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
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