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Recurrent ocular migraines and TIA

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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.


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replied July 22nd, 2010
Stroke Answer A14501
Hi,

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 you’re suggested to consult a neurologist for the same and seek an opinion. I sincerely hope that helps. Take care.




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replied February 28th, 2011
Correct Diagnosis of Stroke or is it occular migraine??
I too have been diagnosed with a TIA and a PFO. The crazy thing is that I had all the symptoms of an ocular migraine (tunnel vision on left eye the progressed and then shrunk, pain on the right side of my head, sick to stomach briefly) and not one doctor even considered it as a diagnosis. My vision was messed up for several days and then returned to normal. Just now it happened again and faded within 20 minutes. I have been on Pradaxa as a blood thinner to prevent stroke because according to my MRI report, I have what appears to be an infarct in my occipital area. Now, I am either continuing to have small TIA's in that area that magically clear up, or the diagnosis is incorrect. My blood tests all came out perfectly normal. I am an otherwise healthy 39 year old male. I am just wondering if many doctors don't diagnose migraines accurately. Maybe it was a stroke, but all of it is not adding up in my mind.
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replied November 25th, 2011
Visual Migraine Stroke
I am a 52 year old male at 51 I had a similar event, 12 hours after heavy exercise i had a visual migraine that quickly turned into a stroke. I spent 9 days in hospital and mri confirmed two areas of bleed and other tests ruled out other pyshiological defects that could have caused stroke. Since this time I continue to have migraine and occasionally complex migraine which link to extra exercise. I am scared of stroke reoccurrance but have not got satisfactory treatment to help my situation. How have you progressed?
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replied December 8th, 2011
b59b,

First thing I can say is that if you drink any caffeine, get rid of it. Doing so completely eliminated (knock on wood) my ocular migraines related to exercise.

I saw 1, 2, 3, 4, 5 different neurologists. Everyone I spoke with said, given my circumstances, that it was unlikely that I would have a second stroke related to migraine and exercise. However, the 5th said, "That's true but let's not find out." She recommended taking a low dose of a BP medication which also lowers the incidence of migraine. I never took it because the migraines didn't come back.

Your situation is quite different from mine - mine was a dry stroke, I had recurrent migraines that were very predictable, I spent less than 24 hours in the hospital, and I'm 10 years younger.

The things the neurologists I saw investigated, as I'm sure yours would have were: PFO related to migraine, blood clotting disorders related to stroke, structural abnormality.

Though many doctors said that I could resume exercise (some put caveats on mountain climbing at altitude), I waited 9 months until I found an explanation I was satisfied with - probably unlikely to recur but given the consequences no need to be proven wrong. Again, my doctor therefore said that if I was still having migraines I should take medication to reduce the risk of migraines occurring (and therefore another stroke). Assuming the migraines could not be controlled by medication, I would have had to have made a judgement about whether to resume exercise. I do not know what I would have chosen honestly.

Bottom line, my advice to you is to see a doctor who specializes in migraines (a 6 month wait for me) and see what they recommend. This specialist was by far the most helpful. There is limited research out there unfortunately about people who this occurs to. There before the grace of God...

I wish you well and good health.
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replied November 29th, 2012
I have been diagnosed as having tia's, and then as having bascular Migraines.

The events occurred as few as one every several months and as often as 6 - 8 times/day. I was admitted to hospital and submitted to 3 days of testing with no positive confirmation that I had other symptoms which would lead to TIA's.

Upon release I decided to treat myself with a heavy metal chelation therapy. This stopped the events within a few days and they went away for 4 years. They began to re-occur but not with the same frequency, and I repeated the therapy. I suspected my condition to be related to mercury toxicity, due to when the events occurred (frequently after eating seafood). I also tested a diabetes medication I was getting from a cheaper source, and found it to be contaminated with mercury, albeit in smaller amounts..17 ppm.

That is what lead me to try the heavy metal chelation therapy in the first instance. The symptoms have not returned since the most recent therapy..approx. 12 months ago. The symptoms were occurring on a semi daily basis the last time.

My neurologist suggested it might be Bascular Migraines, however he had no solution for same. Hence I went back to what seemed to work the first time.
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replied March 30th, 2014
After reading this I have finally got a name to my blurry vision spells after exercise - Ocular migraine. Have had it for years. I am now getting more of the full blown migraines minus the initial blurry vision (lucky me), I am 52, and very debilitating they are. At least I can put a name to it, thanks.
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