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Migraines sometimes mistaken for strokes

October 31, 2011 12:00:00 AM PDT
A jolt of pain, a feeling of numbness, and the panicked feeling that something is terribly wrong: Those are some symptoms of stroke. But they can also be signs of a condition that mimics stroke. How can you tell if it's a bad headache, or something much worse?

Jennifer Lardizabal enjoys every moment of game night when she can. She suffers from complicated migraines, a condition that affects more than 23 million Americans every year.

During one attack, Lardizabal was rushed to a hospital. She thought she was having a stroke.

"I remember all of a sudden this arm went numb, my face went numb, and I was very, very scared," said Lardizabal.

Neurologist Dr. Ralph Sacco says the symptoms are "stroke mimics."

"They have all the symptoms, they seem like a stroke, but it turns out they are not," said Sacco.

Strokes occur when a part of the brain is deprived of oxygen and nutrients. Victims can suffer vision loss in one eye, sudden weakness in one side of the body or trouble speaking. Stroke mimics have similar effects.

"The best examples are migraine, seizures or having either low or elevated blood sugar," said Sacco. "It's difficult to sort through when you are dealing with a stroke mimic and we still tell people, 'Think stroke first.'"

Lardizabal now knows her symptoms are caused by migraines. But when one hits her, her husband is extra careful.

"He asks me certain questions, so we talk about it just to make sure I'm not having a stroke," said Lardizabal.

Sacco says people who suffer from these symptoms are more likely to have a real stroke later in life, but if treated early, that could be avoided.

Several studies suggest that the use of TPA, a clot-busting drug used to treat strokes, has been safe when treating stroke mimics.

WHAT IS A MIGRAINE? The cause of migraines is still not fully understood. They may be caused by changes in the brainstem and interactions with the trigeminal nerve, a major pain pathway. Chemical imbalances may also be the verdict, such as serotonin. Serotonin, aside from influencing one's mood, helps regulate pain in the nervous system. During a migraine, serotonin levels drop and the trigeminal nerve releases neuropeptides which causes the headache pain.

MIGRAINE AURA: A migraine aura is the migraine that is often mistaken for a stroke. It causes temporary visual or sensory disturbances and may be caused by a chemical wave that passes through the visual cortex, the part of the brain that processes visual signals.

CAUSES: There are numerous things that can trigger a migraine such as: Hormonal changes in women

  • Foods: skipping meals, fasting, alcohol, aged cheeses, chocolate, aspartame, overuse of caffeine
  • Stress
  • Sensory stimuli: bright lights, unusual smells, loud noises
  • Changes in sleep pattern
  • Physical factors: intense physical exertion
  • Changes in climate or barometric pressure
  • Certain Medications

SUGGESTED TREATMENT: Tissue Plasminogen Activator (TPA) is a clot-buster drug used to treat strokes that can be used to treat complicated migraines. TPA is a glycoprotein that directly activates the conversion of plasminogen to plasmin. The way it is used is by directly inserting it into the vein or sometimes directly in the artery at the first sign of stroke symptoms. It was first manufactured in 1983 by a recombinant DNA process and became commercially available in 1988


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