Frustrated, Not diagnosed and Don't Know Which Way to Go...Need Help/Suggestions

Hello Everyone,

I’m new here and very frustrated with what has been going on with me for the past 6.5 weeks now. I do apologize for the lengthiness…

About my past first…
I started getting headaches in 2012, which I found out were hormonal. Initially excederine would work then it didn’t. Then when I had a 3 day long headache and trip to ER, which they thought I had meningitis so I let them do a spinal tap (which was negative). They tried Tylenol 3 worked and it worked. Then it didn’t. Then in Jan 2014 with another 4 day long headache and trip to ER and cocktail mix it didn’t work. So my neurologist admitted me to the hospital for 3 days which he was able to get rid of my headache. After that he gave me sumatriptan to use, which has worked ever since. I get a headache and I take sumatriptan it would go away within an hr. I barely got headaches because I only got 9 sumatriptan pills and they would last more than a year or two.

My vertigo episodes started in 2013, which my first one I believe was stress related and was really bad. I was really dizzy for a few days but it went away. Since then I have only had 5 episodes, just a random times. Two of them were since May 2023.

On 10/23/24 around 930pm I was working and felt a little unbalanced when I got out of my car to go to the passenger side to get something I couldn’t reach. I noticed I was a little more unbalanced when I went to go speak to someone. On the way home, around 1130pm I felt a bit dizzy. I figured it was my normal vertigo episode kicking in. When I got home, I wanted to use that Divertigo oil but forgot I ran out and decided I would run to CVS in the morning. I also noticed I was more unsteady on my feet than I normally am with a normal vertigo episode. I was stumbling more and I even kicked over my baby gate (that’s for my dogs) that has been there for the past year. I didn’t pay too much mind, I just did my normal night routine and slept on my left side because when I sleep on my right, during a vertigo episode, the room starts to spin clockwise. On 10/24/24 I woke up and went immediately to CVS to get the Divertigo oil, to put behind my ears, and got the vertigo meds. Then I tried to walk my dogs and I was stumbling everywhere. Even the sun appeared to bright for my eyes. When I have a vertigo episode, I feel a little unsteady but never stumbling, just mainly dizziness, which lasts 72 hours. I called my primary care and scheduled an appointment for that afternoon. Well since I’m an exercise junky, I decided to go to the gym anyway. My friends saw I was stumbling a lot and even thought I was drunk. I just told them I had vertigo and we laughed it off. I was good with most of the crossfit movements that day until I got to bench press and the world started spinning.

I went to my appointment and that’s when things started going downhill. My doctor asked a bunch of questions and then asked me to do the shin test, when you take one foot and run it up and down your shin. I could do it with my right foot but I could barely do it with my left. My doctor even saw some nystagmus in my left eye. She noticed some other things, I guess, enough to alert her that she thought I might be having a stroke. She said she was on the fence of stroke and vertigo and wanted me to go to the ER. So I called a friend to come pick me up and take me. At the ER, I needed help walking because it felt like the floor was tilted and I couldn’t walk straight or keep my balance. When the nurse asked me to do certain things it was like I could comprehend but I couldn’t get my left side to function correctly. So now at this time I could barely walk, I was dizzy and unbalanced, my left side wasn’t functioning properly, and I was talking kind of slurred/slow. They decided to admit me for observation for a possible stroke and wanted to get an MRI. At this time, I finally started getting a headache. They did CT scans and finally after days of being there and trying to get an approval for an MRI, due to having a bladder stimulator, they got one done. Initially they told me I had a stroke but later said the MRI said I didn’t. I ended up staying in the hospital for 7 days, got out 10/31/24 and they left my diagnosis as a complex migraine and to follow up with a neurologist.

My symptoms in the hospital were dizziness (which they gave me meds for and it went away), left side weakness both hand and leg, headache (constant in the temporal lobes mainly left side), eyes sensitive to light, left eye peripheral issues, complex movement skills were off (couldn’t walk on heels or tip toes, couldn’t do heel to toe) balance/coordination was off (felt like I was getting on and off a treadmill), had tingling in hands and feet.

