I am a 41 yo male with a history of recurrent ocular migraines following vigorous exercise. These migraines happen frequently (1x/wk). Last month following exercise I had what was diagnosed by MRI as a TIA. With exception of a positive MRI, all tests were normal - carotids, heart (1/5 PFO), clotting factors, etc. Diagnosis was TIA caused by vasospasm associated with migraine. I was told to take aspirin daily but no other medications or restrictions. I was told I could resume exercise and should not be at a significant risk for a subsequent stroke.
I am having difficulty following the logic. I cannot understand how 1) I have recurrent ocular migraines 2) this led to vasospasm 3) vasospasm led to a TIA and yet 4) I am not at risk of this happening again if I have more migraines. Can you assist with explaining this? Should I follow up with additional doctors and if so, what type of doctor should I seek out?
I have not resumed exercise which is difficult but I want to do so safely too.
Welcome to the forum. I am really glad to help you out. In Ocular migraine, there are rare attacks characterized by repeated instances of scotomata (blind spots) or blindness on one side, lasting less than an hour, which can be associated with headache. Ocular migraine is thought to be a variant of migraine in which headache may or may not occur, but there is often a family history of migraine disorder. It is a difficult diagnosis to make as there is no specific test for it, but if other causes of vision loss are excluded, the diagnosis may be thought of. It is more common in women, and symptoms may include transient vision loss, flashes of light in the peripheral visual field, or other similar symptoms lasting usually 30 minutes or less. Headache may or may not begin within 60 minutes and is often one-sided, throbbing, and may be associated with nausea and light-sensitivity. If these migraines are severe, sometimes migraine prophylaxis with medications such as verapamil or divalproex sodium may be helpful.
Distinguishing between migrainous phenomena and TIA is sometimes difficult, but the exact progression of symptoms, combined with other features, helps make the diagnosis. A history of migraine headaches in the patient or many family members, combined with stereotyped events (similar symptoms occurring over and over for years since a young age) favor migraine. A TIA, or transient ischemic attack, is due to a transient decrease in blood flow to a part of the brain. The symptoms that occur depend on which area of the brain is not receiving blood. TIAs are typically not associated with headache, so in the presence of headache, complicated migraine becomes more likely.
It is not possible to diagnose and treat online and hence youâre suggested to consult a neurologist for the same and seek an opinion. I sincerely hope that helps. Take care.
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