Hemiplegic Migraines Qs

So, I'm at the tail end of a week long migraine (left side) and earlier today my left foot felt numb. It's actually still tingling as if it's asleep. I've suffered from Migraines for over 30 years, but I've never experienced the numbness. I ran a quick Google search and discovered Hemiplegic Migraines, which appears to be a subtype of Migraines with aura, and similar to what i'm currently experiencing. Of course I need to see a doctor quickly to be sure, but am not sure what type of doctor to see. I can see my family doctor, but am now wondering of I should go straight to a neurologist? Any thoughts?

Also, if you've had experienced with these types of Migraines i'd appreciate any advice. I should also mention that I've been taking Imitrex for the last year and this past week my usual pill a day wasn't enough to stop the horrible pain.

tx

You need to see a neurologist, but those appointments are hard to get. Go see your GP in the meantime. If it's the worst headache you've ever had, go to the hospital, please. Migraines rarely last more than three days. If you are taking imitrex every day, you may be experiencing bounce back migraines.

I had migraines every day for six months once. We (my neurologist and I) never found out why, but better to know

Thank you, Mary. The ER has crossed my mind....

bklyngirl said:
Thank you, Mary. The ER has crossed my mind....

It's a tough call, being a migraineur. What IS the worst headache? Better to err on the side of caution... If you think you should go, do so. Migraines won't kill you but there might be another cause...

Definitely see someone who can handle emergency medicine, and be prepared to stay while they do hours of observations to be sure the right medications are given. (Last time I had something like this I spent 11hours in Emergency, just for migraine) you'll be OK, most probably, but each episode is different and may reveal something new.

Good luck! When you can, if you are up to it, tell us how you fare. ><

I had no idea Imitrex could/should be taken daily. I'm basically immune at this point, (or at least it feels that way), and that's not with daily dosage. Granted my migraines are their own breed, but still. Anyhow, good luck and I hope yoh feel better soon.

I would try to get in to see a doctor asap, whether that means your GP or a walk-in place or the ER. And ask right away for a referral to a neurologist. I think this might take a lot more investigation than the average GP or ER can manage, but that step will most likely be necessary to get into a neuro office. Actually, as I'm thinking about it, perhaps the ER is your best bet, because a hospital will have neurologists who can consult, and the equipment to do any tests that are needed right away.

Good luck... I have had migraines for about five years, but not on the magnitude a lot of folks on MOL have. I empathize to the extent I can and sympathize for the rest.

Do you take a second Imitrex after the first, if it doesn't work? I used to get migraines every day, but never hemiplegic. I never had any trouble getting into see neurologist. Sorry I don't have more to add.

What about for the first visit, Gerryl? IIRC, I went with a referral from a cardiologist and another from my ear/nose/throat doctor the first time I made an appointment with a neurologist in NJ. When I tried to make an appointment to see a neurologist in CT without a referral, they refused me.

I would call the GP and ask if there is anything they can do..or if they can help get you into a neuro...if nothing else, maybe they can get things going by ordering an MRI or other tests

Hemiplegic migraines typically cause paralysis not numbness.

http://www.helpforheadaches.com/articles/hemiplegic.htm

Numbness is common in Classic Migraines and can be the aura for some people. Mrs. J.B. is one. This wikipedia entry is a pretty good summation of the basics.

https://en.wikipedia.org/wiki/Migraine

It's still a good idea to discuss any change in headache pattern with a doctor.

Thank you, j_b. Ctzraska, I think that bklngirl was saying that she'd only take it once a day, not that she takes it every day as a rule... But don't you take Sumavel? That's sumatriptan, the same ingredient as imitrex...

For reference: 'The worst headache I've ever had' is the first descriptor for a number of fairly significant conditions, not just migraines, so if an individual has had one of these for more than a day then emergency medicine facilities/hospitals are more appropriate than the family doctor.

Also, marylago, I've had migraines that have lasted weeks not merely 3days. I think these days, it's fairly well recognised that each person's pattern differs from another's although some aspects may sometimes be shared. Last list of signs and symptoms I read numbered over 130-odd (sometimes contradictory) indicators.

I sometimes get hemiplegic migraines in my sleep, confirmed by my neurologist. No paralysis, definitely numbness but it doesn't always hit with these - my main indicator is that they hit while I'm actually asleep, and mainly affect one half of my body. Many hours later or even days later, other parts of my body may become involved.

My neurologist says it's not even worth trying to classify migraine attacks anymore. It's all different parts of the one neurological syndrome.

Thank you everyone for your input. It's always helpful to talk things through. I would say this is the worst headache I've ever had, because of the duration (it woke me up again in the middle of the night!), the fact that no medication is helping and the numbness, which I've never experienced before. I'm in the process of scheduling an appt with a neuro hopefully for this week - may be wishful thinking but I'm pushing hard. Unfortunately, my GP can't see me until October! If i'm not able to schedule something today, then I'm planning on visiting the ER and submit to whatever testing is appropriate.

@ctrzka: You're right Imitrex is not to be taken daily and I don't. I took it daily last week during my headache, but for the first time it didn't work. I'm not taking anything right now - cold compresses and taking it easy. Feel the need to detox after all the pill taking last week.

Thanks again and I will certainly update this thread.

Good luck and hang in there

As an aside, if you get more than 15 migraines a month, insurance will pay for botox. Not what you want to experience, but it has been shown to provide significant relief.

You know, the Botox thing always makes me laugh: I have a paralysed forehead, and cheeks. (Result of three fractures in my skull) I can't frown, I can't wince or wink, I can barely blink and sometimes we struggle to get any kind of flinch or tickle response from eyebrows to any part of my hairline. I still need to take a cocktail of epilepsy, cardiac and tricyclic antidepressants daily in order to try control my very frequent migraines. I really cannot see how Botox treatment helps anyone's pain management...

