By Dr. Dave Hnida

DENVER (CBS4) – The term “complex migraine” describes something that can scare us doctors like few other conditions.

Now, your first thought might that we are simply talking about a severe or unusual headache, after all, the word “migraine” is in there. But headache can be one of the least severe symptoms, and in fact, may not even be present at all.

But what unnerves doctors—and obviously the patient—are the other symptoms.

Those symptoms mimic a stroke.

Meaning, what we see is a patient brought into our emergency department with numbness, weakness of an arm or leg, slurred speech, blurred vision, a dropping face, and a laundry list of other symptoms that show that an area of the brain is not working properly. It can start with extreme weakness or “flu like” symptoms before the other show up, a process than can take hours to days. Sometimes the neuro symptoms are so mild, you are able to fight through them, if only for a bit.

When it’s a stroke, there is a loss of blood flow to a specific area from a clot or bleeding. It can cause permanent brain damage.

When it’s a complex migraine, it usually means spasm in a blood vessel in the brain or some other problem that makes an area of the brain temporarily stop clicking on all cylinders. It typically is not permanent.

The big problem is that we often cannot immediately tell the difference between the two without some super quick testing.

We will run an CT scan to look for bleeding. We will perform a MRI to look at brain tissue. Some doctors will also run a scan with dye through the vessels that supply blood to the brain to make sure they are open and flowing. We also check the heart and run blood tests.

And if someone has a history of a previous problem with blood flow to the brain, like a TIA (transient ischemic attack or “mini-stroke”, we really know we have to move quickly because we can’t afford to waste time or be fooled. (Incidentally, a TIA is a condition where a blockage of blood flow to the brain is temporary, and no permanent damage occurs.)

Now, back to the Emergency Department. Once we run the tests and feel comfortable that there hasn’t been a stroke or TIA, we look at other possibilities like “complex migraine”, and often will give a “cocktail” of medication that includes an anti-nausea drug, an antihistamine, an anti-inflammatory, with occasionally some other ingredients thrown in. Obviously, we keep you around to keep an eye on you.

We try to figure out what happened and why. Frankly, we technically don’t even call these things “complex migraines” these days—mainly because there are about a dozen other variants of migraines that have neurological symptoms. And with all of the variants, putting a finger on one specific cause can be difficult.

But we do believe, like with regular migraines, that things such as stress, lack of sleep, lack of food or fluids can all trigger something like this to happen.

The treatment afterwards is fairly simple: rest.

Then some more rest.

All while trying to come up with a formula for prevention. These complicated headaches often have a genetic component, so if you get one, you may be prone to get another. And some research suggests that your risk of a stroke may be a little higher than average if you get headaches with visual or other neurological symptoms.

That’s where medications may help, as well as lifestyle changes. Changes that we all know are easier said than can be done.

Sometimes you just need to do the best you can, and keep your triggers to a minimum.

Bottom line, if you think Gary Kubiak just had a bad migraine, think again. It was a situation where medical teams and trainers worried something bad was happening, and took no chances. It had to be scary for everyone involved, especially the Coach and his family. Fortunately, the outlook is good.

And we all get reminded, football is only a game, not life.

Dr. Dave Hnida is CBS4’s Medical Editor. He blogs about the latest studies and trends in the health world. Read his latest blog entries, check out his bio or follow him on Twitter @drdavehnida 







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