Neurologist Questions

Migraines

For the last 15 years I've had migraines. I have dealt with them on my own and never received treatment. While I was pregnant with my last daughter they got a little worse but I wouldn't take medicine because I didn't want to effect my baby. That was 2 years ago. After having her they seemed to ease back up. Then in the last 6 months they have came back with a vengeance. My migraines typically all start the same. Blackcspots start in my eyes, I start feeling weak and nauseous, then I get tunnel vision, my head starts hurting really bad , I begin vomiting and I go to bed. My head is sore for 1 -2 days after and I'm good to go. About a month ago I had a migraine that was nothing like my typical migraines. I was at work and I started feeling really weak and sick. I went home and my head was hurting so bad so I went to bed. I woke up still in alot of pain but made it through the remainder of the day. Went back to sleep for the night and for the first time in my life I woke up with a migraine. It wasn't a usual migraine though the entire left side of my body was tingling and I was having trouble walking. I went straight to the restroom because I was so nauseous. I had so much going on that weekend that I had to get better so I took some Tylenol and went back to bed. I woke up later still in pain but able to function well enough. I made it through the day. The next day I got up with some head pain and the tingling was still there. No pain not pins and needles just tingling my face, leg , arm , foot head all 9n the left side. I suffered through I had things I had to get done and began to clean. The migraine began to come back so I checked my BP and it was 132/104. The bottom number seemed a little high for me so I figured I better go to the hospital. I went and got checked out they done a CT and said it was a migraine. Gave me liquid gold and I felt alot better but the tingling didn't go away and still a slight headache which they said was normal with a sever migraine. I've seen a neurologist and a nurse practioner since then I've been put on Topamax, emgality , sumatripitan and a few other meds and the tingling isn't going away. Some days it gets worse than others. I'm sure my dr. Thinks I'm crazy but something feels wrong. Is this Normal to have these symptoms this long after a migraine ? I did have an mri and waiting on results.

Female | 32 years old
Complaint duration: Month
Medications: Emgality , Topamax
Conditions: Migrain

2 Answers

Everything you describe can occur with migraine. The neurological symptoms are called migraine with aura . The medication and testing being done are appropriate. It’s not unusual to need to try 3 or more medications before you find one that works to prevent the migraines and to treat them when they come on. Botox is also used as a migraine prevention if oral or subcutaneous medication doesn’t work.
If they seem to have gotten worse 6 months ago, it would be worth looking at whether anything changed that might have caused them to worsen: different diet, different job, did you stop or start new medication, ilklks your sleep pattern different? Especially if you are getting less sleep, Did you start snoring? Are you drinking more or less caffeine? Are you on a new or different birth control? All of these are possible reasons migraines can worsen.
You have what is known as a complicated migraine which can often cause weakness or numbness and sometimes micro I farcts ( strokes). These are best seen on MRI scans and CT scans do not normally pick them up. Another possibility is the preventive treatment with Topamax can also cause numbness or tingling ( a combination of both is also a possibility).  The concerning issues are if you have such ( complicated migraines,  triptans = sumatriptan are relatively contraindicated ) while the CGRP's are a new class of both symptomatic treatment ( Emgality ) also can be used as preventive ( Nurtec ). If the Topamax is the primary culprit of your numbness then changing to a different category ( to be determined by you and your Neurologist should be discussed ). If your blood pressure is on the high side usually blood pressure medication such as Beta blockers ( propranolol) may offer significant benefits. Contact your Neurologist and ask him about getting an MRI scan and sitting down and discussing above issues.