Migraine and Hypertention

by Sarah
(Buffalo, ny )

Hi Mary Kay. My name is Sarah, I live in buffalo. I came accross your website while searching for information on various type of migraines. I am 25 years old and I have been suffering from debilitating migraines since I've been 21, however this past year they have increased to almost 2-3 per week.

Additionally, I also have an extreme heart rate (usually resting is about 110 but ranges to 150) as well as high blood pressure (this afternoon it was 178/110)

I have had MRI's of my brain, an MRA of the neck, mra of the andrenal glands as well as the abdomen. I've had a stress test, an echo and currently I am waiting for the approval for a thoracic aorta mra. I am on 1200 mg of lebelalol, 150 mg of tekturna and 50 mg of sprinactolone, 100 mg of topamax, Daily asprin, magnesium, fiorcet as needed. I recently discontinued use of depakote and indomethicen as well as calan 240mg.

My migraines are so aggressive.. My aura mimics stroke like symptoms, I slur words when I try to speak, I'll say the complete wrong word also.. It gets confused coming from my head to mouth it seems. I lose all feeling in my hands and I have muffled hearing usually as the first predictor that a migraine is coming. The pain never comes first but I have only about 10-20 minutes before the pain is there, and there it stays for up to usually 3-4 days. My longest migraine has been 7 days.

Pheochromocytoma has already been ruled out at this point. I cannot take abortive meds because of the increased risk of stroke so I'm limited in what I can do here. I do not take birth control and haven't for at least A year and a half.

I have been evaluated at the Cleveland clinic for my hypertension and the reasoning for my blood pressure being elevated is quite unclear however I was told that I have to keep trying to control my bp with various medications until I find the right combo that works for me... I'm on the 10th blood pressure medicine I've taken in 4 years. I appreciate that you take the time to read these emails, I think it's so kind of you. I saw the message that these emails are on hold until you return, but I thought I'd give it a shot so you may see it when your back.

Thank you for your time, Sarah


Hi Sarah,

Thanks for the complete history. It is so much easier to answer when I know what is going on.

Your work up has been very complete and appropriate. I am going to assume that somewhere you saw a renal specialist who ruled out renal artery stenosis.

As far as your migraines are concerned, if you can tolerate an increase in the topamax, think about that. We consider 100mg to be the starting dose and range it up to 600mg for migraine. Talk to your neurologist.

I do have a couple of patients who have severe hypertension and because of this, I have basically cut to the chase and given them Botox for their migraines. If you have 15 headache/migraine days per month or more then you qualify. I have been doing Botox for our patients for about 6 years and had some good success with this. If you are interested, call our office at 250-2000 to see me and talk about it. Our clinic apparently, (according to Allergan the makers of Botox) has more experience and uses more Botox than any other headache center so far.

You mentioned in the title that you have auras with your migraines. Have you had a PFO (patent foramen ovale) ruled out? That is a small hole in the heart and it is associated with migraine with aura.

Stopping indomethacin was a good choice as it could raise your blood pressure. If you have not tried Keppra, Zonagran or Seroquel these are also good choices for severe migraine. Seroquel however also has the potential to raise BP.

Good Luck..come and see us if you want.

Mary Kay Betz MS RPA-C

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Exercise induced vertigo

by Anonymous

For the past 3 months, whenever I try to run I get very dizzy and nauseous. When I stop, I vomit or dry heave and it feels like the world it spinning. I need to lie down for at least an hour before the nausea and vertiginous feeling goes away. The feelings of dizziness last for several days afterwards.

I always eat before I run (milk, cereal, fruit) and drink enough water. I have had an MRI which came back normal. My blood pressure was normal. I am not overweight. I have never had this problem before. It happens even if I try to run for 5 minutes. My doctor gave me a motion sickness pill but it did not help. I do not run anymore because of this and I really miss it and do not want to give it up.

I saw a neurologist who thought that this behavior fell into the category of a migraine variant--a variation without headaches since I do not have headaches. I have no history of headaches and there is no history in my family. However, I have not been told what I can do to stop this problem. Please let me know what you advise. I appreciate you help. Thank you.



