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Dr. Andrew Rynne

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Suggest treatment for hemiplegic migraine

Answered by
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Dr. Eris Ranxha

Neurologist

Practicing since :2009

Answered : 686 Questions

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Posted on Tue, 12 Aug 2014 in Headache and Migraines
Question: Hello,

Please can I ask that this is answered with somebody with specific experience of Hemiplegic Migraine.

My daughter, aged 20, started having hemiplegic migraine 10 days ago. She has no prior history of migraine (although her father’s side of the family does have migraine history).

She has visited hospital emergency room 3 times, had CT scan and they have eliminated other possible causes and are absolutely sure this is hemiplegic migraine.

The attacks started infrequently (every couple of days) but she is now having on average 1 or 2 attacks each day. Mostly the aura lasts <1 hour then the headache/nausea sets in and lasts 2-3 hours.

For the headaches:
Started on Neproxin, no effect.
Now on Sumatriptan 1 x each attack, but we don’t think is having a positive effect, plus Ibuprofen and Paracetamol.

For the nausea:
She was given first Ondansetron 4mg, 3 x daily, which did not give much relief.
She has just started with Metoclopramide 10mg, 3 x daily

This morning is her worst and longest attack yet. She is 5 hours in and it has not subsided. It started shortly after waking and has had so far 3 episodes of Aura and constant violent headache and nausea since the start. We have tried 800mg Ibuprofen, 400mg Paracetamol and they have been unsuccessful. We are now trying Aspirin.

- Please can I have some advice on how to best deal with this.

- Is it normal to have so many attacks over this period (at least 7 attacks in the past 10 days).

- Does the frequency of attacks indicate that they are still being triggered by something that we have not found yet?

Many thanks.

XXXX
doctor
Answered by Dr. Eris Ranxha 2 hours later
Brief Answer:
Be calm, wait

Detailed Answer:
Dear
I am sorry for the symptoms your daughter is suffering
First of all you should be calm, as CT scan is normal
There are two things to be done, schedule a brain MRI and start medication (in my opinion amitriptiline, discuss with your neurologist about dosage)
Continue sumatriptan on attacks and ibuprofen daily 1200 mg per day.
Hope my answer will help you
Best regards
Dr Eris Ranxha
Neurologist
Above answer was peer-reviewed by : Dr. Vaishalee Punj
doctor
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Follow up: Dr. Eris Ranxha 36 minutes later
Dear Dr Ranxha

Thanks for your response.

MRI is already scheduled for Friday and GP appointment scheduled for tomorrow.

Two questions:

1. A lot of the time don't know what is an "attack" as the phases are not clear. If the headache and nausea continue but the aura goes and then comes back after an hour, is this one or two "attacks"? We have been told not to repeat the dose of Sumatriptan in the same attack, so we are confused if there is no period without headache/nausea between.

2. Are you able to answer my last question from before...Does the frequency of attacks indicate that they are still being triggered by something that we have not found yet? Or is it possible that the initial trigger was 10+ days ago (before the first attack) and we are still in some sort of long sequence as a result?


Thanks XXXX
doctor
Answered by Dr. Eris Ranxha 23 minutes later
Brief Answer:
Attacks

Detailed Answer:

Unfortunately one aura is a prediction of one attack which can go on till three days.
It is just one attack

Sumatriptan is efficient if it is taken the first aura during the first hour
Abusing with sumatriptan can be a precipitive factor so don't use more than one tablet in a week

There isn't a specific trigger or there may be no trigger at all
Migraine is such a pathology, comes when you are fully healthy and goes with ages.
Don't bother to find the trigger, you can't

As prophylaxis avoid all caffeine drinks and food, avoid energic drink too
In conclusion migraine is bothering but it is treatable and isn't risky, so be calm

Regards
Dr Eris Ranxha

Above answer was peer-reviewed by : Dr. Vaishalee Punj
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