It's good to know if you're deemed a good candidate you can get support, though.

How they choose who's a good candidate is an interesting question.

I'd heard of the Botox treatment and wondered the same thing. @joanne: how dare I complain with what you have to take on a daily basis.

bklyngirl said:
I'd heard of the Botox treatment and wondered the same thing. @joanne: how dare I complain with what you have to take on a daily basis.

You are allowed to complain. It's terrible that joanne suffers so, but that does not make your pain less real. Please don't marginalize yourself.

You're right Mary.

That is absolutely true: everyone's experience is valid and as marylago always reminds us, a migraineur's life (every migraineur's life) is never easy!! I'm very fortunate to have a support team (including marylago) who can explain what's happening, as well as being really committed to finding practical answers on how to live with this condition.

Here's what's happening inside our brains with every episode:

Our brains are little more specialised at adapting to some kinds of neural signalling than other brains. Researchers don't yet know why. They do know that this is why regular painkillers stop working with most of us after a while, because our brains are very fast adapters and very fast signallers, and what we're especially good at adapting around is workarounds for overstimulation and pain. We call the overstimulation 'triggers', but the truth is that what most of us recognise as triggers are the ends of a long chain of hyperstimulation we've failed to recognise because most of us are over-processing everything around us all the time. We're always aware of all of our sensory input and don't understand people who aren't.

So we get a surge of activity in some region of our brain (for me, it's irregular electrical surging between the cells that make up my brain), and the resulting discomfort/tension is registered as pain. We put up with it. The affected area grows and as the brain reorganises its signalling so that we can still handle incoming information, we become very efficient trainers. Researchers have seen this on fMRIs; non-migraineurs don't do it as well. We train our brain to continue to handle all the incoming info, only now it's labelling all the new info 'pain' even when it knows it's not pain-inducing sensation. Sound? Now pain. Heat? Now pain. Light touch? Now pain. Absence of pain? Now pain (the rebound effect). The resulting confusion prolongs the episode, sets us up to be 'more efficient pain processors' next time round, and works against the way most painkillers are designed to work (dealing with pain). The key is to find what prevents the overloading and work with that. (I'm on stuff that deals with electrical signals and various salts [?])

So: I think the Botox approach is meant to reduce the electrical reaction in the nerves and muscles of your forehead/face, thereby coaching your autonomic system into not flaring to Migraine Response every time you feel anything. It's the way something like topamax is meant to work, too. But not everyone's migraines work that way, not every migraine starts there, and to me it seems quite extreme. I'm happier knowing how my brain is working, ruling out stroke, aneurysm or other major brain issues, and trying to meditate or sleep.

It did not work for me, but for some people Topamax is taken prophalactically (sp?) and seems to help.

Great description joanne! Don't forget strong smells - pain. Strong perfume gets me every time.

Never heard of Topamax - will explore it. Have an appt w/neuro this week.

marylago said:
Thank you, j_b. Ctzraska, I think that bklngirl was saying that she'd only take it once a day, not that she takes it every day as a rule... But don't you take Sumavel? That's sumatriptan, the same ingredient as imitrex...

Ah. I'm on sumatriptan as a generic. I suppose I can switch, but IIRC I need to be off it for about a month first. I've gotten somewhat used to the pain, but not fully, and when the crushing ones come I need at least some relief. One day I may just roll the dice.

bklyngirl said:
Great description joanne! Don't forget strong smells - pain. Strong perfume gets me every time.
Never heard of Topamax - will explore it. Have an appt w/neuro this week.

Seizure med. Otherwise known as Dopamax. Did squat for me but left some side effects worthy of the nickname. On 1500mg/day (neuro wants 2000mg) of Depakote, which worked to stem them at first, or at least reduce frequency and/or intensity, but now notsomuch. It always seems like the damn migraines find a way to overcome whatever initially seems to work.

Yeah, that's why I'm on the max daily dose, plus 120mg isoptin daily, plus nortriptylene (allegron, have forgotten the dose but it's fairly low). They all work differently, and that's the key: pain is keyed in our brains differently. Mine works by triggering the inflammation/ immune neurotransmitter channels , and I need to block sodium and calcium channels as well as control electrical surges. The surges also come into play in controlling the flexibility of vein and capillary walls as nerve and axon reactions. So, if your immune system is flaring, or your arthritis, and you're susceptible, plan for a migraine day.

Did you know there are over 35million USians who are known to regularly get migraines???

That's the part that surprised me for some reason - the fact that Migraines eventually find a way around meds that initially worked. As a kid, I started with tylenol, then moved up to advil, then motrin, then Excedrin and every other OTC out there. Yet for some reason I thought that Imitrex would work forever!

I just want to extend my sympathies to you who suffer. I opened the thread because I used to get migraines from the age of 12. A bad car accident made my college years miserable, until a traction procedure 3 years later stopped them pretty much cold. Starting in my late 30s they did come back occasionally, complete with auras, but never to the extent that I'd have to take Fiorinol like my mom did. I totaled my car a few weeks ago and suffered a concussion. The headaches were a different sort, and though I no longer wake up to pain, I seem to have developed a TMJ type of skull-ache.

Musicmz, you may need another mechanical fix (there's apparently a plate or something that can help with the TMJ issue, to keep that bunch of nerves and muscles freer and less sensitive). Some of us just learn to 'overclock' our brains, and that resulting physical overloading/overheating means shutting down until it returns to normal settings.

Bklyngirl, have you recovered yet? Sought more help yet?

Xxxx

sorry to hear music.

Joanne: No headache today, but numbness on left side remains. Have an appt with a neuro tomorrow and will take it from there. Thanks and will update with my ultimate diagnosis.