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Suggest Treatment For Stress And Migraine
Question: I am a76 old female with a pacemaker and 1 stent. I also am in afib all the time.I take various medications including warafin, I have had this condition for about 10 years. In the last week I have been under some stress involving family. As a young women I Had familial migraines. In the last three days I have had an aura squiggles. Came on suddenly and lasted about 5 minutes. I read on the internet that it could be a sign of a stroke? YYYY@YYYY . Should I go to the ER/
Brief Answer:
The biggest risk factor we all have for stroke IS AGE
Detailed Answer:
Good evening. I am an adult neurologist and headache specialist.
It is not necessarily true that what you describe (phosphenes- squiggly lines) is the sign of a stroke. That would suggest that permanent damage was done somewhere in the brain. And especially with your history of migraine headaches there is actually what is referred to as a "bimodal" graphical representation of population incidence of migraine headaches and you young lady may have just found the 2nd modal peak of the migraine curve!
In other words, there is a little known fact running around that people (doctors as well) don't know about when it comes to migraines and that is that such headaches tend to come on (and especially in women) at 2 different times of a person's life. The first common age of occurrence is in the teenage to young adult years (20-35) and this is first peak where the most number of people will experience or be diagnosed with migraine type headaches. Then, as people progress past 35 years of age the likelihood that migraines will come on for the first time decreases until it gets very very low....usually somewhere around menopause "or the change." And this is where people will say, "Oh, I can't wait for menopause to cure my headaches...." because that is the prevalent notion. Menopause cures migraines....but guess what??? Migraines never read those comments that people make without knowing about what happens LATER IN LIFE....which is years after menopause....years after having had the last kid....years after everything when one is retired, living peacefully, enjoying grandchildren, and watching their own children begin to come into their own.....and that is the DREADED 2ND MODAL SPIKE and that happens around the 70's of age...for both men and women....and this is where a large part of people recognize the bubble gets burst...migraines again? Unfortunately, yes....but there is treatment that you should consider if that's what this may turn out to be and find either a headache specialist or at least a good neurologist who can advise since your situation is clearly a bit more complicated with the A-fib and treatment with coumadin.
As far as your thought of going to the ER my opinion is that if you feel that something is not right about these aura or if you feel that the warfarin is not up to where it should be in its INR which I'm sure you're checking regularly or there are other symptoms suggest of a TIA or other neurological signs or oddities that you should not hesitate to be seen. Of course, remember that since you have a pacemaker and stent that getting an MRI is no longer possible. The best you can do really is the CT of the head but you can also do what's referred to as a CTA of the neck as well as as a doppler/ultrasound of the blood vessels of the brain. These will be able to tell with some level of accuracy what the status of patency is in your circulatory system feeding the brain.
I hope these suggestions and opinions satisfactorily address your question and give some additional information that you can discuss with your doctor for consideration. If so, may I ask your favor of a HIGH STAR RATING with some written feedback?
Also, if there are no other comments, may I ask you not forget to CLOSE THE QUERY on your end so the question can be transacted and archived for further reference by colleagues as necessary?
You are invited to direct more comments or inquiries to me in the future by going to my web address at:
bit.ly/drdariushsaghafi
I would be honored to answer you quickly and comprehensively.
Please keep me informed as to the outcome of your situation.
The query has required a total of 36 minutes of physician specific time to read, research, and compile a return envoy to the patient.
The biggest risk factor we all have for stroke IS AGE
Detailed Answer:
Good evening. I am an adult neurologist and headache specialist.
It is not necessarily true that what you describe (phosphenes- squiggly lines) is the sign of a stroke. That would suggest that permanent damage was done somewhere in the brain. And especially with your history of migraine headaches there is actually what is referred to as a "bimodal" graphical representation of population incidence of migraine headaches and you young lady may have just found the 2nd modal peak of the migraine curve!
In other words, there is a little known fact running around that people (doctors as well) don't know about when it comes to migraines and that is that such headaches tend to come on (and especially in women) at 2 different times of a person's life. The first common age of occurrence is in the teenage to young adult years (20-35) and this is first peak where the most number of people will experience or be diagnosed with migraine type headaches. Then, as people progress past 35 years of age the likelihood that migraines will come on for the first time decreases until it gets very very low....usually somewhere around menopause "or the change." And this is where people will say, "Oh, I can't wait for menopause to cure my headaches...." because that is the prevalent notion. Menopause cures migraines....but guess what??? Migraines never read those comments that people make without knowing about what happens LATER IN LIFE....which is years after menopause....years after having had the last kid....years after everything when one is retired, living peacefully, enjoying grandchildren, and watching their own children begin to come into their own.....and that is the DREADED 2ND MODAL SPIKE and that happens around the 70's of age...for both men and women....and this is where a large part of people recognize the bubble gets burst...migraines again? Unfortunately, yes....but there is treatment that you should consider if that's what this may turn out to be and find either a headache specialist or at least a good neurologist who can advise since your situation is clearly a bit more complicated with the A-fib and treatment with coumadin.
As far as your thought of going to the ER my opinion is that if you feel that something is not right about these aura or if you feel that the warfarin is not up to where it should be in its INR which I'm sure you're checking regularly or there are other symptoms suggest of a TIA or other neurological signs or oddities that you should not hesitate to be seen. Of course, remember that since you have a pacemaker and stent that getting an MRI is no longer possible. The best you can do really is the CT of the head but you can also do what's referred to as a CTA of the neck as well as as a doppler/ultrasound of the blood vessels of the brain. These will be able to tell with some level of accuracy what the status of patency is in your circulatory system feeding the brain.
I hope these suggestions and opinions satisfactorily address your question and give some additional information that you can discuss with your doctor for consideration. If so, may I ask your favor of a HIGH STAR RATING with some written feedback?
Also, if there are no other comments, may I ask you not forget to CLOSE THE QUERY on your end so the question can be transacted and archived for further reference by colleagues as necessary?
You are invited to direct more comments or inquiries to me in the future by going to my web address at:
bit.ly/drdariushsaghafi
I would be honored to answer you quickly and comprehensively.
Please keep me informed as to the outcome of your situation.
The query has required a total of 36 minutes of physician specific time to read, research, and compile a return envoy to the patient.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
I do have a neurologist whom I have great faith in. I have had 2 cat scans of my head because of some shaking which occurred and there was some thing the radiologist suggested a repeat cat scan. From the beginning she said, "It was nothing to worry about." She was right. I feel better having received your reply!
Brief Answer:
Very happy to have helped you
Detailed Answer:
Thank you for your kind comments. I am very happy to have helped out and glad you find your neurologist trustworthy and you are good with following their advice.
Good luck with everything.
If you would be so kind to do the favor of adding some positive commentary on our interaction by offering a HIGH STAR RATING and closing the consult query so that others may benefit as well from your query then, I would be most appreciative.
Best to you for success in the future and don't forget to contact me in general at:
bit.ly/drdariushsaghafi if you ever have other questions on anything.
Cheers!
Very happy to have helped you
Detailed Answer:
Thank you for your kind comments. I am very happy to have helped out and glad you find your neurologist trustworthy and you are good with following their advice.
Good luck with everything.
If you would be so kind to do the favor of adding some positive commentary on our interaction by offering a HIGH STAR RATING and closing the consult query so that others may benefit as well from your query then, I would be most appreciative.
Best to you for success in the future and don't forget to contact me in general at:
bit.ly/drdariushsaghafi if you ever have other questions on anything.
Cheers!
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Answered by
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