Question: Hello,

Please can I ask that this is answered with somebody with specific experience of Hemiplegic Migraine.

My daughter, aged 20, started having hemiplegic migraine 10 days ago. She has no prior history of migraine (although her father’s side of the family does have migraine history).

She has visited hospital emergency room 3 times, had CT scan and they have eliminated other possible causes and are absolutely sure this is hemiplegic migraine.

The attacks started infrequently (every couple of days) but she is now having on average 1 or 2 attacks each day. Mostly the aura lasts <1 hour then the headache/nausea sets in and lasts 2-3 hours.

For the headaches:
Started on Neproxin, no effect.
Now on Sumatriptan 1 x each attack, but we don’t think is having a positive effect, plus Ibuprofen and Paracetamol.

For the nausea:
She was given first Ondansetron 4mg, 3 x daily, which did not give much relief.
She has just started with Metoclopramide 10mg, 3 x daily

This morning is her worst and longest attack yet. She is 5 hours in and it has not subsided. It started shortly after waking and has had so far 3 episodes of Aura and constant violent headache and nausea since the start. We have tried 800mg Ibuprofen, 400mg Paracetamol and they have been unsuccessful. We are now trying Aspirin.

- Please can I have some advice on how to best deal with this.

- Is it normal to have so many attacks over this period (at least 7 attacks in the past 10 days).

- Does the frequency of attacks indicate that they are still being triggered by something that we have not found yet?

Many thanks.

XXXX

Dear Dr Ranxha

Thanks for your response.

MRI is already scheduled for Friday and GP appointment scheduled for tomorrow.

Two questions:

1. A lot of the time don't know what is an "attack" as the phases are not clear. If the headache and nausea continue but the aura goes and then comes back after an hour, is this one or two "attacks"? We have been told not to repeat the dose of Sumatriptan in the same attack, so we are confused if there is no period without headache/nausea between.

2. Are you able to answer my last question from before...Does the frequency of attacks indicate that they are still being triggered by something that we have not found yet? Or is it possible that the initial trigger was 10+ days ago (before the first attack) and we are still in some sort of long sequence as a result?


Thanks XXXX