted easily

29. Headaches or pains in the neck or head

30. Difficulty in falling asleep

31. Waking in the middle of the night, or restless sleep

32. Unexpected waves of depression occurring with little or no provocation

33. Emotions and moods going up and down a lot in response to changes around you.

34. Recurrent and persistent ideas, thoughts, impulses, or images that are intrusive, unwanted, senseless, or repugnant 35. Having to repeat the same action in a ritual, e.g., checking, washing, counting repeatedly, when it's not really necessary

Once I recieve your answers, I shall provide a proper answer for your questions.


Waiting for your response

Dr. Anvekar.

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Hello XXXXXXX

Thanks for the follow up query.

Let me give you a complete list of signs and symptoms that are seen with Classic migraine.

1. VISION DISTURBANCES - Which may involve any or all of the following:
- A temporary blind spot.
- Blurred vision.
- Eye pain.
- Seeing stars or zigzag lines.
- Tunnel vision.

2. MIGRAINE HEADACHES - can be dull or severe. The pain may be felt behind the eye or in the back of the head and neck.
The headaches usually:
- Feel throbbing, pounding, or pulsating.
- Are worse on one side of the head.
- Start as a dull ache and get worse within minutes to hours.
- Last 6 to 48 hours.

OTHER SYMPTOMS that may occur with the headache include:
- Chills.
- Increased urination.
- Fatigue.
- Loss of appetite.
- Nausea and vomiting.
- Numbness, tingling, or weakness.
- Problems concentrating, trouble finding words.
- Sensitivity to light or sound.
- Sweating.

4. SYMPTOMS PERSISTING AFTER AN EPISODE :- Symptoms may linger even after the migraine has gone away. This is called migraine "hangover."
Symptoms can include:
- Feeling mentally dull, like your thinking is not clear or sharp.
- Increased need for sleep.
- Neck pain.

OTHER MEDICAL CONDITIONS THAT CAN BE ASSOCIATED WITH MIGRAINE:
1. Irritable bowel syndrome - Presents as constipation.
2. Chronic Fatigue syndrome.
3. Fibromyalgia.

These disorders are associated with abnormal levels of the hormone serotonin, which is an active hormone in the Enteric nervous system controlling the bowel movements and functions. Hence the abnormal levels result in the onset of symptoms like alternating constipation, chronic body pain, Fatigue, lethargy, etc.

It seems that you have a combination of all the symptoms that I have mentioned above. Hence I would suggest you to consult your treating doctor, and ask him if he can prescribe a SSRI called Venlafexine. This might be helpful to treat some of your symptoms.

Here are the answers to your earlier questions.

1. For how many days/months I have to take the prescribed medicine?
4. If I have to take medication for migraine/headaches on daily basis or SOS?

Medications given for treating migraine have different uses including:-
1. Reduce the number of attacks - Such medicines need to be taken daily.
Eg : Divalproex (in your case)- this prevents the onset of the attacks by inhibiting the activity of the excitable neurons.

2. Stop the migraine once early symptoms occur - Such medicines are taken only when you have the symptoms and stop after they subside.

3. Treat the pain and other symptoms - Taken during the episode of migraine.
Eg. Domperidone and Naproxen.

When to stop the medications : -
If the symptoms resolve for weeks, then you can reduce the dose or stop the medication all together after consulting your treating doctor.


2. Why I have had erratic bowel movement (constipation sometime/normal sometimes) even though there is no change in any pattern of life style.

This could be due to stress induced symptoms associated with Irritable Bowel Syndrome, which is sometimes associated with Migraine.

Remedy : Lifestyle changes and stress reduction techniques, along with good dietary habits.
Occasional use of laxatives (Eg Dulcolax) to relieve your symptoms - as and when you have them will help too.

3. Why I am feeling numbness in right feet and right hand (two fingers only)?

These symptoms are common with Classical Migraine, and occur due to abnormal hormone levels (serotonin) which causes perception of abnormal sensations by the nervous system in the absence of actual Neurological damage. This will resolve over time and treatment.

A physical examination when done, helps to rule out any musculoskeletal or neurological issues if actually present.

5. and if I am showing symptoms of Multiple Scelerosis?

You do not have multiple sclerosis.
This has been proved by the MRI of the brain - which showed normal appearance.

In case if you had Multiple Sclerosis, you might have issues like Optic Neuritis (blurring or loss of vision), Spasm , weakness or Paralysis of muscles, Urinary and Bowel incontinence, Incoordination, Hearing loss, etc.

Your symptoms do not indicate that you have MS.

Your uric acid levels are just borderline elevated and not that significant.
There is no need to worry about it. Treatment is warranted only when you have a confirmed diagnosis of conditions like Gout.

The elevated Albumin is also a nonspecific sign and, there is no need to worry about it. It is clinically significant only when it is low and not when high.

I hope the answers given here address your concerns.

Regards,

Dr Anvekar.

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