Ask the Expert: Migraine with Aura

Dear Dr. Haplea,

I've been suffering from "occular" migraines, or migraines with aura for about two years. I get no headache at all; the aura comes on with no warning, lasts about twenty minutes, and is followed by two to three days of absolute exhaustion. During the exhaustion phase, I am non-functioning. I need to sleep about 16-18 hours a day. For the last year, the episodes have occurred once or twice a month, usually during the first two weeks of the month. I saw a neurologist who thought it was caused by hormonal changes (I am in menopause). She wanted me to have an MRI, but I had a panic attack and couldn't go through with it. (more stress = more migraines!)

Last week, I had a truly frightening experience. I was in my kitchen talking with a friend (totally relaxed) when I was overcome with dizziness. Then my right leg went weak. I felt like I had no power in my leg. It was difficult to walk, and I started to sweat. I thought I was having a stroke and went straight to the emergency room. My blood pressure was sky high (150/160). They did an EKG and blood tests and said there was no sign of heart attack or stroke. The doctor said that some migraines could be accompanied by dizziness and weakness in the extremities, but had never heard of the symptoms I experienced without the usual headache or aura.I went straight to bed from the hospital and slept for 24 hours, and then remained dizzy and exhausted for the next three days (blood pressure returned to normal range within a few hours). I don't know what where to turn. I'm terrified that this could happen again with no warning. What type of doctor should I see? If a hormone imbalance is causing the migraines, should I be treating the hormones, or should I treat the migraines? Are these kinds of symptoms common among people with migraines?

Migraine auras can come in several types. Visual aura is the most common. Sensory aura with numbness or tingling is perhaps the next most common aura. Dizziness, weakness, slurred speech, or confusion can occur before or during a migraine as well, although less commonly. Strokes can occur in patients during a migraine attack. I advise my patients to go directly to the emergency room if they have new neurological symptoms or prolonged neurological symptoms with or without headache. Some of my patients that have menstrual-associated or hormone-associated migraine headaches work with me in conjunction with their gynecologist to find effective preventive therapy for their migraines. Oral contraceptive agents can help regulate hormonal levels; however these medications can increase the risk of stroke and may not be advisable in all individuals. It seems that younger women respond better to oral contraceptive agents for treatment of their migraine headaches.

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