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Question
Posted by: Belinda | 2009-10-24

Migraine with unilateral numbness

Doc,

I have recently (in the last year) started to suffer from migraines. I do not get an aura or nausea. I go numb in my face and always, always get the headache im the back of my head in line with my ear (left). I also get very sore wrists and thirst as a ' warning'  just before the migraine starts. In May I had a MRI which came out clear. on the 26 Sep at 3am in the morning I woke up with an excrutiating migraine and I took Maxalt (If I take it very early it helps). The first dose did not help and I took a second dose. It still did not help. My face and my leg wav very numb (just the left side) and is still numb now four weeks later, I have not had one day without a headache - altough they have ot all been as severe as the one that woke me. My gp refered me to a neuro and I had another MRI. The results read : A few small focal T2 hyperintense areas are seen in the cerebral deep white matter and could be in keeping with mild chronic deep white matter ischeamic changes ir as a result of migraine. No DWI or recent infract" 

I want to know what this means. The neurologist is away for another week. I am in pain. I am 37y old otheriwise very healthy female of normal weight. Normal bp, non smoker, non drinker. Apart from the 2 Maxalt I have had no other pain meds. My Gp came to give me an injection at home last night as the pain was extremely bad - I dont even know what it was. The neurologist perscribed 2 courses of 80mg Predisone (completed) since the 26th and I am on 100mg Topamax. I had the numbness of the face and leg before the topamax so I know that is not a side effect.

Can you give me any direction please.

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Our expert says:
Expert ImageHeadache expert

Dear Belinda,

The facial and leg numbness is a type of aura – although these usually disappear when the pain starts, prolonged auras are known to occur. As long as your neurological examination and MRI were clear, then your prolonged aura, although unusual, is just part of your migraine. The thirst can be part of what is the ‘prodrome’ – these are warning signs of an impending attack. With regard to the wrist pain, this is highly unusual, but as long as it disappears when the attack is over, then it is just another unusual migraine symptom, and is nothing to be concerned about – we are all different!

With regard to the focal hyperintense areas, they can be found in anyone, but are more common in migraine sufferers. They are of no danger, and can be ignored.

If, your neurological examination and MRI were clear, then the cause of your migraine is not neurological. To get to the root of the problem, you need what is called a “multidisciplinary assessment”. There are so many different structures in the head and neck, all of which can be involved in the headache process, that no single specialist can have all the knowledge necessary to make a comprehensive assessment and diagnosis. For instance, a neurologist will examine the brain and nervous system, a physiotherapist will look at the muscles, a dentist will examine the teeth etc. For this reason, the “multidisciplinary assessment” combines and integrates the expertise of different specialists who would normally treat headache patients in isolation, into a single more comprehensive body of knowledge. This enables the different members of the team to provide a co-ordinated treatment plan, so that all the contributing factors are addressed. In the majority of migraine sufferers, the problem can be successfully treated without resorting to invasive drugs such as prednisone and topamax – all medications have undesirable side-effects and should be avoided if at all possible.

This assessment must include a thorough examination of the head and neck muscles to determine the presence of abnormal tension, and of the external carotid vasculature to determine whether there is an arterial element to the pain.

Headache sufferers often have a poor Quality of Life due to the constant pain and associated symptoms. For a free assessment of how your headaches are affecting your Quality of Life, click on http://www.headacheclinic.co.za/

This information has been supplied and checked by the multidisciplinary team of specialists at The Headache Clinic, in association with The International Headache Society and the South African Institute of Headache and Migraine Science. For consultation with these specialists, call The Headache Clinic (Cape Town, Durban, Johannesburg) on 0861 678 911.

The information provided does not constitute a diagnosis of your condition. You should consult a medical practitioner or other appropriate health care professional for a physical exmanication, diagnosis and formal advice. Health24 and the expert accept no responsibility or liability for any damage or personal harm you may suffer resulting from making use of this content.

1
Our users say:
Posted by: headache expert | 2009-10-25

Dear Belinda,

The facial and leg numbness is a type of aura – although these usually disappear when the pain starts, prolonged auras are known to occur. As long as your neurological examination and MRI were clear, then your prolonged aura, although unusual, is just part of your migraine. The thirst can be part of what is the ‘prodrome’ – these are warning signs of an impending attack. With regard to the wrist pain, this is highly unusual, but as long as it disappears when the attack is over, then it is just another unusual migraine symptom, and is nothing to be concerned about – we are all different!

With regard to the focal hyperintense areas, they can be found in anyone, but are more common in migraine sufferers. They are of no danger, and can be ignored.

If, your neurological examination and MRI were clear, then the cause of your migraine is not neurological. To get to the root of the problem, you need what is called a “multidisciplinary assessment”. There are so many different structures in the head and neck, all of which can be involved in the headache process, that no single specialist can have all the knowledge necessary to make a comprehensive assessment and diagnosis. For instance, a neurologist will examine the brain and nervous system, a physiotherapist will look at the muscles, a dentist will examine the teeth etc. For this reason, the “multidisciplinary assessment” combines and integrates the expertise of different specialists who would normally treat headache patients in isolation, into a single more comprehensive body of knowledge. This enables the different members of the team to provide a co-ordinated treatment plan, so that all the contributing factors are addressed. In the majority of migraine sufferers, the problem can be successfully treated without resorting to invasive drugs such as prednisone and topamax – all medications have undesirable side-effects and should be avoided if at all possible.

This assessment must include a thorough examination of the head and neck muscles to determine the presence of abnormal tension, and of the external carotid vasculature to determine whether there is an arterial element to the pain.

Headache sufferers often have a poor Quality of Life due to the constant pain and associated symptoms. For a free assessment of how your headaches are affecting your Quality of Life, click on http://www.headacheclinic.co.za/

This information has been supplied and checked by the multidisciplinary team of specialists at The Headache Clinic, in association with The International Headache Society and the South African Institute of Headache and Migraine Science. For consultation with these specialists, call The Headache Clinic (Cape Town, Durban, Johannesburg) on 0861 678 911.

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