FAMILY MEDICINE® COLUMN

By John C. Wolf, D.O.Associate Professor of Family Medicine Ohio University College of Osteopathic Medicine

SON HAD RARE "STATUS MIGRAINE," NEEDS TO PLAN FOR NEXT ATTACK

Question: Our 31-year-old son has had migraine headaches since he was three years old. Sometimes he has difficulty talking or getting up when he has an attack. He has seen many doctors with this problem over the years and has also had many "normal" MRIs. They always come back with the same diagnosis -- migraine. In October he had a headache that became so severe he couldn't get out of bed, eat or drink, and then he began talking "out of his head." We took him to the hospital, where he was admitted to the psychiatric ward. After four days he was almost back to his old self so they released him. He does seem to still have a bit of confusion, though. He thinks that we bought all new furniture while he was gone even though nothing has changed. Is this type of migraine attack common?

Answer: Migraine headaches are common, but your son's form is quite rare. Before I talk more about his problem, I want to tell you about the more common forms of this disorder. As strange as it seems, the brain itself has no pain sensors. The covering of the brain, the attachment structures, and the supplying blood vessels do have them, however. In addition, muscles, blood vessels and other structures of the face have pain nerve endings that when irritated are perceived as a "headache."

The current theory of migraine says that the disorder is triggered by a brief narrowing within the blood vessels supplying the brain followed by a swelling of them. This process stimulates the nerve endings within the vessels and, thereby, creates pain. At the same time, a poorly understood temporary dysfunction is activated within the brain itself. Together these changes within both the blood vessels and the brain produce the migraine headache symptoms.

About 50 percent of migraine sufferers have symptoms that precede the attack of pain. Sleepiness, blurred or otherwise distorted vision, numbness or tingling usually in an arm or leg, and confusion are common examples. When the headache begins, it is on one side of the head only. It is usually quite intense and made worse by physical activity, bright light or by noise. Many suffer nausea and generally feel absolutely miserable. Some individuals lose vision, have numbness, are unable to properly move a body part, or have other signs that would in someone without a history of migraine suggest the presence of a stroke or other serious neurologic disorder. Most migraine attacks subside within three days if no treatment is used. That is a long time to suffer! The prolonged attack and severe neurological symptoms that your son experienced is more than a common migraine. His attack is called a status migraine, and it requires prompt hospitalization and the administration of the proper medication. You may be concerned that some emergency department physician had your son admitted to the incorrect unit. I wouldn't fault him or her for that decision because there are several psychiatric disorders that cause an individual to withdraw from interactions with others and become unable to take care of their own needs. The important thing is that he received good care and was able to come home in only a few days. After a migraine it is not uncommon to have some confusion for a while. After status migraine, this period can last for several days. I imagine that your son has returned to his normal state by now.

An important thing for your son to do is to talk to his doctor about the benefit of taking medicine and adjusting his lifestyle to prevent or reduce the frequency of future attacks. This is also good advice for any migraine sufferer. In addition, your son should develop a treatment plan for any additional attacks that he may have, and this plan should be communicated to the appropriate family members.

"Family Medicine" is a weekly column.

To submit questions, write to John C. Wolf, D.O., at Post Office Box 110, Athens, Ohio 45701.

Past columns are available online at http://www.FamilyMedicineNews.org.