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How To Distinguish From A Migraine Complex And A TIA?
Question: How can one distinguish from a migraine complex and a TIA? Can high dose prednisone taper work for migraine?
Brief Answer:
History, physical exam, tests, prednisolone not id
Detailed Answer:
Hi and thanks for the query,
The past medical history remains a very important tool that could be useful. A history of hypertension, family history of stroke, history of diabetes of lipid disorders could be very contributive and suggestive of a Transient Ischemic Attack.
TIA usually develops gradually, rarely accompanied by severe and periodic headaches as seen in migraine, rarely accompanied by unilateral headaches like in migraine. However, TIA could present with visual disorders depending on the affected site as seen in some migraine headaches.
The past medical history, family history, history of hypertension, heart disease or ischemic heart disease, history of previous TIA are all important in distinguishing these two conditions. In migraine however, generally one usually experiences an aura or announcing signs. (visual, nausea, vomiting, menses etc). Chest X rays, electrocardiogrames, Lipid profiles, cardiac ultrasounds are important to better ascertain some of these risk factors.
Prednisolone or oral steroids are not standard recommended medications for migraine. I think there exist many effective drug options in managing migraine. Analgesics, Caffeine, Non steroidal anti inflammatory drugs, Selective Serotonine Reuptake Inhibitors. You might need to seek the opinion of your doctor.
Dr Bain
History, physical exam, tests, prednisolone not id
Detailed Answer:
Hi and thanks for the query,
The past medical history remains a very important tool that could be useful. A history of hypertension, family history of stroke, history of diabetes of lipid disorders could be very contributive and suggestive of a Transient Ischemic Attack.
TIA usually develops gradually, rarely accompanied by severe and periodic headaches as seen in migraine, rarely accompanied by unilateral headaches like in migraine. However, TIA could present with visual disorders depending on the affected site as seen in some migraine headaches.
The past medical history, family history, history of hypertension, heart disease or ischemic heart disease, history of previous TIA are all important in distinguishing these two conditions. In migraine however, generally one usually experiences an aura or announcing signs. (visual, nausea, vomiting, menses etc). Chest X rays, electrocardiogrames, Lipid profiles, cardiac ultrasounds are important to better ascertain some of these risk factors.
Prednisolone or oral steroids are not standard recommended medications for migraine. I think there exist many effective drug options in managing migraine. Analgesics, Caffeine, Non steroidal anti inflammatory drugs, Selective Serotonine Reuptake Inhibitors. You might need to seek the opinion of your doctor.
Dr Bain
Above answer was peer-reviewed by :
Dr. Vinay Bhardwaj
I have been having these evry day upon awakening. Severe headache, ringing in ears, loss of balance, numbness in extremities, and a feeling of disorientation. Sometimes i awake a say things that make no sense until I can fully awake. I told my sister for emample that I was trying to pulla sword out of my neck and was in a panic. I didn't know where I was for about a minute. I have been to 3 neurologists and have had an mri, ct scan, spinal tap and echo. On;y thing was one carotid doppler said 50% blockage. THey repeated it at another facility and it was normal. I am currently on excedrin migraine and ativam and sometimes take motrin. They barely help. I am afarid I am going to have a serious stroke if I do not frid out what is wrong and prevent it. The doctors are running out of patience with me and ae acting lke te have done all they are going to do. I am 57 and on medicare. I guess I am not valueable to them....
Brief Answer:
You are very important please
Detailed Answer:
I do understand perfectly how you could feel at this point in time. However, I really do not think you need to be this worried.
The symptoms you describe are very much suggestive of a TIA and needs prevention to be on the safe side as you rightly put it. The fact that you are hypertensive, on treatment and at age 57 compel you to be on a strict anti platelet aggregant therapy (low dose Aspirin or Clopidogrel). I suggest you should take regular and appropriately low dose Aspirin to reduce the risk of having these stroke events.
Secondly, your blood pressure control is another very important factor you need to consider keenly. Ensure respect of drug doses and life style changes (exercise, reduced salt intake etc). I would suggest you get a lipid profile done to exclude any abnormalities like high Cholesterol levels, high Low Density Lipoproteins. If these risks are well managed (blood pressure control, low dose aspirin, compliance to medications and lifestyle recommendations, lipid control), the tendency of you developing a stroke would be greatly reduced.
A complete and regular review by your cardiologist is very important. You need not be discouraged. Be strong. Thanks and kind regards as I wish you the best of health.
Dr Bain
You are very important please
Detailed Answer:
I do understand perfectly how you could feel at this point in time. However, I really do not think you need to be this worried.
The symptoms you describe are very much suggestive of a TIA and needs prevention to be on the safe side as you rightly put it. The fact that you are hypertensive, on treatment and at age 57 compel you to be on a strict anti platelet aggregant therapy (low dose Aspirin or Clopidogrel). I suggest you should take regular and appropriately low dose Aspirin to reduce the risk of having these stroke events.
Secondly, your blood pressure control is another very important factor you need to consider keenly. Ensure respect of drug doses and life style changes (exercise, reduced salt intake etc). I would suggest you get a lipid profile done to exclude any abnormalities like high Cholesterol levels, high Low Density Lipoproteins. If these risks are well managed (blood pressure control, low dose aspirin, compliance to medications and lifestyle recommendations, lipid control), the tendency of you developing a stroke would be greatly reduced.