A sudden onset of neurological symptoms such as you describe does warrant an MRI. Although aneurysms can be seen on an MRI, to rule this out, I would consider an MRA to get a better look at the arteries. You do not give your age, if you are over fifty this must include carotid dopplers, too. Finally, a trans-cranial doppler or TCD will measure the ability of the arteries at the back of the brain, to push blood to the brain. Sometimes vertigo can be caused by this, and it can also screen you for a PFO (patent forament ovale) which is a small hole in the heart.

I would also consider a test called BEAR or brainstem evoked auditory response. This can determine if the problem is coming from the brainstem.

The problem with vertigo and dizziness is that it is either neurological or cardiovascular. A full work up should look at both, especially the cardiovascular end if it is exercise induced. Have you had a cardiac stress test?

If in the end the diagnosis remains vertigo, many people respond to a few months of Elavil or amitriptyline low dose taken at night. I usually have to move the dose up slowly from 5-10 mg at night (few hours before bed) to 40 or 50 for vertigo.

If the problem is coming from the arteries at the base of the skull, verapamil might be a better choice.

Basically, given the information, I would recommend you return to your primary care and discuss further testing.

Good luck!

Mary Kay Betz, MS RPA-C


I am a 52 yr old black female who has been experiencing exercise induced vertigo for the past yr. The symptoms include dizzieness, sweaty/clammy skin that last for about 2 mins after beginning my run within the 1st 10 mins. It seems when my heartrate increases, the symptoms begin. I resort to walking after that. It doesn't matter if I'm inside on the Treadmill or outside running. I had an MRI done in 2000 and 2003 for a benign microadenoma tumor due to an imbalance of my prolactin and estrogen. I am possibly in my perimenopause stage of life. History of being anemic, so I take Floradix Iron Supplement and Vitamin D3 for calcium intake. No other medications consummed. Would it be fesible to see a Physical Therapist who specializes in this area?


I will assume the anemia is under control. If not, when your heart rate goes up, you may get dizzy as you are not getting enough oxygen quickly enough.

Secondly, you need to have your heart checked out to be sure there are no underlying arrythmias causing the problem as sometimes these are silent. This does not sound like vertigo (room spinning) but vasovagal symptoms of lightheaded-ness. Lightheaded-ness may require a tilt table test. Talk to your primary care about seeing a cardiologist to get both a tilt table and an echocardiogram.

Best of luck!
Mary Kay

When I read your post, I felt some comraderie. My passion is running and since 1999 I've been having a similar experience. What started as sporadic has become chronic. Now after about 12 min of running I get an aura and uneasy feeling, as I continue I black out and 50% of the time vomit. After seeing all the specialist you mention and then some, I gave up trying to get to the bottom of this. This also happens when I cycle and even happened in the pool. This is a very rare condition, but a very real condition. It is not life threatening, and can be controlled by not doing what we enjoy, but hey, let's band together and see if we can figure this out.

Hi, I have the same kind of problem. I Am 24yrs old healthy male, exercising regularly at least 5 times per week and I took a fat burner called Animal cut a month ago just for one day and at the same day I had a hypertension attack about 159\100 with headache was considered as a migraine. But now the blood pressure back to normal 100\65 and the headache still present but has increase after I joined the gym again but with vertigo an nausea invoked by exercises specially weight lifting. And soon Am going to have the MRI.

1-headache: frontal, occipital, and behind the eyes
2-Vertigo with nausea invoked by exercises
3- normal hypertension
4- healthy diet with salt restriction and excess intake of water
5-I vomited once on my 1st day at the gym (may be because I have exhausted myself)

need answers:
1-what the possible cause ?
2-what are the best investigations should i have?
3-do u recommend anything to do?



First of all if anyone in your family has migraine (even minor with menses) then you have the migraine gene. It sounds as if the hypertension event set it off.

I assume you are seeing a neurologist since getting the MRI.

Vertigo is a common symptom of a severe migraine and at this point you are in status migrainosus. Aggressive treatment at this point should include IV infusion of steroids with magnesium, but if your doctor can't do that, a course of prednisone for 2-3 weeks would help.

In the presence of normal blood pressure and no aneurysm, triptans are acceptable treatment while on the steroid. You may have to wait until the MRI is over for the triptans.

Additional treatment should include either low dose verapamil or amitryptiline which is what we use to treat vertiginous migraine.

