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Please can I ask that this is answered with somebody with specific experience of Hemiplegic Migraine.

My daughter, aged 20, had her first hemiplegic migraine 12 days ago. She has no prior history of migraine (although her father’s side of the family does have mild migraine history).

The attacks started infrequently (every couple of days) but she is now having on average 1 or 2 attacks each day. Mostly the aura lasts <1 hour then the headache/nausea sets in and lasts 2-3 hours. She is now permanently weak and exhausted.

She has visited hospital emergency room 3 times. CT scan was negative for stroke/TIA and they are absolutely sure this is hemiplegic migraine. MRI is booked for Friday.

For the headaches:

Started on Neproxin, no effect.

Now on Sumatriptan 1 x each attack, no more than 4 x daily. We don’t think is working well to abort the attacks. Plus Ibuprofen and Paracetamol.

For the nausea:

She was given first Ondansetron 4mg, 3 x daily, which did not give much relief.

She has just started with Metoclopramide 10mg, 3 x daily. We do not know if this is working yet.

This morning was her worst and longest attack so far - 6 hours long. It started shortly after waking and she had 4 separate episodes of Aura. A violent headache and nausea were constant since the start. We tried 800mg Ibuprofen, 400mg Paracetamol with no real success. We are now trying Aspirin.

May I ask 4 questions:

1. Please can I have some advice on how to best deal with this.

2. Is it normal to have so many attacks over this sort of period (at least 7 attacks in the past 10 days).

3. Does the frequency of attacks indicate that they are still being triggered by something that we have not found yet? Or is it possible that the initial trigger was 12+ days ago (before the first attack) and we are still in some sort of long sequence as a result?

4. A lot of the time don't know what is a single "attack" as the phases are not clear. If the headache and nausea continue but the aura goes and then comes back after an hour, is this one or two "attacks"? We have been told not to repeat the dose of Sumatriptan in the same attack, but we are confused if there is no period without headache/nausea in between.

Thank you

Jeff Ward

Category: Neurologist, Medical

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Category: Pediatric Neurologist
 30 Doctors Online

Hello. Thank you for posting your query at
I have noted the details of your daughter and my replies are below.
1. If sumatriptan is not helping in reducing the headache, then, other options are rizatriptan tablets. The usual dose is 10 mg and it can be repeated after one hour if the headache does not subside with one tablet. For more severe headache and nausea, injection tramadol and ondansetron can be given in the ER.
In addiiton, as she has frequent episodes, she should be started on preventive medications, such as topiramate, divalproex or beta blockers.
2. It is uncommon, however, about 5-10% of patients do have this type of increased frequency of attacks.
3. The increased frequency could be due to an unknown trigger or just be a natural course of the disease, until the medications start having full effect.
4. The absence of headache would signify the end of attack/episode.
Please keep me informed about the MRI brain report. She should also undergo an MR angiogram along with that.
Best wishes,
Dr. Sudhir Kumar MD (Medicine), DM (Neurology)
Senior Consultant Neurologist

Dr. Sudhir Kumar
Category: Pediatric Neurologist
Senior Residency, Fellowship: DM, Neurology, CMC, Vellore, 2001
Junior Residency: MD, Internal Medicine, CMC, Vellore, 1998
Medical School: MBBS, Christian Medical College, Vellore, 1995
Dr. Sudhir Kumar and 4 other Medical Specialists are ready to help you

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