First Time Migraine?

Hi mcmarilyn,

Just a few things that strike me (as a physician) on hearing about your headache.  It is very unusual for a woman to have onset of her migraines after age 50.  Anyone that age with the worst headache of their life not only needs a CT scan of their head but, if that is negative, also a lumbar puncture (spinal tap) to rule out a small subarachnoid hemorrhage.  People (especially women in their 40s and 50s) can have small aneurysms in their brain blood vessels that can begin to leak a little and cause a terrible headache -- yet nothing shows up on CT or even MRI.  Only a spinal tap would show the red blood cells in the spinal fluid.  These small "warning leaks" can sometimes come before bigger bleeds (larger subarachnoid hemorrhages) and thus present an opportunity to prevent a more serious problem.  Since you are too old for onset of migraines (and you have to have more than just one for it to be a migraine anyway) I would make very sure that your neurologist knows you are concerned about the possibility that you had a warning leak and may have a small aneurysm (some are too small to be seen on MRI).  Now you may not have any of this, but it would be a shame to gloss over it when it should have been investigated.  The problem is that the blood in the spinal fluid starts to break down after a few days, so I don;t know that a lumbar puncture would help at this point.   You can look for what is called xanthochromia (coloring of the spinal fluid from when the red cells bust open), but even that only lasts for so long.  Ask your neurologist.  But do NOT just blow this off as a migraine. Don;t worry, just see this through.  And in the meantime don;t do any weightlifting or other type of straining.  Hope this is helpful.

Laura L. 

VIEW IMAGE

Hi there,

As far as I am aware, there are no changes on an MRI to indicate migraine (if there are it is something ultra new, because I read all the journals about migraines and have had my own MRI for migraine when my headaches increased in frequency and severity).  And I do not know of any blood work that would "show" a migraine.  He may be checking an erythrocyte sedimentation rate (ESR) which is a general indication of inflammation and is elevated in temporal arteritis, a connective tissue disease that affects the temporal arteries -- they are inflamed; this is diagnosed by biopsy; treated by steroids.  Can;t really think what else he might be checking other than maybe some lipids (cholesterol, etc.) in case he thinks you have cerebrovascular disease (which can lead to stroke).  Get on him about the berry (that's what they are called - berry) aneurysm thing --  that you are concerned that severe headache could have been a warning leak from a berry aneurysm and how can that be addressed?  The only way really is cerebral angiography (squirt dye into the arteries in your brain) which has some slight risk but is able to show smaller aneurysms than MR angiography as far as I am aware (I could be wrong - you might want to ask the resolution of MRA (MR angiography) vs. traditional cerebral angiography.)  So this guy is a neurologist?  Keep me posted on how you are feeling and how your work up is going.

Laura L.

I was researching on here today.. not a good thing to do if you are already DXed with a brain aneurysm and have surgery scheduled for the next day BUT
I couldn't help but read this thread and I decided to add something to it as it might be useful for someone else in the future.. I am assuming that since this thread died out so quickly that either the person who started it went through with the other tests or just stopped posting

What my neurologist told me.. and she is co-chairman of the neurology dept at her hospital.. was that often when a person who has had migraines for a long time... there will be "white dots" that show up on their MRI.. This was not the case with me and I have had migraines since I was 9. What they did find on the regular MRI was what they determined to be either tortuous vessels or an aneurysm.. Unlucky for me that after the MRA it was DXed as an aneurysm.

My whole life, I had dealt with my migraines with my regular doctors. And since I can't take imitrex or any of those other similar migraine medicines (everyone in my family either dies from a stroke or a heart attack) I relied on fiorinals, and before those were finally prescribed to me, the occasional darvon, tons of aspirin, advil, saline spray, antihistamines, but mostly I suffered. I tried cold packs for my head, heating pads for my neck, and not one of my doctors told me to go to a neurologist!!

Well, it was last October and I was in the hospital for an unrelated matter, and I awoke with the worst headache of my life. They wouldn't give me a thing for it except all those meds I can't take.. after ice packs and my boyfriend rubbing my neck for hours they finally gave me a fentanyl patch for my neck.. I was supposed to be discharged but I couldn't even get out of bed. My PCP had come to visit me with a neurologist colleague but the jerks at the nurses station told them I was discharged already!! So after nausea meds and finally being able to swallow a fiorinal I started to feel better much later in the evening.

I tell this story because this was the WORST headache I've ever had... and I've had migraines that have lasted for 4 days with vomiting but the pain wasn't as bad as this.. and BECAUSE of this.. along with my new DX of an aneurysm all the surgeons I have talked to are fairly convinced that I had a small "bleed" while I was in the hospital. THERE IS NO DOUBT IN MY MIND that had I not been a woman, I would have been treated with far more seriousness and probably sent to the neurology wing. I was too weak and too in pain to ask for any of this.. BUT they should have known better.
NY Veggie