Complex Migraine

The confounded symptoms of brain injury and migraines…

Ten years after Sarah’s brain hemorrhage, I was driving to an appointment in the middle of my work day, when I received a call from Sarah. When I answered the phone, she was frantic and said, “Dad…I can’t see”. I heard what she said, and my heart started beating really fast. While I was pulling over and trying hard to have a calm voice, I asked her to repeat what she said, and of course she said the same thing. I asked Sarah to tell me what had happened and her location. She told me that she was walking on campus when she suddenly could not see anymore, but she was able to sit on a short wall at the campus bus stop. After a quick chat, I knew exactly where she was, and started heading that way. I reached Sarah’s location as fast as I could. I don’t know how long it took or how I got there as I was in a terrified shock.

After parking, I stepped outside to help her into the car. She seemed less frantic. Apparently her vision had started to return, thank god. But I headed to the University Hospital ER around the corner anyway. On the way to the hospital, I was trying to maintain a calm conversation, asking her for more details. She explained that things suddenly seemed too bright, then she started losing her sight while developing a massive headache. A headache for us is a scary thing. Her brain hemorrhage symptom was a headache, and we were warned to head to the nearest ER anytime she experiences such a severe headache.

While driving to the ER, I could not help but recall those dark days of her brain hemorrhage, which left her with many issues including right superior (top right) peripheral vision deficiency. Once at the ER, they ran a CAT scan and sent a neurologist to examine her. After all the necessary testing and checkups, the neurologist reported no new issues, and informed us that her CAT Scan looked the same as the previous one, with no changes. The neurologist recommended other more specific testing, and a visit to a neuro-ophthalmologist.

This was relatively good news, and at this point, we were both relieved but exhausted from this experience. But now we faced a new challenge figuring out what just happened. How was this related to her AVM condition, or was this a consequence of brain injury?

Three things to point out about migraines. First, Sarah had struggled with headaches and migraines since elementary school, and we became aware of the cause after she was diagnosed with AVM. Second, the brain hemorrhage itself started with a severe migraine along with projectile vomiting. Third, the Gamma Knife radiation treatment and the biological changes in her brain had contributed to a new kind of migraine, aura migraine, which starts with a vision issue. In her case those issues were magnified because of her peripheral deficiency.

Most brain injury survivors suffer one form of migraine or another. Some are stress and anxiety related, and some are just the nature of the beast, meaning it is part of the brain injury itself. Thankfully, most migraines can be diagnosed and there is a variety of medicine or medicine cocktails available to help.