The Truth About Migraines

Migraines sound pretty boring as a blog topic. Actually they aren’t. I know. I take care of them. And I have them myself. And I named my first novel Presidential Migraines.

Migraines have been in the news this summer when it was leaked that Congresswoman Michelle Bachmann, a Presidential candidate, has them. The press claimed Ms. Bachmann might be laid up for days at a time and this could impact her effectiveness in the Oval Office.  The story is almost certainly nefarious political fiction; these days migraines are well treated in the vast majority of people, be they Presidential candidates or anyone else.

Migraines affect 12% of the American population with 18% of females and 6% of males having at least one per year). Yet, they are clearly underdiagnosed, a core reason being that some people with migraines never get headaches. Estimates are 3%, but I suspect that is grossly low because most people don’t think they have a migraine unless it includes an incapacitating headache and head-in-the-toilet vomiting. To neurologists that would simply be called  a bad migraine

Take my migraines, which I never knew ran in my family for every known generation until I started asking questions. At age 27 as a G2 neurology resident at the University of Minnesota, I experienced spells where I thought I was going to pass out, couldn’t think straight, and was dizzy, but had no headache. To be sure that I wasn’t simply hypoglycemic, I had my blood checked. Normal.  Same for CT and EEG. Then I spoke to Mom—often an excellent resource—and she clued me in on our family’s history with migraines. In fact, as I child, I had a few emergency room visits for possible appendicitis, which turned out to be abdominal migraines. This goes to show it’s not always in your head!

Hemiplegic migraines run in some families, where the sufferer  becomes paralyzed on half his body (with or without a headache), almost like a stroke. Some get aphasic; they can’t speak or understand–or both–even though they know exactly what they want to say! This can also cause partial or total blindness (scotoma and hemianopsia). Some people even pass out–not from the pain either.

Certain foods and medications are known to be precipitants of migraines, such as cheese, chocolate, red wine, and hormones. If you’re prone to migraines, you may need to curtail or avoid consumption or usage altogether.

To this day I rarely get actual headache symptoms. On rare occasions, I may find myself reading the same medical report three times and can’t understand it–I recognize that to be a symptom of my migraines and simply take two ibuprofen.

If you suspect you have migraines and are concerned, you should seek the help of your physician or a neurologist. Neurologists are specialists who deal with migraines as well as other brain diseases.

Transient Global Amnesia

As originally posted on Dr. Lyle’s Writer’s Forensics blog.

“Where am I?” you ask the nurse on the locked psychiatry ward.

“You are in County General,” he replies.

“Where is that?”

“Downtown. You were found wandering inside a coffee shop, confused, and without identification.”

“I remember nothing since I left home this morning. My memory is just blank.”

“Your husband is on his way. I called him a few minutes ago after you were able to recall your name and phone number for me. He said you pulled your car out of the garage, ran into the tree in front of your house, left it there, and then drove his car to your clinic. He said he had a day off so he slept in and has been trying to reach you ever since he realized something was amiss, but you left your purse, briefcase and cell phone in your car. You went to work, went through mail, charts and dictated letters. Your secretary said you seemed a little different–she thought something was definitely wrong when your dictations didn’t make sense. She said you went out for lunch and never came back. By that time your husband had called your office and the police brought you here, confused from the coffee shop.”

Transient Global Amnesia or TGA is a condition I diagnose in patients 2-4 times per year. There are many causes, but often none is found. Almost all patients have a full recovery, but in a few, the condition will recur. My first case was essentially the one described above–an MD whose TGA was caused by an unusual medication reaction. In almost all cases, patients function somewhat normally but their judgment is impaired and they make no memories.

My second case was a man who also wound up in the locked ward. He had a continuous epileptic attack but was able to talk to me reasonably well.  He was confused, but fluent in speech. I went through my usual protocol of blood tests, an electroencephalogram (EEG), and brain scans. When I looked at the results of the EEG, I noticed that he was having continuous seizure activity, yet was not moving a muscle. I re-examined the patient to see if I had missed some shaking, eye twitching, or anything that might look epileptic, but I saw nothing abnormal.  I gave him a large intravenous dose of a seizure medication. The next morning, he was totally recovered. He recalled nothing of the day before or of my examining him twice.

Other causes of TGA may include a large number of factors including migraines and various chemical abnormalities, as well as stroke-like problems. There are other patients who simply have psychiatric problems or feign the condition after perpetrating certain criminal acts or hoping to get an edge in legal cases.

Overall, Transient Global Amnesia is a fascinating condition that demonstrates the complexities of the brain and our limited understanding of what is the organ of the human body that we understand the least. The brain is the last frontier of medicine.