Tired of searching the internet for answers?
Tired of searching the internet for answers?
It’ s time to learn from those in the know. In every issue of HeadWise ®, our experts respond to reader-submitted questions about migraine and headache disorders.
PERSISTENT MIGRAINE PRODROME / AURA
I have recently been diagnosed with persistent migraine prodrome / aura. My symptoms of vague visual disturbance, increased sleepiness, photophobia, and mild headaches began almost 3 months ago. When the visual disturbance did not develop into a normal aura and headache that I have come to expect from my migraines, I grew concerned and sought medical help. An optometrist, general physician, two neurologists, and one neuro-ophthalmologist later, I was diagnosed with some form of persistent migraine prodrome.
Upon doing some of my own research, I’ ve found that what I have seems similar to Persistent Aura Without Infarction( PAWOI) or something similar. As far as I’ ve been able to find, there is very little known about this, including how long it may continue. I would greatly appreciate if you could identify any resources that may help me better understand my condition. I am about to enter my final semester of college, and I am concerned that if my condition persists after graduation, I will struggle to find employment. Is there some type of document I should have requested from my doctor to help explain my condition and how it limits me to potential employers? – Colleen M
That syndrome exists and there have been very few studies that address how that is treated. We use migraine preventive agents to reduce the excitability of the cortex of the brain and see if that resolves it. There are several of these, and none proven better than another. The trials of each are fairly long, as it often takes 6 weeks to determine whether this will work.
Your note doesn’ t tell enough details about the visual disturbance, but sometimes the complaint is“ visual snow” which is felt not to be a variation of migraine. Since you have light sensitivity and headache, that is less likely to be the cause.
This is a very specialized problem, and best managed by a headache specialist in your area. They would be aware of all of the preventive agents for migraine that are available and would do these trials with you. The NHF can probably point you to a specialist.
Mark Green, MD Mount Sinai Medical Center New York, NY
UNEXPLAINED VERTIGO / DIZZINESS EPISODES
The patient is male, 52 years old, 5’ 10”, 220 lbs. He started getting vertigo / dizzy symptoms 2 years ago and went to his regular doctor and all of his vitals checked out. Then, he was referred to a neurologist. He is now taking topiramate 75mg, 2 times a day and also Meclizine 12.5 mg, 2 times a day. An MRI did not reveal anything. He continues to experience daily episodes that last only from 30 seconds up to a few minutes. Usually, the spells occur during lunch, either before or after eating the meal. Nothing appears to trigger these episodes. The scary part is that these episodes have occurred while he was driving, and luckily he had a little bit of a warning to pull the car over to the side of the road. He had a normal eye exam during this time. It has been 9 months since his last neurological exam. He is following up with his neurologist and the eye doctor in a couple of months. He is just concerned that this can happen when he is driving and doesn’ t want to be denied driving privileges, especially, since he needs his car for work, etc.
This case is hard to address in the absence of more precise information. For example, the term vertigo / dizziness can be interpreted many ways, but the description makes me wonder about causes which have nothing to do with migraine. The differential diagnosis of frequent, short duration disequilibrium / spinning attacks would include cardiac arrhythmia or even vertebrobasilar insufficiency. Neurological and cardiac causes need to be ruled out before these symptoms could be attributed to a structural ENT or migraine explanation. Cardiac event monitoring and cerebral and extracranial MRA would be helpful.
Edmund Messina, M. D. Michigan Headache Clinic East Lansing, MI
www. headaches. org | National Headache Foundation 15