Migraine Awareness 5: #MHAM #CDNmigraine

#Migraine can and does kill through stroke and suicide. #MHAM

migraineurmutteringsandmusings.com

Patients with migraine with aura had a greater than 2-fold increased risk for ischemic stroke compared with patients with migraine without aura (unadjusted odds ratio [OR], 2.4; 95% confidence interval [CI], 1.6 – 3.6; P < .0001). The results held up after adjustment for stroke risk factors.

Migraine with aura had a stronger association with cardioembolic stroke (OR, 3.3; 95% CI, 1.4 – 8; P = .009) than with thrombotic stroke (OR, 2.0; 95% CI, 1.2 – 3.4; P = .01). No significant association was observed between migraine with aura and lacunar stroke.Medscape

I had a suspected stroke myself, but with no evidence it is hard to say whether that neuros speculation was right or not since I didn’t go to the ER. I stopped going to the ER for status migraines a long time ago due to their incompetence, lack of knowledge and lack of treatment. Anyway, I had a status migraine and into it I woke up with half my hand numb. This numbness spread over my entire hand. It is peripheral neuropathy but the neuro speculates I had a stroke of some sort in my sleep. I personally don’t believe so because when the nerve damage was spreading over the hand, it started on the other hand although not as severely. Whatever process started it, it doesn’t sound like a stoke. Nevertheless my Other neuro believes the status migraine caused the nerve damage because they were common when I was working full time (status migraines) and that one in particular had persisted for a bit. Stroke risk is a worry and in particular status migraines are dangerous. Things neuros, doctors and ourselves have to be aware of. I know my doctor and I have had conversations about menstrual migraines and hormonal treatment… and no estrogen based birth control for me but we did try the depo shot for a bit. My neuro also has me trying to quit smoking, not because any speculation it might help with the migraines which he doesn’t believe, but simply because of my stroke risk factors.

It is important to be conscious of stroke symptoms when we have migraines. Be aware of what they are. It seems tricky sometimes with our auras. I have some insane auras that have freaked me out sometimes. And some silent migraines that freaked me out even more to be honest.

Stoke symptoms:

  • Sudden numbness or weakness in the face, arm, or leg, especially on one side of the body.
  • Sudden confusion, trouble speaking, or difficulty understanding speech.
  • Sudden trouble seeing in one or both eyes.
  • Sudden trouble walking, dizziness, loss of balance, or lack of coordination.
  • Sudden severe headache with no known cause.

None of these would alarms me in the least by the way. So I assume Unusual?

Acting F.A.S.T. Is Key for Stroke

Acting F.A.S.T. can help stroke patients get the treatments they desperately need. The most effective stroke treatments are only available if the stroke is recognized and diagnosed within 3 hours of the first symptoms. Stroke patients may not be eligible for the most effective treatments if they don’t arrive at the hospital in time.

If you think someone may be having a stroke, act F.A.S.T.1 and do the following simple test:

F—Face: Ask the person to smile. Does one side of the face droop?
A—Arms:
Ask the person to raise both arms. Does one arm drift downward?
S—Speech:
Ask the person to repeat a simple phrase. Is their speech slurred or strange?
T—Time:
If you observe any of these signs, call 9-1-1 immediately.

Note the time when any symptoms first appear. Some treatments for stroke only work if given in the first 3 hours after symptoms appear. Do not drive to the hospital or let someone else drive you. Call an ambulance so that medical personnel can begin life-saving treatment on the way to the emergency room.

Treating a Transient Ischemic Attack

If your symptoms go away after a few minutes, you may have had a transient ischemic attack (TIA). Although brief, a TIA is a sign of a serious condition that will not go away without medical help. Tell your health care team about your symptoms right away.

Unfortunately, because TIAs clear up, many people ignore them. Don’t be one of those people. Paying attention to a TIA can save your life.CDC

Migraines and suicide 

Pain itself is a suicide risk factor. Suicidal ideation and intent can happen when pain exceeds our coping strategies. Which happens when we have no pain management and we are exceeding our pain limits.

I have had suicidal ideation. I have had suicide attempts. The main difference is that suicide ideation happens when pain levels are high, I get mood dips in the prodrome of the migraine and sleep issues like painsomnia. Even with pain management I have episodes of suicidal ideation although not as frequently as before. With suicide intent and attempts I had no pain management. I was exceeding my pain limits and coping strategies and there was no one there it help me with it. I had a completely disinterested doctor even when I explained I was having trouble coping with the pain. Doctors have little experience or training in pain management. I am stoic when in pain due to… well a very long history of pain. And then there is gender bias as well which I have experienced. I was constantly pushing through the pain. Crawling through existence. A life by inches. With a raw desperation I never want to experience again. Wasted years consumed by pain that it is astonishing I did live through to be honest.

The fact is it does kill. Pain kills. Lack of pain management kills. It is not something that is acknowledged these days but it is a fact. Treatment of chronic migraines is very difficult and not always an easy solution. I have had no luck with preventatives which complicates things. No answer with botox. How to live with the pain becomes a very difficult question with a very complex answer. All chronic pain has a higher suicide rate for this reason. Migraines though, we have something there that really kicks that in gear and it might very well be the mood issues in the prodrome that don’t help the issue at all. Certainly they have been the bane of my existence with extreme migraines. Doctors Need to pay attention to this risk factor. With chronic migraines we need pain management. I cannot stress the importance of a psychologist who specializes in pain as well.

During the 2-year followup period, persons with migraine or severe headache were at least 4 times more likely to attempt suicide than controls. The odds ratio in migraineurs — adjusted for sex, psychiatric disorder, and previous history of suicide attempt at baseline — was 4.43 (95% Confidence Interval [CI] 1.93, 10.2). Persons with non-migraine headache of comparable intensity and disability also had a greatly increased likelihood of suicide attempt as compared with controls: odds ratio, adjusted for the same covariates, was 6.20 (95% CI 2.40, 16.0). [Due to the wide, overlapping CIs the difference between the 2 odds ratio estimates was not statistically significant.]

The likelihood of suicide attempt was not influenced by alcohol- or drug-use disorder, or by migraine with or without aura. However, the average pain intensity score of persons who attempted suicide during the follow-up period was significantly higher than in persons who did not attempt suicide: mean 7.58 (Standard Deviation [SD] = 2.75) on a 0-to-10 scale compared with 5.18 (SD = 3.70), respectively. Essentially, the risk of suicide attempt increased by 17% with each 1 point rise on the pain-intensity scale; or, in other terms, an increase in pain score of 1 SD unit raised the odds of suicide-attempt by 79% (OR = 1.79).

The researchers conclude that their study provides strong confirmation of previous reports on the increased risk of suicide attempts associated with migraine and other headache of comparable severity and disability. Pain severity appears to be a most important etiological factor in this association — more so than co-occurring depression or anxiety disorder, or other factors; therefore, pain-relieving strategies may be of primary importance in these patients. Pain-topics

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