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What causes migraines with aura before menstruation?

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Posted on Mon, 15 May 2017
Question: I am 35 and have been getting migraines with aura since I was 17 or 18. The aura always starts with zig zag bright flashing lights in my vision and a loss of peripheral vision, then in half an hour to an hour pain and vomiting, or sometimes no pain at all. I also get slurred speech and confusion,, like I can't find the write word I'm trying to say and when I write I can't spell. This frightens me. I found that exercise and caffeine were triggers. My worst aura was at age 25, when I got my usual aura and went home from work, but then I felt really confused. I called 911 and was in the ER where I lost all ability to speak and was so confused I could not pull my pants down for a urine sample. The nurse thought I took illegal drugs and abused me (punched me) so I have panic disorder and ocd from post traumatic stress still to this day. I was discharged from the ER as having panic attack with migraine and given Maxalt which later I found was not safe for migraine with aura. But I never found out what kind of migraine I had in the ER back then (2007). I have been migraine free for two years now and in that time frame I was on doctor orders no exercise as I was having multiple surgeries for an unrelated fistula in ano. Now I started exercising two weeks ago with a personal trainer after several years of no exercise and today she worked me out very hard. A little over 4 hours after my workout I got aura. I got the zig zag flashing lights, loss of peripheal vision, confusion, slurred speech, and couldn't even spell common words. How can I prevent this from happening when I exercise or happening again at all? I'm so scared I'm going to die! I really want to be able to exercise again and can't have this interrupt my work. I was well hydrated prior and during the workout, but my neck was straining really bad. What should I do?

Oh and this most frequent episode not only happened after exercise, but 5 days prior to menstruation.
doctor
Answered by Dr. Olsi Taka (1 hour later)
Brief Answer:
Moderate exercise

Detailed Answer:
I read your question carefully and I understand your concern.

It is obvious that you are scared and in panic but I really do not see a reason for panic. There is no indication from any part of your story that there is any threatening brain lesion. It is only migraine with aura associated also with an anxiety disorder. Not that I mean to minimize things, migraine can really affect a patient's quality of life and it requires attention, but it is not something which risks your life, you shouldn't be scared of dying.

Migraine can have many triggers like lack of sleep, certain foods, hunger, dehydration, stress etc. Such triggers may also be exercise as well as the menstrual cycle. Menstrual cycle may affect migraine due to the hormonal fluctuations it brings.
As for exercise usually it is strenuous exercise which triggers migraine. Moderate regular exercise actually is thought to be beneficial as it is thought to increase release of endorphins (natural pain controlling chemicals in the body). It is strenuous exercise, especially in patients who haven't been training regularly which is thought to trigger migraine headaches.
So you should talk with your personal trainer about this issue, inform him on your migraine diagnosis, the fact that the intense session you had triggered migraine attack and of the need to avoid intense workouts and prefer mild aerobic exercise. Perhaps in the future you can increment the degree of intensity, but that should be done very gradually. Of course as you seem to be aware attention to regular sleep schedule, proper eating and hydration is necessary.

I remain at your disposal for other questions.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Olsi Taka (4 minutes later)
I'm scared that the speech confusion (not knowing the right word, not being able to spell words, forgetting people's names, stuttering) is seizures and not migraine, even though I was told otherwise.
Yes, the training was very intense with heavy weights. I have scoliosis and noticed my neck straining and hurting really bad towards the end of the workout. Would this be a factor? If so, what would be a better way of strength training to reduce muscle tension that can cause these migraines and auras? After the aura clears I am so naseated.
doctor
Answered by Dr. Olsi Taka (15 minutes later)
Brief Answer:
Read below

Detailed Answer:
Seizures can be of many types, so one can't exclude them completely, but I do not think they are likely in your case. There is no loss of consciousness so one can't speak of a generalized seizure and those symptoms are not a typical focal seizure presentation either. The association with the migraines make migraine with aura a much more likely cause, I do not see any reason to suspect seizures.

Neck straining doesn't help and it is an indicator of how intense that work out has been. I am a little puzzled by the choice of heavy weight workouts because migraine apart that type of exercise shouldn't really help with your scoliosis either, adding extra weight on the spine doesn't benefit it.
The exercises you should prefer as I said are moderate aerobic activities like jogging, cycling, brisk walking, aerobics. Swimming is an excellent sport as well which doesn't put any weight on your spine and wouldn't affect the scoliosis. 3 times a week 30 minute sessions of the above activities are most appropriate for the first 2 months, then you can try to increase if you are feeling fine.

Let me know if I can further assist you.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Olsi Taka (4 minutes later)
Would I be able to strength train with light weights more reps as opposed to heavy weights or would this still trigger migraine? The reason I ask is I currently have no access to a swimming pool. I'm trying to tone my muscles as I lose weight without straining them enough to cause migraine.

Thanks so much for your help
doctor
Answered by Dr. Olsi Taka (9 minutes later)
Brief Answer:
Yes it can be tried.

Detailed Answer:
In principle yes, it is not the weights in itself which trigger migraine, it is the straining. As I said moderate is the key word.
I can't say which is the weight you should be using, there is not an exact threshold beyond which one gets migraine and what is a light weight for someone may be heavy for another. So you have to try it to know it.
Just try to get things slowly, with very gradual increases, do not jump from one stage to the other in only 2 weeks, give it at least 4-6 weeks before switching to a slightly heavier weight. I get that you are eager to tone your muscles quickly (I am a little like that myself, overeager to increase the load) but you should be patient and listen to your body.

I hope to have been of help.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Olsi Taka (8 minutes later)
Just one more question so sorry! I own an elliptical machine, is this low impact enough for safe aerobic exercise for me?
doctor
Answered by Dr. Olsi Taka (14 minutes later)
Brief Answer:
Yes

Detailed Answer:
Yes I believe an elliptical machine would be a very good choice indeed, you can use it.

Wishing you good health.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Olsi Taka (3 minutes later)
Thank you so much for your help, you have been very informative and kind.
doctor
Answered by Dr. Olsi Taka (1 minute later)
Brief Answer:
Thank you.

Detailed Answer:
You're welcome, I hope things work out for the best.


Above answer was peer-reviewed by : Dr. Arnab Banerjee
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Dr. Olsi Taka

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Practicing since :2004

Answered : 3657 Questions

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What causes migraines with aura before menstruation?

Brief Answer: Moderate exercise Detailed Answer: I read your question carefully and I understand your concern. It is obvious that you are scared and in panic but I really do not see a reason for panic. There is no indication from any part of your story that there is any threatening brain lesion. It is only migraine with aura associated also with an anxiety disorder. Not that I mean to minimize things, migraine can really affect a patient's quality of life and it requires attention, but it is not something which risks your life, you shouldn't be scared of dying. Migraine can have many triggers like lack of sleep, certain foods, hunger, dehydration, stress etc. Such triggers may also be exercise as well as the menstrual cycle. Menstrual cycle may affect migraine due to the hormonal fluctuations it brings. As for exercise usually it is strenuous exercise which triggers migraine. Moderate regular exercise actually is thought to be beneficial as it is thought to increase release of endorphins (natural pain controlling chemicals in the body). It is strenuous exercise, especially in patients who haven't been training regularly which is thought to trigger migraine headaches. So you should talk with your personal trainer about this issue, inform him on your migraine diagnosis, the fact that the intense session you had triggered migraine attack and of the need to avoid intense workouts and prefer mild aerobic exercise. Perhaps in the future you can increment the degree of intensity, but that should be done very gradually. Of course as you seem to be aware attention to regular sleep schedule, proper eating and hydration is necessary. I remain at your disposal for other questions.