Complex Migraines

Complex migraines can be extremely frightening to patients and at times baffling to doctors,..even neurologists. This is because many times the symptoms mimic a stroke.

Fortunately, this is not a common type of migraine. Most migraines have common symptoms such as photophobia (light hurts your eyes), phonophobia (sound bothers you), and nausea and vomiting. These symptoms resolve by the time the headache is over. What is of concern to medical professionals is if these symptoms go beyond the headache phase by hours, or if there are new more severe symptoms.

Complex Migraine Symptoms

The symptoms that are a bit unusual with this type of migraine and may look like stroke, includes the following:

  • Weakness, or a sense of heaviness on one side of the body
  • Tingling that progresses from fingers or toes up the body limb
  • Blindness in one eye
  • Seeing half of objects
  • Slurred speech
  • Mental confusion
  • Moderate to severe head pain


One of the first things to know is that your physician most probably will order a complete neurological work up to rule out a stroke. Complex migraine is not the first thing on the list that a doctor is thinking about...it is the last thing. This is because it is not a life threatening situation whereas as stroke may be.

A complete work up will include a CT or MRI of the brain, blood work, possibly an EEG (electrical study of brainwaves) and an MRA of the brain's arteries. Additional tests should include carotid artery dopplers and perhaps a type of doppler called a transcranial doppler. This is an ultrasound study that gets a look at the arteries at the back of the head, the vertebral and basilar arteries. The reason to look at all of these is to make sure blood is flowing to the brain the way it should. 90% of blood to the brain comes from the carotids, but 10% comes from the vertebrals and basilar artery.

Let's assume all tests come back normal. What is left then is a diagnosis of complex migraine.


Treatment is the same as regular migrainous headaches. Daily prophylactic therapy of anti-seizure medications or some other medication is a good idea. Why?? Because of the severity of the symptoms. It is a good idea to treat this to calm the brain down a bit and reduce the symptoms. After all..you wouldn't want this to happen while driving.

As with other headaches, acute therapy includes triptans or ergots (DHE). The best headache medication is the one that takes your pain away in under 30 minutes and allows you to return to your activities.

Keep in mind that you must look at the stressors in your life, stop smoking, exercise three times a week minimum, and put yourself on vitamins to prevent this problem. This includes magnesium, vitamin B2, and feverfew.

Read more about different types of headaches.

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