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MIGRAINE WITH AURA for years old patientwith normal MRI, DVT.

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Neurology: I am a 64 year old male who has suffered from migraine with aura since age 13. Typically attacks occurred at a frequency of 3 or 4 times per year. Later in life 45 to 55 they occurred only infrequently. At 60 they occurred again 3 or 4 times a year but with no or minor headache just aura. The aura typically last 30 minutes and start with a blind spot that progressively expands from center to left, shimmering sparkling lights in a side wise "u" pattern. No weakness, drooping muscles or other sensory symptoms, some sensitivity to light afterwards.

Three weeks ago I underwent a cardiac ablation for pvc, svt and non sustained vt. The ablation was without complication at a major university hospital. Since the ablation, starting the night of, I have suffered from more frequent silent auras, probably 10 occasions over the 3 week period. The cardiologist does not think the aura/migraines are related to the ablation procedure. The frequency of the aura is upsetting although I don't seem to have any stroke like symptoms i.e. speech, paralysis etc. that would indicate a TIA or stroke. However, I am worried about this increase in activity.

I am trying to get an appointment to see a neurologist here but the soonest I can get in anywhere here is September 25th. That's a long time to worry about the situation and at what point is this critical enough to warrant a trip to the emergency room. I am not diabetic, do not have any significant heart disease or other major illnesses. I have ben put on xarelto for 1 month as a prophylaxis for a DVT of the right leg suffered several years old patientago. I have also been prescribed atenolol 25 mg daily to help with the potential pvc cardiac issue. I take no other medicines except Tylenol.

I am at my wits end with worry about all of this and have trouble functioning normally and going about my business. Seems like I am always worrying about when the next attack will come. Any advice or professional comment appreciated. I can add that 1 year ago an MRI of the brain was done with no abnormalities reported. The test was done due to a few attacks of vertigo that occurred without reason.

Category: Neurologist, Medical

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Dr. Sudhir Kumar
Category: Pediatric Neurologist
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Expert:  Dr. Sudhir Kumar
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Hi,
Thank you for posting your query at DoctorSpring.com
I have noted your symptoms, past history and details about cardiac procedure.
First of all, I would like to reassure you that your symptoms are not suggestive of brain stroke or any other serious neurological illness.
Migraine, as a disease, has a nature of flaring up at times and becoming quieter at other times. So, these episodes are suggestive of migraine attacks with increased frequency (sometimes, only auras occur without headaches). The exact reason for this increase in frequency can not be ascertained. However, let us hope that it would settle down soon.
If necessary, preventive medications may be started, such as topiramate or divalproex. These would reduce the frequency and severity of migraine attacks.
If the episodes continue to occur frequently, an MRI brain may be done (I noted that your earlier MRI was normal).
Best wishes,
Dr. Sudhir Kumar MD (Medicine), DM (Neurology)
Senior Consultant Neurologist


Patient replied :

Thank you for your comprehensive reply. It is a hard syndrome to deal with, especially since attacks were so infrequent and now have become frequent. i have read that people who suffern from these auras are much more likely to suffer stroke and was concerned that the increased frequency was a precursor to a stroke. Even though the attacks in my case are relatively short duration they are none the less incapacitating at work or other activities and as I am not a young person anymore trying to prevent major issues and so on. Is there any urgency in the follow upof this as it is difficult to schedule neurolgy appointments in my area, typically 2 or more months. Thanks in advance for your replies.


Expert:  Dr. Sudhir Kumar
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Thank you for getting back.
Migraine does increase the risk of stroke, however, in isolation, the risk is very low.
Increased frequency of migraine attacks is not a precursor of stroke.
Presence of other risk factors (such as smoking, high cholesterol, BP or sugar) in a patient with migraine would increase the risk of stroke. Since you have none of these, I presume, the risk of stroke is not increased in your case.
As of now, there is no emergency evaluation needed.
Best wishes,
Dr. Sudhir Kumar MD (Medicine), DM (Neurology)
Senior Consultant Neurologist

Expert:  Dr. Sudhir Kumar
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Thank you for getting back.
Migraine does increase the risk of stroke, however, in isolation, the risk is very low.
Increased frequency of migraine attacks is not a precursor of stroke.
Presence of other risk factors (such as smoking, high cholesterol, BP or sugar) in a patient with migraine would increase the risk of stroke. Since you have none of these, I presume, the risk of stroke is not increased in your case.
As of now, there is no emergency evaluation needed.
Best wishes,
Dr. Sudhir Kumar MD (Medicine), DM (Neurology)
Senior Consultant Neurologist

Dr. Sudhir Kumar
Category: Pediatric Neurologist
Experience: 
Senior Residency, Fellowship: DM, Neurology, CMC, Vellore, 2001
Junior Residency: MD, Internal Medicine, CMC, Vellore, 1998
Medical School: MBBS, Christian Medical College, Vellore, 1995
Dr. Sudhir Kumar and 4 other Medical Specialists are ready to help you

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