Dangerous, complex migraines linked to high risk for stroke

Published on May 16, 2012 at 8:45 AM · 7 Comments

Nicole Soriano had headaches before but nothing like the one that struck in the middle of one summer night. A coincidence led nine days later to Cedars-Sinai Medical Center, where a rare type of migraine was diagnosed and treated - but any moment during that time could have been disastrous.

"Nicole 'dodged a bullet.' Her symptoms were classic for a type of migraine that causes stroke, but it was diagnosed only after she was referred to Cedars-Sinai for something entirely different. From the time the migraine started to the time we began treatment, she was at high risk for stroke," said Patrick D. Lyden, MD, chairman of the Department of Neurology.

The horrible headache struck at 3 a.m. on July 11, 2010. "I woke up with a more severe headache than I had ever had before," said Nicole, who got up and took an over-the-counter drug that usually worked within 20 minutes. This time, the pain only got worse, so the then-16-year-old woke her parents, who called 911.

"She was in excruciating pain - doubled over in pain - dripping wet, pale, kind of numb and tingly, and when the paramedics got here they said, 'Let's get her in (to the hospital) right away,'" Nicole's mom, Marla, recalled.

They took the Calabasas resident to a local hospital where doctors examined Nicole for neurological problems and did a CT brain scan before concluding she was suffering a migraine headache. They gave her a strong pain reliever and let her go home.

But when Marla and her husband, Jacques, picked up a copy of the brain scan to share with Nicole's pediatrician, the image showed an abnormal growth called an arachnoid cyst, which had not been shared with them at the local hospital. Nicole's intense headaches continued to come and go. In addition to light sensitivity, the headaches were accompanied by slight tingling in Nicole's hands, and left arm weakness - symptoms mimicking those of a possible stroke or other serious brain disorder.

To find out more about the arachnoid cyst, Nicole was referred to Cedars-Sinai's Department of Neurosurgery, where MRI and ultrasound scans were done. Moise Danielpour, MD, director of the Pediatric Neurosurgery Program, determined the cyst was harmless - just something to monitor over time. But the new scans showed a blood vessel abnormality that looked similar to an arterial dissection - an area where the inner layer of an artery separates from the wall. Danielpour referred Nicole for further evaluation to Lyden.

"As it turns out, what she really had were very unusual and severe migraines that caused an artery in her brain to spasm. Migraines strong enough to cause arterial spasms can lead to stroke, so we started aggressive treatment with a powerful anti-migraine medication and short-term Plavix to be sure the artery remained open," said Lyden, the Carmen and Louis Warschaw Chair in Neurology.

He said the seriousness of Nicole's migraine was similar to that of Serene Branson, the KCBS reporter who had a sudden and severe migraine that affected her speech during on-air reporting of the Grammy Awards in February. Her mental lapse and inability to express her thoughts led to the belief she had suffered a stroke.

"Stroke incidence is increasing among younger patients, largely due to migraine and arterial dissections. Stroke isn't your grandparents' disease anymore. It can strike at any age, and we all need to pay more attention to stroke warning signs. If you think someone could be having a stroke, don't assume they are too young. Call 911," Lyden said.

Signs of a stroke include:

•Sudden severe headache
•Sudden severe numbness or weakness on one side
•Sudden loss of speech or comprehension
•Sudden severe unsteadiness or dizziness
•Sudden severe loss of vision

Although Nicole, who will turn 18 in November, had not had a migraine before that night in July, she had an experience the previous month that had worried her parents. The Calabasas High School student, who is a member of two choirs and an a cappella group, was in the middle of a performance when she looked ill.

"We noticed while she was on stage that she had become as white as a ghost. She said she was light-headed and feeling like she was going to pass out, and it came out of nowhere. That's when I started to notice that she wasn't herself. She had never done that before. There were 200 other kids there, and it was hot for all of them, but nobody else was about to collapse," Marla said.

