WebMD Medical News
Laura J. Martin, MD
Television reporter Serene Branson’s on-air stroke scare following the Grammy Awards turned out not to be a stroke at all. Instead, a migraine was to blame for her slurred speech during the live report.
Footage of that report spread quickly on the Internet, and, for our readers, it raised many questions about migraines: what they are, what causes them, what happens when they occur.
Most migraines do not cause symptoms like what Branson experienced. That makes her migraine "atypical," meaning it was an unusual migraine.
Richard B. Lipton, MD, professor of neurology at the Albert Einstein School of Medicine and director of the Montefiore Headache Center, responds by email to WebMD readers' questions. Lipton did not treat Branson.
"She had migraine with aura, specifically migraine with aphasic aura," Lipton says. "Aphasia" means difficulty speaking (which Branson had), reading, or understanding language.
"The term 'complicated migraine' is an older term that is used to refer to auras that are either long-lasting or nonvisual," Lipton says.
"Of the 35 million Americans with migraine (18% of women and 6% of men have it), about 60% have premonitory features or prodromes. These are changes in mood or behavior that precede headache onset by hours," Lipton says.
"Common prodromes include irritability, sad mood, food cravings, difficulty sleeping, thirst, and hunger. Auras are also a kind of warning. Auras occur in 20% of migraine sufferers and consistent of neurologic symptoms preceding pain onset by 5 to 60 minutes, typically."
"Aura is usually fully reversible," Lipton says. "On the rarest of occasions the aura may never go away, leading to brain damage."
"For the first episode of weakness or language difficulty, going to the hospital is the right thing to do," Lipton says. "For typical aura or recurrent episodes, medical attention is not necessary.”
"Tingling and numbness can be symptoms of what is called sensory aura," Lipton says.
"In people who have migraine, in some situations the chances of having an attack increase in certain circumstances. For example, drinking red wine, eating chocolate, falling barometric pressure are all triggers," Lipton says.
"Stress and relaxation after stress are also triggers in some people. Identifying and learning to avoid triggers are a common strategy in migraine management. Triggers differ markedly from one person to the next. [It's] best to learn to identify and avoid the triggers that matter for you and not everyone else."
"Migraine generally gets worse in the first trimester of pregnancy and better in the second two trimesters," Lipton says.
Lipton says menstrual periods are a "powerful" migraine trigger in many women. "Headache risk goes up from two days before bleeding starts until three days after bleeding starts in many women," he says. That may be due to a drop in estrogen levels.
“No,” Lipton says.
Migraine and epilepsy have some things in common. They're both neurologic disorders marked by "episodic attacks of brain dysfunction," Lipton says.
But migraines are about activation of pain pathways; seizures are about abnormal electrical activity from nerves.
Seizures and migraines do have “overlapping genetic risk factors and overlapping treatments and may occur in the same person,” Lipton says, “but they are distinct disorders.”
SOURCE:Richard B. Lipton, MD, professor and vice chair of neurology, Albert Einstein School of Medicine; director, Montefiore Headache Center.
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