I've tried to find info on "complicated" migraine, but to no avail. Family history of migraines (mom/siblings,etc). My order of conditions: TBI w/seizure commencement; migraines, osteoporosis, then RSD. What a great Neuro plan for me..lol. Anyhow, I have been moved from neuro doc to doc due to my lack of response to meds. Blocks tried, short lived. About March 09, I started slurring words, had trouble with confusion & short term memory loss, w/plain out weird symptoms I didn't understand. Neuro did the brain MRI, negative. Was on 100mg Topamax as prophylatic, Bubital and Toradol for onsets. Topamax cut in half and seemed to be doing better at first. The confusion was returning, but only after an RSD flare-up (co-incidental, probably not from what I researched) All these neuro's can have cormodity. On top of that 2 months ago, I had an "episode" where I had a left side "migraine", on top of the right side usual one. Tried to reach my neuro on weekend, but gave up after 3 tries to get someone. Monday, doc called me, and somehow it went weird from there. She said at the hospital later that I was smacking my lips, I asked her who I was talking to (cause I 4got), and she urged me to go to the ER. A few hours later, my daughter came home to me speaking a different language (gibberish). She took me to ER, where apparently I had what they thought was a seizure. Had all the normal tests, you know, and the EEG had spikes in left temporal lobe. I also had markedly increased weakness in right side; but everything else fine. 12 hours later, I could speak again. I was discharged with the term "complicated" migraine in 3 days. What I see is more like a "hemiplegic" migraine. Interested in your opinion about diagnosis. Perhaps I should seek out a migraine specialist as opposed to a neuro (who is co-chief of neurology at a teaching hospital)?
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Q: Diagnosis challenge: "Complicated" vs. hemiplegic migraine
Hi imasponge,
I really want to help you with an answer to your question, but can't, because it cannot be adequately answered online. A diagnosis can only be provided by a doctor who can review your medical history, your family's medical history, discuss your symptoms, and conduct a complete exam in person.
Now having said that, yes, I would see a Migraine specialist and it is important to note that not all neurologists are Migraine specialists. A Migraine specialist treats only one disease - ours- Migraines and headache disorders. Neurologists treat so many different conditions like MS, stroke, and epilpesy it is hard for them to be experts in one area. Take a look at the article Migraine and Headache Specialists - What's So Special? If you need help finding a Migraine specialist, check our listing of Patient Recommended Migraine and Headache Specialists.
One of the most important things is to get an accurate diagnosis. To simplify matters and make it easier for people to get information and treatment, doctors usually go by the gold standard for diagnosis, the International Headache Society's International Classification of Headache Disorders, 2nd Edition (ICHD-II). Under ICHD-II, there is no diagnosis of "complicated Migraine." It was an older term used. You can read more about the importance of a correct diagnosis in The Type of Migraine Does Matter.
I hope this helps,
Nancy
imasponge,
-:¦:-•:*'""*:•.-:¦:-•*Welcome to MyMigraineConnection!*•-:¦:-•:*'""*:•.-:¦:-
As Nancy told you, there's no diagnosis of "complicated" Migraine in the ICHD-II, which is really the gold standard for diagnosis and classification for Migraine and other headache disorders.
If the right-sided weakness was due to a Migraine, that fits with hemiplegic Migraine, which is the only form of Migraine that causes weakness or paralysis. You can read more in Hemiplegic Migraine - The Basics.
I agree with Nancy that a Migraine specialist is probably your best option, especially if you may have hemiplegic Migraine.
Please keep us posted?
Welcome again,
Teri
You're welcome!
There aren't any Migraine specialists close to me either. It's only been in the last year or so that there were any at all in my state. When I started seeing a specialist, I drove eight hours each direction for appointment every three months. I did that for four years. It wasn't easy, but it was SO worth it because that was the turning point in getting my Migraines under control.
The hospital probably billed using a code just for Migraine. The ICHD-II is used by doctors for diagnosis and classification, not insurance companies.