Nicole's headaches and symptoms have subsided but she will have follow-up exams and brain scans for the coming months or years. Set to graduate from high school this June and attend college in Boulder, Colo., she is being weaned off the powerful drugs but still takes an aspirin a day to thin her blood while the artery continues to relax and heal. The busy student also is under doctor's orders to not skip meals, Lyden said with a smile.

"Anyone who has a history of severe, complex migraines needs to keep doing whatever works to prevent recurrences. Nicole should be fine as long as she's diligent about preventing her migraines, and in her case that involves remembering to eat and stay well hydrated. For a lot of people, a drop in blood sugar can lead to headaches and migraines," Lyden said.

Source:

Cedars-Sinai Medical Center

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Comments
  1. Karen Peltier Karen Peltier United States says:

    Thank you for this article.  I've had complex or complicated migraines for five years now.  Came out of the blue around menopause; and I had no personal or family history prior.  It is difficult for people to understand them; even some physicians are not familiar with the 'complicated' part of these type of migraines.  People hear the word 'migraine,' and a certain image pops into their head of someone with a bad headache.  Complex migraines go way beyond the traditional migraine.  The symptoms do resemble a stroke (as mentioned above); however, usually nothing shows on any scans.  So, in the case of the article, the patient was very fortunate that something showed up.  Generally, physicians think if nothing shows up, then you the patient are making it up, exaggering, etc.  Nothing could be further from the truth.  I strongly advise anyone with this condition to work with a neurologist; they are about the only ones capable of understanding all the nuances, as far as I'm concerned.

    • chrystie chrystie United States says:

      I saw your comment and totally related. i went through menopause a couple years ago due to hysterectomy. I've had migraines since puberty but at the age of 45 I had my first complex one. This one required a trip to the hospital. The pain came and went for 6 days. During the 6 days, I had difficulty working on my computer, could not spell words that should have come easily and had tremendous confusion. At the er, i was given medication for pain and a ct scan, which i was told was normal but referred to my regular dr. She referred me to a neuro, because of what she said was "altered mental status." This was about 3 weeks ago and I'm waiting for appt.  My usual migraine med failed me miserably with this one. What have you found that helped? I am terrified of having another. Especially when I might be home with my 11 year old or driving.

  2. Ginny Ginny United States says:

    I have been so frustrated with my very recent experience. I was on vacation in San Francisco and was hit in the back of my head with a severe pain like I have never felt before. I could not move for over an hour. It was my second day of vacation and my first vacation in 2 years. My vision in my left eye was blurry and I had difficulty keeping my eye open. I have had headaches since I was a child and I am now 44 years old. This was unlike any headache I had ever experienced. I returned home a week later still with the headache, no better and my vision still blurry. The headache affected only the left side of my head which was atypical for me. I returned to work that Monday and my headache worsened along with my vision,nothing helped.I eventually went to see my primary who prescribed fioricet for me. I don't take anything routinely and most meds tried in the past were ineffective so I learned to live with my migraines. This particular headache started to cause me to slur words here and there . I chalked it up to the pain. I finally went to the emergency room and was given morphine IV which intensified the pain. They then gave me a combination of IV meds which did stop the pain. The cat scan was negative and I went home. Six hours later the meds wore off and I was back to where I was. I then went to see a neurologist who suggested botox and put me on prednisone. The prednisone was on a titration schedule and did ease the pain ,however did not stop it. I did not proceed with the botox.When I asked him the side affects of the botox he responded"you lose a few wrinkles" I asked the success rate he had with botox teatments and he was vague. I felt like he did not take my atypical headache seriously and just needed another subject for botox. As soon as the prednisone was completed the pain was back . I was at work and I became unable to speak clearly. I knew what I wanted to say but had so much difficulty saying it. I was so scared and thought I was having a stroke. A co-worker of mine took me to the emergency room  and I was admitted. All the scans and blood work were negative and thats all I kept hearing yet my speech was messed up , I was vomitting from the pain and could not keep my eyes open because of the pain. The hospitalist kept suggesting to my family that it was a psyche issue because all the tests were negative. I was released from the hospital this past Saturday 10/20/12 and my speech still is not fully returned to normal, however has become better. I was placed on Topamax which seems to have made a difference for me. I do take B12 and B6 vitamin supplements. My Complex migraine lasted from 9/22/12 to 10/19/12. No one should ever have to suffer with that level of pain. It was the ER physician who diagnosed me with the complex migraine. I am a registered nurse and I amj very disappointed in physicians,neurologists and hospitalists who still don't take this condition seriously because the tests are negative. I only hope they themselves never have to experience this first hand before they change their attitudes and responses to those of us that do. God bless you all.

