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Suggest Treatment For Hemiplegic Migraines

Posted on Thu, 9 Apr 2015

Question: I am diagnosed with hemiplegic migraines& absent for months. The droop starts with a twitch, it can come with stress sometimes &/or a migraine. BUT NOT MORE THAN 20% of the time. I was jumped 18 years ago and beaten somewhat on my left side. around when this started. MRI/V/A shows possible 40% stenosis although ultrasound says no. what can this be, how concerned should i be? I am beginning to freak out- last for seconds to no more than 2 minutes.
what i am asking is whether or not any of you have had a patient who displayed this particular symptom absent a TIA or stroke. I am pretty sure i would be dead by now for as often as I get these of it were serious- unless it is a pre cursor. My docs are great, but running to the ER constantly is not suitable for me anymore...twice last month, once this month...too much.
can this be something simple like damaged facial nerves, can a test show that- also I am ALLERGIC to oral XXXXXXX for CT and yes, MRI contrast.
I had a PFO closure about 10 years ago hoping the TIA's would stop and the drooping would too, to no avail- should i be on lovenox, warfarin, or plavix? what do i do?

Answered by Dr. Drkaushal85 (1 hour later)

Brief Answer:
No, this is not as simple as damaged facial nerves

Detailed Answer:
Hello dear, thanks for your question on HCM.
I can understand your situation and problem.
You had head trauma in the past.
You also have 40% stenosis in MRI report.
Both these facts point towards brain pathology as a cause for your TIA (Transient Ischemic Attack).
To rule out facial nerve damage, you can get done EMG-NCV (electromyography and nerve conduction velocity) study of facial nerve.
This test will suggest you the function of facial nerve is proper or not.
I want more information about your MRI brain report. You said 40% stenosis. I want to know in which brain vessel you had this stenosis.
Stenosis in MRI report with TIA should be checked for
1. Hypertension
2. Diabetes
3. Dyslipidemia
4. Stress and anxiety.
Even if you have normal reports, low doses of blood thinners and lipid lowering agent is recommended for you.
So please reply me
1. 40% % stenosis in which vessel?
2. Have you checked for hypertension, diabetes and dyslipidemia?
So that I can guide you better.
I will be happy to help you further.
Wish you good health.
Thanks.

Above answer was peer-reviewed by : Dr. Vinay Bhardwaj

Follow up: Dr. Drkaushal85 (35 minutes later)

Thank you, i will pull the report. I do have anxiety, that started about 5 years ago after withdrawling from topomax cold turkey. I didn't have it until i was 33 and started with these episodes at 17. My face fell twelve times today, yet here i sit, a bit nervous, but otherwise fine. I used blood thinners in college,then stopped until i had the pfo closure in 06. I threw a clot on plavix, but they feel it was due to the surgery not my blood or other situation. Should i go to the er every time my face falls, i have three smaller children....i am at a loss.

Answered by Dr. Drkaushal85 (5 minutes later)

Brief Answer:
Are you taking any medications at present?

Detailed Answer:
Hello dear, thanks for your follow up question on HCM.
I can understand your situation and problem.
I am not getting your point. Are you taking any medications at present?
And in ER which medicines they give you?
Please reply me answers of above asked questions, so that I can guide you better.
I will be happy to help you further.
Wish you good health.
Thanks.

Above answer was peer-reviewed by : Dr. Yogesh D

Follow up: Dr. Drkaushal85 (28 minutes later)

I am not on anything except aspirin. They just give me fluids or heparin at the er. Could this be signs of some thing serious. But given the tia last month, i was told it may be best to visit the er every time my face falls...which could be every day

Answered by Dr. Drkaushal85 (39 minutes later)

Brief Answer:
Have you checked for lipids?

Detailed Answer:
Hello dear, thanks for your follow up question on HCM.
I can understand your problem. Yes, this can be the indication of something serious.
Have you ever checked for lipids and diabetes?
Are you having obesity?
Aspirin is good drug and should be given. But lipid lowering drugs will be more beneficial if you have dyslipidemia or obesity.
So please reply me answers of above asked questions, so that I can guide you better.
I will be happy to help you further.
Wish you good health.
Thanks.

Above answer was peer-reviewed by : Dr. Shanthi.E