Posted by medlib on May 29, 2000, at 0:52:13
In reply to Re: Unexplained symptoms--Long, posted by Cynthia M on May 28, 2000, at 18:24:33
> Medlib- do not apologize for your lack of brevity.. I think we may have found something here ! Ye s many of the symptoms you have described my daughter has experienced.....extreme pain in bright light ( she has been wearing sunglasses even indoors ) with slight to no constiction of the pupils..and she took a shower yesterday ( immersion in very warm water) and came out feeling horrible and she said she almost passed out.... and she started her period on Thursday, the first day of symptoms ( and her first period in two months due to undiagnosed hypothyroidism) thank you for the web site I will definitely investigate further.. I am wondering at this point if maybe we should remove her from the paxil to rule out any reaction from that... what is your opinion? Thnaks so much for the info... I cannot express how valuable the people here are for so much support I have recieved... any other opinions are welcome.. we definitely know there are no drugs involved other than her synthroid and 40mgs a day of paxil.. thanks again...Cynthia
-------------------------------Cynthia--
Thanks for the kind words. As usual, some of my attempts to be brief end up being cryptic; I'd better clarify a few points.
--By "headache specialist" I meant neurologist. Most neurologists will see new patients only by referral from a primary care physician or NP. Often neurologists specialize in major disorders, such as epilepsy, or Parkinson's--or headache. There's even a journal called "Headache" put out by the American Headache Society at www.ahsnet.org (linked from JAMA's Migraine Center under a slightly different name).
--My emphasis on cardiovascular changes was meant to describe the actions responsible for migraine
Sxs--cerebral ischemia (insufficient blood flow, oxygen delivery). Most Sxs are related to the areas of the brain initially deprived of oxygen; pain is caused by vasodilation. Although migraine Sxs resolve eventually, seratonin abnormalities (which cause the arterial changes) remain, hence the susceptibility to future attacks.
--Cerebral ischemia is also the mechanism responsible for stroke and TIA Sxs, so effects can be identical. Strokes are very unlikely in one so young, unless from a AVM (arteriovenous malformation) or the combination of contraceptives and smoking (neither of which you mentioned). I got the impression that the speech difficulties resolved rather quickly, and you did not mention them in your description of her second attack. (Of course, TIA Sxs are "transient", too, but there should be *no* lingering symptomology from a TIA.) The longer any stroke-like Sxs remain, the greater the possibility that something more than migraines may be involved, I suspect. Photophobia is a characteristic of most migraines, but is less likely to be a stroke Sx, I think.
--The "hands in warm water" test can be a home indicator of increased cerebral blood flow. When hands are heated, blood flows away from the head to the extremities (to "cool" the overheated hands). Many migraine sufferers experience some temporary lessening of headache pain (which, unfortunately, lasts only as long as the hands are heated). Hot water on the head in a shower would only further dilate the cerebral arteries and exacerbate the headache pain.
--It is very confusing that seratonin-based drugs can cause, prevent and/or treat migraines. I don't know enough to explain those mechanisms at the receptor level.
--I would not recommend discontinuing Paxil without checking with her doc first. Paxil, like Effexor, can have distressing withdrawal Sxs, and is best withdrawn sloooowly. NSAIDs such as Advil (not aspirin) are probably okay to reduce inflamation and pain. If she has *any* remaining ischemic (stroke-like) Sxs Monday, I would take her back to the ER and ask them to "rule out" stroke and/or migraines--just to be on the safe side. For instance, I would suggest ice packs to relieve pain, but, until a clot-based stroke is ruled out, it's not really safe to apply cold.BTW, I had a right parietal lobe hemorrhagic CVA (stroke) due to an AVM. I also have migraines, for which I take ergotamine tartrate. But, YMMV. I think my mind "niggle" came from imagining going from a dark bus to bright sun, and from parking lot glare to a dark department store. In a susceptible person, just that abrupt change in light levels can trigger a migraine.
Hope things go well with you and your daughter---
medlibP.S. At the JAMA web site check out the articles in the "Newsline" section for info on the seratonin connection. BTW, one of the problems I have posting here is not knowing how much to explain; if your preferences differ from my output, please let me know.
poster:medlib
thread:34845
URL: http://www.dr-bob.org/babble/20000526/msgs/35050.html