Brief Answer:
explained

Detailed Answer:
Hello and Welcome

I appreciate your concern.

The history you describe requires a cardiac work up in addition to a neurological work up in my point of view. The feelings of dizziness passing out ( almost) and syncope requires a cardiac evaluation especially in the light of your complains of irregularity of your heart rate.

your doctor is suspecting a classic migraine headache

Magnesium (200 - 600 mg per day) -- People with migraines often have lower levels of magnesium than people who do not have migraines, and several studies suggest that magnesium may reduce the frequency of migraine attacks in people with low levels of magnesium. In one study, people who took magnesium reduce the frequency of attacks by 41.6%, compared to 15.8% in those who took placebo. Some studies also suggest that magnesium may be helpful for women whose migraines are triggered by their periods.

Vitamin B2 (riboflavin, 400 mg per day) -- A few studies indicate that riboflavin may reduce the frequency and duration of migraines. In one study, people who took riboflavin had more than a 50% decrease in the number of attacks.

Researchers aren't sure what causes a migraine, although they know it involves changes in the blood flow in the brain. At first, blood vessels narrow or constrict, reducing blood flow and leading to visual disturbances, difficulty speaking, weakness, numbness, or tingling sensation in one area of the body, or other similar symptoms. Later, the blood vessels dilate or enlarge, leading to increased blood flow and a severe headache.

There also seems to be a genetic link to migraine headaches. More than half of migraine patients have an affected family member. Migraine triggers can include the following, try to identify yours and avoid that trigger
Alcohol, especially beer and red wine
Certain foods, such as aged cheeses, chocolate, nuts, peanut butter, some fruits (like avocado, banana, and citrus), foods with monosodium glutamate (MSG), onions, dairy products, meats containing nitrates (bacon, hot dogs, salami, cured meats) fermented or pickled foods
Skipping meals
Crying
Fluctuations in hormones -- for example, during pregnancy, before and during your period, and menopause
Certain odors, such as perfume or smoke
Bright lights
Loud noises
Stress, physical or emotional -- often, the headache happens when a person is relaxing after a particularly stressful time
Sleeping too little or too much
Caffeine
Smoking or exposure to tobacco smoke
Some medications
Heat, high humidity, and high altitude

I would recommend a baseline ECG and an ETT, strict blood glucose monitoring in light of your Diabetes. Blood pressure monitoring to see for any hypotensive episodes that may be associated with these episodes. There are several choices and combination of medication that can be tried on a patient with migraine depending on the severity and patient s tolerance to the medications and whether there is any contraindication present to the use of the meds or not.

Treatment for migraines is aimed at preventing them from happening and reducing pain once an attack starts.

You can control your migraines with a combination of medications, lifestyle changes, and complementary therapies. Biofeedback (see also: Mind-body medicine) may help you control the initial contraction of blood vessels. Relaxation techniques may reduce both the frequency and intensity of attacks.

Lifestyle

Keeping a migraine diary, particularly when you first begin to have migraines, can help identify the triggers for your headaches so you can avoid them. When a migraine happens, write down the date and time it started. Note what you ate for the preceding 24 hours, how long you slept the night before, what you were doing just before the headache, any unusual stress in your life, how long the headache lasted, and what you did to make it stop.

Other lifestyle measures that may reduce the number of migraines include:
Avoiding cigarettes, caffeine, and alcohol
Exercising regularly
Getting enough sleep each night
Relaxing and reducing stress in your life
Eating regular meals
Once a headache or migraine symptoms begin, it helps to: Rest in a quiet, darkened room


Let me know if you have any query

wishing you best of health

Thanks

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Brief Answer:
explained

Detailed Answer:
Hello again,

The 24 hour monitor was most probably placed to detect arrhythmias or heart blocks and other rhythm abnormalities.

The blood pressure medication in light of your current B.P readings , are more than adequate. B.P measurements can vary and there is not any fix point, though the range you described is fine for the time being.

Stress can be minimized via deep breathing exercises , yoga and meditation. Psychotherapy and a psychiatric consult can be sought if you feel that the stress is overwhelming. A XXXXXXX mental state exam can be performed to ascertain if there is any anxiety or depression associated with your overall symptoms.

Its good to hear that you are keeping the migraine diary and have identified some risk factors, I would suggest you to record the findings extensively and you may share them with me any time.

I would advise you to continue the migraine treatment for the time being as it requires at least 2 to 3 weeks to have a proper effect on the symptoms. I would suggest Gabapentin be added to your regimen to see for improvement. you may discuss this option with your doctor.

Thanks

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