Temporary speech impairment can happen with most forms of Migraine. The right-side weakness, though, is very telling.
Let us know if we can do anything for you.
Teri
Wow. Sorry. That is a ways. Yikes. I've been switched soo many times from doc to doc for my headaches. At least now, I can go armed with knowledge (printed out as well so I remember) to my next appointment. That's what more people need to do, I think. I even have a pain management doc for them. But that doesn't even help. I know I take OTC's way too much as well, which is not good for me.
I don't think enough people ask questions either. They just go with whatever the doc says, and say...okay..he/she knows best. When in fact, we are the patient with the body that changes and I think "we" would know more about our bodies. Yes, the ones with egos (and you know who they are), like to flaunt that by saying "who's the doctor here, you or me." Or better still, "I went to medical school, how many years did you say you went?" That can't admit that they are wrong or just haven't kept up with the medical changes.
Just my opinion.
I totally agree with you. My doctors have to be willing to work with me as a treatment partner, making decisions WITH me, not FOR me.
Here's my most recent slogan: The person with the most at stake gets to be in charge.
Don't be sorry about my traveling so far. Lots of us have to do that, and as I said, it was very much worth it. Traveling to that doctor helped me get my life back.
Teri
This is Juan from Mexico. I have been a pastor and missionary for 31 years and have had migraines on and off, but 2 months ago they became every day and "out of control". I have taken preventive meds- nortriptiline 30 mg, Indomethecin 75 mg. and Ibuprofin 2,500 mg to 3,000 mg per day and have had Botox 10 days ago.
The reason I am writing is that I have symptoms like yours. I am completely disabled, speech and memory problems and functional 15 to 30 minutes per day. In my reading, you are the first person I have read that has been mentally impaired by the pain wtih weakness. I seem to fall in the "complicated migraine classification. I have retired from my work and am able to do nothing but pray. I would treasure any info that deals with cromic migraine with cognitive impairment. Thanks and God bless!
Thanks Juan. I've spoken to my neurologist as well as a opthamologist/neurologist who both tell me that in my case, I have three different headaches going on, and at times, all at the same time: occular, occipital and migraine. I also had seizure activity during that "complex migraine" which further complicates matters. They then diagnose me with that diagnosis because it is very hard to differentiate between a transischemic attack (TIA) aka "mini-stroke" or a seizure with a migraine. Go figure. I have always been the 1% patient. Meaning quite simply that I'm that 1 out of 100 that would have something more complex, different and unique, or perhaps not even in the medical books at all. Oh well. Something the docs can learn from me this time.
Dear imasponge-
Wow. I so appreciate hearing from you. The uniqueness of your condition I'm sure has been difficult, as finding help is like finding a needle in a haystack. If you don't mind, I'd like to share some more of my symptoms and maybe you or someone out there might have some insight.
First, what is your life like? Can you work at all? Can you concentrate and use your mind? That is where I find myself. I had a 30 minute meeting yesterday and the pain just came on and it was horrendous. Trying to think makes the pain so much worse. And I can't come up with the words or get them to come out right. Has your condition gotten any better? I have not been able to work at all for the last 2 months.
Thanks again, for caring enough to write...
Juan
No, I do not work Juan. Doc put me on 1000 mg of Depakote, 50 mg of Topamax, down from 100 mg, and lots of other drugs. But mainly, you have to talk to your doc. The lowering of the Topamax helped with the memory and confusion issues to a great extent. It was a LOT worse before while taking 100 mg. Everyone is different, take it from me.
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Thanks. There's no migraine specialists really close to me. There's only 3-4 in all of my state in fact. How rare they must be.
Strange then if it isn't in the ICHD-II code book, I wonder what the insurance company is using for an in-hospital stay code???? That's what's on my discharge papers. And that's why I can't find anything on it.
Not only right side weakness, but temporary speech impairment as well.
I've been to the sites you've listed. That's where I got the info I have.
Thanks bunches both you.