Best of luck!
Mary Kay

I I have been affected by exercise-induced dizziness since I was about 30 (now 49). It first occurred with running. Then with cycling. I resorted to swimming, where it does not occur, for exercise. The dizziness attack of the 1s kind occurs after 8-12 min. of exercise, and comes on as a spike event, leaving the world falling before me. I can still ride & no one would notice. Over the years a 2nd kind began, which occurs about 2 min. after the 1st kind (with continued exercise). 2nd kind involves extreme sudden & utter dizziness (fall over on bicycle). I throw up & cannot move 1 inch. for about 30 min. Recovery from 1st kind (resting) is about 5-10 min. I went to the Stanford Medical Center ENT Clinic and the Neurology Dept. Later I went to the Univ. of Wash. Med. Ctr. Lastly I went to otoneurologist Dr. Jeffrey Brown of Portland, Oregon. I have seen general physicians, neurologists, ENTs, neurootologists, otoneurologists, cardiologists. I've had stress tests and all sorts of other interesting tests. No one has been able to satisfactorily diagnose the problem, let alone provide a cure or treatment. (Brown thought it might be some form of episodic cerebellar ataxia, which is more or less a description of the problem.) CT scans, MRIs, MRAs of the brain and inner ear were clear. My passion is with cycling. I recently discovered I can ride a recumbent trike (Catrike 700) just fine. The only caveat is that when riding in a tree-lined area on a sunny day, the strobe effect can bring on the dizziness spells as well. I suspect some kind of epilepsy at play or multiple systems. No drugs I tried from Dr. Brown worked, I tried several. Here's a potentially useful webpage:


I've had to resort to my doctor's "DDT" advice:

"Doctor, doctor, it hurts when I ..." "Well, then Don't Do That!"

Best wishes.


Interesting case..you do not mention whether or not you had been tested for vitamin B12 deficiency which can cause severe neurological symptoms.

I would agree that this is either cerebellar, or brainstem. If brainstem, amitriptiline would work once over 50mg per day.

If cerebellar, a calcium channel blocker should have helped.

Good luck!
Mary Kay

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Migraines vs seizures

by JM

I have had migraines for years and at the age of 63 I had my first seizure. I'm now seeing a neurologist and taking Keppra. Prior to the seizure my migraines had been getting better.

Since the seizure I have had a constant tension headache that is not throbbing but pressure related and will not go away. My migraines have always been on the right side and this pressure headache covers my whole head. Should I be seeing a different specialist?



Hi JM,

I am going to assume that with a new onset of a seizure you had a full work up to rule out a tumor or other seizures. This would be and MRI with and without contrast, EEG, and possibly some blood work.

Keppra may have worked well for your migraines but sounds like it is not working for this new headache.

Without more information it is hard to say what type of headache you are having, as it may be a tension type headache.

I would see the neurologist again and discuss your options. Have them examine your neck to see if this is influencing the problem. A short course of steroid or perhaps anti-spasmotic may help the situation.

Good Luck!

Mary Kay Betz MS RPA-C

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Migraine, vertigo and tremor

by Clare


I have a patient who has had a diagnosis of Menieres for years. From her history I think she may actually have vertiginous migraine. Interestingly she also has a diagnosis of atypical parkinsosn or PSP, that she says puzzles the neurologists.

Do you ever see parkinson's type symptoms with migraine?


Hi Clare,

First of all, PSP as you know is extremely rare. In 10 years of practicing neurology, I have see only a handful of cases and none survived beyond 6 months. Parkinson's is much more common and seems to have a genetic component among some groups of people such as the Irish and Italians.

Although anxiety, depression, and IBS.
There is some thought now that fibromyalgia is also associated with migraine to a small degree.

Now..the vertigo. Many migraineurs have vertigo or even mild dysequilibrium just before and/or during a migraine. What makes migraine vertigo different from vertiginous migraine, is that in the later, the vertigo overwhelms the migraine. The migraine really isn't that severe but the vertigo can be disabling.

I had a case of a Physician Assistant who worked in surgery and virtually could not stand up the vertigo was so severe. We could not get her to an appropriate dose of verapamil for this as it kept dropping her blood pressure. Finally we settled on a low dose of verapamil (about 40 mg) and increasing doses of amitriptyline. I had to start her at 10mg 2 hrs before bed and work it up to 40mg. These patients respond around 40-60 mg at night. The anti-cholinergic effects of this med really help settle the brainstem and dampen the vertigo.

Hope this helps....

Mary Kay Betz MS RPA-C

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