A complete and regular review by your cardiologist is very important. You need not be discouraged. Be strong. Thanks and kind regards as I wish you the best of health.
Dr Bain
Above answer was peer-reviewed by :
Dr. Vinay Bhardwaj
THank you. Is low does asprin BETTER tahn a 325mg one. I take a 325mg every day. I thought it would protect me more. Am I wrong. Also wanted to ask you....I had been on Diovan before and I expeienced migraine auras, etc. Tney went away when I was switched to Lisinipril but I had to sto that drug due to allergies. It seems like now that I've been back on Diovan, the neuro symptoms have returned. Could Diovan be part of the problem? If I were to take another drug in the same class wouldit help? One more thing. I forgotto tell you that I have a very bad neck. C-3-C-7 are all herniated with severe stenosis and cord comrassion. Plus artritis. I has been that way for many years but getting much worse. Could this be causing trouble? I am just trying to get answers.....
Brief Answer:
Low dose Aspirin effective, not hypertensive drugs
Detailed Answer:
Hi and thanks for the update,
Low dose Aspirin at doses of 75 to 100mg daily are grossly very sufficient and effective. The 325mg dose is effective but would be more likely to produce side effects like gastrointestinal bleeding and gastritis.
Lisinopril and Diovnam are drugs used mainly to manage hypertension and has no indication in the management of migraine. It could be imagined that Diovnam could been producing some side effects with you that could be falsely assimilated to migraine auras, or that you Tolerate Lisinopril more and you might at that main point in time when taking Lisinopril were truly experiencing real migraine attacks.
Migraine is a disease entity with specific diagnostic criteria, and specific classes of readily available and effective drugs for its management. I suggest a review from your internist or neurologist for any headaches would be most valuable.
Neck lesions described, stenosis and arthritis are difficult to be incriminated as being root causes of the above cited signs and symptoms you experience. They could cause pain that could irradiate to other areas, but rarely to the upper regions of the head. Their associated signs and symptoms have nothing to do with migraine or TIA - like symptoms.
Thanks and kind regards as I wish you the best of health. Please, do feel free asking further questions in case of need.
Dr Bain
Low dose Aspirin effective, not hypertensive drugs
Detailed Answer:
Hi and thanks for the update,
Low dose Aspirin at doses of 75 to 100mg daily are grossly very sufficient and effective. The 325mg dose is effective but would be more likely to produce side effects like gastrointestinal bleeding and gastritis.
Lisinopril and Diovnam are drugs used mainly to manage hypertension and has no indication in the management of migraine. It could be imagined that Diovnam could been producing some side effects with you that could be falsely assimilated to migraine auras, or that you Tolerate Lisinopril more and you might at that main point in time when taking Lisinopril were truly experiencing real migraine attacks.
Migraine is a disease entity with specific diagnostic criteria, and specific classes of readily available and effective drugs for its management. I suggest a review from your internist or neurologist for any headaches would be most valuable.
Neck lesions described, stenosis and arthritis are difficult to be incriminated as being root causes of the above cited signs and symptoms you experience. They could cause pain that could irradiate to other areas, but rarely to the upper regions of the head. Their associated signs and symptoms have nothing to do with migraine or TIA - like symptoms.
Thanks and kind regards as I wish you the best of health. Please, do feel free asking further questions in case of need.
Dr Bain
Above answer was peer-reviewed by :
Dr. Vaishalee Punj
Is LOUD riinging in the ears associated with migraine, TIA or mostly just sinusitis? I have blocked sinuses and load ringing that comes and goes. Also thick drainage that is so thick, I can not blow it out but rather have to snort it back. It's terrible and has been here for 3 months. It goes along with a very stiff neck and blurred vision and disequalibrium. Sinus CT showed what they refered to as minimal sinusits. I don't know what that means. I thought it was nothing and then someone said it WAS an infection but in only like 2 of the 5 sinus cavities. I am confused....
Brief Answer:
ENT specialists opinion
Detailed Answer:
Hi and thanks for the update,
Sinusitis is a health condition that must be treated urgently to avoid complications. The fact that you have been having these symptoms for over three months indicates already a chronic process that requires treatment. drugs alone could be sufficient.
However, the opinion of ENT specialist to know if drainage could be more appropriate or not is needed. Fluid collected could be sent for culture and antibiogramme to identify causative organism and probable effective drugs to be used.
Sinuses are linked to the ears and spreading of such infections, or blocking or the circulating air system between ears, sinuses and nostrils could be compromised at some point by such infections. See an ENT specialist for evaluation of the ear ringing and sinus issues.
Kind regards
Dr Bain
ENT specialists opinion
Detailed Answer:
Hi and thanks for the update,
Sinusitis is a health condition that must be treated urgently to avoid complications. The fact that you have been having these symptoms for over three months indicates already a chronic process that requires treatment. drugs alone could be sufficient.
However, the opinion of ENT specialist to know if drainage could be more appropriate or not is needed. Fluid collected could be sent for culture and antibiogramme to identify causative organism and probable effective drugs to be used.
Sinuses are linked to the ears and spreading of such infections, or blocking or the circulating air system between ears, sinuses and nostrils could be compromised at some point by such infections. See an ENT specialist for evaluation of the ear ringing and sinus issues.
Kind regards
Dr Bain
Above answer was peer-reviewed by :
Dr. Vaishalee Punj
Answered by
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