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What Causes Severe Persistent Headache?
Question: Neurology question :
I've had migraines since I was 9. I suffer from hemiplegic migraine. I have constant head pain (since thunderclap headache in Feb 2014), but can cope with the level of pain. However, when I suffer a migraine, I have aura symptoms (vision, hearing) and suffer sickness, paralysis, sometimes it affects speech, etc. I have had three attacks this week, but have had complete collapses with a loss of consciousness on each of those times. I have also been unable to recall how I get home on two of the occasions etc.
I'm a lawyer and due to represent a client next week. My GP, when she saw me today (to review medication and provide Triptan prescription) said I should not be working for the next two weeks. She said complete rest was necessary, for at least a week, but at the back end of next week and the week after I can 'risk' working. I'm really upset. I feel like I'm letting everyone down. I'd prefer to try to get to court. I discussed whether I could take two days off and prepare Monday, to work from Tuesday, the GP said this was too risky. I was sent for an ECG immediately and I have to have blood tests early next week, with an urgent referral to neurology again (I see my consultant neurologists every 3-6 months and my homeopathic neurology specialist every 2-6 month). My GP also said if I suffer another attack, I must attend A&E. A scan has been recommended too, though I did have one in March.
Can you advise if I can attend court for my client? What are the risks if I do so?
Thank you in advance for your advice. XXXXXXX
I've had migraines since I was 9. I suffer from hemiplegic migraine. I have constant head pain (since thunderclap headache in Feb 2014), but can cope with the level of pain. However, when I suffer a migraine, I have aura symptoms (vision, hearing) and suffer sickness, paralysis, sometimes it affects speech, etc. I have had three attacks this week, but have had complete collapses with a loss of consciousness on each of those times. I have also been unable to recall how I get home on two of the occasions etc.
I'm a lawyer and due to represent a client next week. My GP, when she saw me today (to review medication and provide Triptan prescription) said I should not be working for the next two weeks. She said complete rest was necessary, for at least a week, but at the back end of next week and the week after I can 'risk' working. I'm really upset. I feel like I'm letting everyone down. I'd prefer to try to get to court. I discussed whether I could take two days off and prepare Monday, to work from Tuesday, the GP said this was too risky. I was sent for an ECG immediately and I have to have blood tests early next week, with an urgent referral to neurology again (I see my consultant neurologists every 3-6 months and my homeopathic neurology specialist every 2-6 month). My GP also said if I suffer another attack, I must attend A&E. A scan has been recommended too, though I did have one in March.
Can you advise if I can attend court for my client? What are the risks if I do so?
Thank you in advance for your advice. XXXXXXX
Brief Answer:
I would rest.
Detailed Answer:
I read your question carefully and I understand your concern.
Yours is obviously a difficult case and there aren’t clear cut answers, it is hard to make precise predictions. However, I tend to side with your GP. Migraine is known to be exacerbated by several factors, stress, lack of sleep, exertion being among them. So considering the amount of work I imagine is put into preparing for a case and the added stress the likelihood of migraine attacks would be higher. In the setting of coming at a period of worsening with three attacks inside a week the chance of other attacks during this period would be even higher. It is wise to be referred for a re-evaluation by your neurologist as well because the association with losses of consciousness makes it necessary to consider other hypothesis such as seizures reason for which an EEG might be recommended as well. Ordering brain imaging is also sensible given the new symptoms as migraine is also a risk factor for stroke, so in front of these new manifestations it is a possibility to be excluded. Other possibilities like heart arrhythmias might also be considered (a normal EKG at a given moment in time makes it less likely but doesn’t exclude a transitory episode with normal rhythm in between).
Of course you might choose to go on with your case. If it’s simply due to complications of migraine and not related to above mentioned possibilities in the courtroom itself, it could at worst interrupt the session if you had another attack with altered consciousness (while not physically dangerous, I wonder though if your client would like that). However, I would like to remind you that there are also other risks involved like injuring yourself during these losses of consciousness. It might happen while you’re driving, going up or down the stairs, having a bath, cooking and so on. So for that reason I would also rest, as was suggested resume work only if having at least an attack free week.
I remain at your disposal for other questions.
I would rest.
Detailed Answer:
I read your question carefully and I understand your concern.
Yours is obviously a difficult case and there aren’t clear cut answers, it is hard to make precise predictions. However, I tend to side with your GP. Migraine is known to be exacerbated by several factors, stress, lack of sleep, exertion being among them. So considering the amount of work I imagine is put into preparing for a case and the added stress the likelihood of migraine attacks would be higher. In the setting of coming at a period of worsening with three attacks inside a week the chance of other attacks during this period would be even higher. It is wise to be referred for a re-evaluation by your neurologist as well because the association with losses of consciousness makes it necessary to consider other hypothesis such as seizures reason for which an EEG might be recommended as well. Ordering brain imaging is also sensible given the new symptoms as migraine is also a risk factor for stroke, so in front of these new manifestations it is a possibility to be excluded. Other possibilities like heart arrhythmias might also be considered (a normal EKG at a given moment in time makes it less likely but doesn’t exclude a transitory episode with normal rhythm in between).
Of course you might choose to go on with your case. If it’s simply due to complications of migraine and not related to above mentioned possibilities in the courtroom itself, it could at worst interrupt the session if you had another attack with altered consciousness (while not physically dangerous, I wonder though if your client would like that). However, I would like to remind you that there are also other risks involved like injuring yourself during these losses of consciousness. It might happen while you’re driving, going up or down the stairs, having a bath, cooking and so on. So for that reason I would also rest, as was suggested resume work only if having at least an attack free week.
I remain at your disposal for other questions.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you for your advice.
I'll follow it. I'm very upset by being unable to work, which doesn't help the migraine issue, as I'm meant to avoid being upset too!
Thank you for getting back to me so quickly. I'll agree to have the tests that have been recommended.
Thanks, XXXXXXX
I'll follow it. I'm very upset by being unable to work, which doesn't help the migraine issue, as I'm meant to avoid being upset too!
Thank you for getting back to me so quickly. I'll agree to have the tests that have been recommended.
Thanks, XXXXXXX
Brief Answer:
Hope you feel better soon.
Detailed Answer:
You're welcome, hope you'll feel better soon.
Hope you feel better soon.
Detailed Answer:
You're welcome, hope you'll feel better soon.
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Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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