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Suggest Remedy For Sever Migraine

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Posted on Fri, 23 Jan 2015
Question: My daughter had a severe migraine much worse than ever. She is 42 with 4 children she could hardly get up and the back of her neck and head were so painful. Her neurologist sent her to the ED and had a CAT scan done without XXXXXXX and that was okay so they did the spinal tap. All 4 tubes had blood in it. They immediately sent her for another CAT scan with XXXXXXX that was okay but they said they needed to check the small vessels, they will do an arterial gram tomorrow originally they had said I thought an angiogram to check the small vessels in her neck and head, they said it was not the procedure ( spinal tap) that produced the blood in all 4 tubes. They did a MRI at 11:30 tonight but we have not received the results. The migraines are usually once a week but never like this and she knew it was different as the neurologist did. What could this be? What questions do we need to ask to make sure everything is being looked into, they put her on an IV antibiotic for precaution. Please give some advise. Lynn a very worried mom!
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Answered by Dr. Olsi Taka (1 hour later)
Brief Answer:
Subarachnoid hemorrhage, cause to be determined

Detailed Answer:
I read your query and I understand your concern.

From your description seems like the most probable diagnosis is a subarachnoid hemorrhage meaning a bleeding along the surface of the brain. It is life threatening and the cause has to be determined and prevented, because if it ruptures again it could be more serious.

Most of the times that happens in the setting of a malformation of a blood vessel in the brain the usual one is an aneurysm, a dilatation in the wall of the blood vessel. Rarely it's another type of malformation like a arterio-venous malformation or a dissection (a tear in the vessel wall).

To find out if that is the case exams like Angio MRI or Angiogram are needed, angiogram is the most sensitive exam.
If such an aneurysm is found surgery or endovascular intervention (entering through a catheter - like the angiogram) is needed to exclude that aneurysm so that it does not rupture again which could be life threatening.

Once that is done there is still the risk of some complications due to the blood already present, like spasms of the vessels due to irritation by blood causing ischemia, but since CT was negative at first it seems not much blood is present so that risk is smaller (but present) and the blood will be absorbed in the coming few weeks gradually.

It is a serious condition but from what you are describing your doctors seems to be taking all the right steps, making all the necessary exams and not leaving things to chance.

I remain at your disposal for further questions.
Above answer was peer-reviewed by : Dr. Shanthi.E
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Answered by
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Dr. Olsi Taka

Neurologist

Practicing since :2004

Answered : 3673 Questions

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Suggest Remedy For Sever Migraine

Brief Answer: Subarachnoid hemorrhage, cause to be determined Detailed Answer: I read your query and I understand your concern. From your description seems like the most probable diagnosis is a subarachnoid hemorrhage meaning a bleeding along the surface of the brain. It is life threatening and the cause has to be determined and prevented, because if it ruptures again it could be more serious. Most of the times that happens in the setting of a malformation of a blood vessel in the brain the usual one is an aneurysm, a dilatation in the wall of the blood vessel. Rarely it's another type of malformation like a arterio-venous malformation or a dissection (a tear in the vessel wall). To find out if that is the case exams like Angio MRI or Angiogram are needed, angiogram is the most sensitive exam. If such an aneurysm is found surgery or endovascular intervention (entering through a catheter - like the angiogram) is needed to exclude that aneurysm so that it does not rupture again which could be life threatening. Once that is done there is still the risk of some complications due to the blood already present, like spasms of the vessels due to irritation by blood causing ischemia, but since CT was negative at first it seems not much blood is present so that risk is smaller (but present) and the blood will be absorbed in the coming few weeks gradually. It is a serious condition but from what you are describing your doctors seems to be taking all the right steps, making all the necessary exams and not leaving things to chance. I remain at your disposal for further questions.