    • Argentina Bruce Argentina Bruce United States says:

      I have noticed that most females deal with the complexity migraine. I wonder why when Dr.'s don't have the answers they automatically say that its something we are making up believe me these types of migraines and their severity in different forms of degrees are not something we want to impose on anyone.I have had them for about a year now....I wish i had the ability to never had made this thing a part of my life just want to understand what to do in order to live a normal life

  3. Kristin c Kristin c United States says:

    So, thru the years I've had migraines - always the same triggers & location in my head. Last week had my first Complex migraine. Although I have no pre-cursers for stroke, I too questioned if I was having one.  Speech slurred, walked like I was drunk, and left arm numb/tingly, neck pain with a head shattering migraine unlike ANYTHING I've ever had before, and not in the location that I get migraines. Also, none of my triggers were present PLUS it came on fast outta no where 0 I usually "build up" to a migraine. I went to bed & woke up with it still (thats a new one). I Went to the Er, and they gave me a shot, and 4 pills (Benadryl, Compazine, and Toradol).  I questioned the benadryl?? Apparently, the anti-histamine will relax your blood vessels (alleviate migraine... NOW they tell me?!) the other stuff was an anti-inflamatory and I can't recall the other one. Online says its for nausea, etc., but thats not why they gave it to me. So who knows. All I know, is within 40min I felt normal again and w/out pain.  I informed the ER staff and they said they'd test me before releasing me.  Basically 'stroke patient tests'.  I'm 39, and failed the last test.  Put your arms straight out in front of you, palms up & close your eyes while they count to 10.  Apparently, my left arm "drifted" down - they tested me 2x. Failed both. Off to catscan, which they said - unless you had a major stroke will show nothing. You need an MRI, to see mini-strokes and migraine effects. (No idea why they didnt give me the MRI). Anyhow, I've been referred to neurologist - to see where we go from here.  This was the first time I've ever heard of a complex migraine and yeah, its a dangerous one. They told me if I start having another to go IMMEDIATELY to the hospital. This aint a normal migraine people.  *Migraines do run in my family - family members who had gallbladders removed (other reasons) noticed that afterward, they never had a another migraine??? Related??)  Good luck everyone.

  4. Diana Langis Diana Langis Canada says:

    My 15yr old daughter was diagnosed with complex migraines 4 yrs ago after what seemed like a stroke..and just lately she has started passing out with leg paralysis after..8 times in the last 4mths..Drs cant find anything wrong with her ..although a neurologist has not seen her about it..i think its her complex migraines ..could i be right?

  5. silvana gagliardi silvana gagliardi Australia says:

    I have experienced the same thing and have had migraine headaches since 2004. It happened to be of May this year that I had my first attack of a complex migraine.  It started with a very hoarsey voice and my right arm went numb and I felt so weak that I couldn't move it.  So I was taken to the hospital in ED and then I started having a slurred speech and they ran through so many tests brain scan, mri, you name it.  Nothing showed up so they decided to admit me.  I stayed for 6 stays in hospital and in the end they diagnosed it as a complex migraine and TIA.  They put me on  the right medication and now I'm feeling ok, well so far so good.  I can understand of your daughter's condition and it's best for her to go to hospital and they will be able to see her in that state.  Good luck and God bless.        Silvana Gagliardi

The opinions expressed here are the views of the writer and do not necessarily reflect the views and opinions of News-Medical.Net.
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