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Friday 20 May 2011

Migraine, potentially fatal if diagnosis missed

Migraine is a unilateral, usually temporal headache of moderate to severe intensity. It is in a third of cases associated with an aura which could originate in the brainstem, optic nerve, occipital or even frontal lobes. Associated symptoms can be diplopia, nausea and vomiting, scotoma or funny odour depending on the area involved. Adolescents have an equal number of males as compared to females suffering from migraines but by early adulthood the women comprise seventy five percent of the sufferers. Women tend to suffer more from common migraines than classical migraines.

If one suffers a classical migraine as a parent, it’s very likely that the kids will too. Women are in the majority of the patients and bear the brunt of the morbidity. Men on the other hand suffer the more severe classical migraine syndromes.

What I want to discuss though is the disastrous consequences following wrong diagnoses either by including or excluding migraine as a diagnoses when it should be otherwise. This is not to minimize the fact that women using oral contraceptives are at a higher risk of strokes if they have migraine. Complicate this with smoking and the stakes keep rising. I will use a personal example from student days. I have classical migraine with third nerve palsy as complication if the episode is prolonged. When I had my first episode in medical school, I was diagnosed as posterior communicating artery aneurysm and prepared for theatre in case of eminent rupture. Through the mist of a sedative (pethidine) I was a third party in the discussion and signing of the consent to operate. Worse still was that even though the pethidine makes one ineffective in decision making it does not stop the migraine headache. I could not tell my family as they would out rightly refuse that I get operated. We have a saying in my culture that once your brain is handled by a surgeon you never the same. You can say the same about the heart. Brufen did a lot more to relief the headache. I made a solemn contract with myself that day that I will make sure if anything that anybody that a neurosurgeon is going to open up and let his or her hallowed brain be exposed to hands and instruments should at least have some pathology to justify the insult.

By the way mine was not exposed in the end because a brave professor called Saeffer dared ask a question,’ where is the aneurysm on the oblique view?’ I have and will always use that which he taught me that what you clinically see is more important than any test or combinations of tests one can ever do as a doctor. It’s probably why I can’t stand American type of medicine.  I still suffer migraine and still occasionally get third nerve paralysis but the difference is that I never let any doctor close during that time in case I get given pethidine. Funny for a doctor to be afraid of what colleagues with investigations in the file can do to a patient. I just meditate my way through the headache.

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