For my headache, initially they wouldn’t give me Sumatriptan, which typically helps with my headache and make them go away quick, because they wanted to wait to get the MRI done. But of course, it was delayed until 10/29/24 because of the bladder stimulator approval issue. So they tried Firocet, Depakote and then finally Sumatriptan and even the main migraine cocktail plus steroids but my headache was persistent and still wasn’t going away.

My CT scans w/o contrast were clear, but my CT scan with angiogram showed a small cluster of vessels, measuring 7 x 4mm, within medial aspect of the left temporal lobe which could be a vascular malformation. However, my MRI which only did MRA on the circle of willis, said everything was clear.

After leaving the hospital I had the following symptoms left side weakness in the leg not really noticeable in the arm/hand, headache (which was constant in the temporal lobes mainly left side, mostly pressure but when angry it migrates to the front) felt like swelling over my left eye, both eyes sensitive to light, left eye peripheral issues, complex movement skills were off (couldn’t walk on heels or tip toes, couldn’t do heel to toe) balance/coordination was off (felt like I was getting on and off a treadmill). I also couldn’t look down to the left or lean my head to the left or I would get dizzy.

I went to training course for two, which I thought would be easy for me since it was only sitting, doing math equations and listening. Well this is when I found out that anything scrolling, fast zig zag movements and camera bouncing made me dizzy and nauseated. So I started closing my eyes during those type demonstrations. Driving was a bit of a struggle initially from the head movement, but I soon learned to compensate to be able to turn and look in my blind spots.

I finally went to my first neurology appointment on 11/8/24, which I didn’t see the neurologist because he had covid but I saw his PA. The PA believed I have a hemiplegic migraine. I brought up the possibility of an AVM and he said my results should clear, but my CT angiogram didn’t say clear. So he said basically because I had migraines in the past this is just a migraine and all my symptoms resemble a migraine. So the PA put me Topiramate and Ubrelvy for hopes this would cure my migraine and all my other symptoms would go away. The Ubrelvy made my head worse (tried it two different times). The Topiramate, I started having auditory hallucinations, the left bottom portion of my face became numb and I started having ringing in my ears, plus having memory issues (either forgetting words or short term memory issues like forgetting people’s names in the gym who I see every day) The PA even said I can even go back to the gym, so I did. There I noticed I wasn’t as strong. I normally can do a 300lb deadlift and now 75lbs feels heavy, I can’t do front squats, back squats or overhead squats or power cleans because my mind and body aren’t functioning together. A 35lb barbell throws me off balance a bit so I have to use the small 25lb bar. I could normally do over 100lbs in snatches, but I can’t get over 70lbs without being off balanced. I can barely jump so double unders are off the table plus the coordination part. I can’t run or even do v-ups because I can’t get my raise high enough or move fast enough.

11/19/24 I went to another ER, because someone suggested they could probably solve my issue. For two days they tried the original migraine cocktail twice and two different migraine cocktails (using combinations of Toradol, magnesium, sodium, camosine, decadron, sumatriptan). None of these worked to get rid of my headache. Even one doctor didn’t believe the headache was causing all my issues, so they did an MRI on my T and C spine but found nothing. So they just left my case as a complex migraine.

So by then it’s been about 4 weeks and my symptoms are left side weakness in the leg not really noticeable in the arm/hand, headache (which is constant in the temporal lobes mainly left side, most time pressure but when angry it migrates to the front). There’s nothing that triggers the headache just constant and gets angry whenever. I still felt like theres some swelling over my left eye, both eyes sensitive to light, left eye peripheral issues, complex movement skills were off (couldn’t walk on heels or tip toes, couldn’t do heel to toe) balance/coordination was off (felt like I was getting on and off a treadmill), brain and body disconnect, eyes can’t track things bouncing, zig zag or scrolling or I get dizzy and nauseated, left lower portion of face is numb, constant ringing in ears, now a wave of a heat sensation in my left ear (of and on), plus memory issues.

So because the Ubrelvy and Topiramate didn’t work the PA put me on Qulipta. This is now my 10th migraine medicine and nothing is breaking this headache or changing my symptoms.

I started PT which the physical therapist does neurology disorder type stuff (like strokes, concussions, vertigo, MS and so on). My physical therapist did a couple test and noticed I have a vestibular issue but was negative on the PPPD. I started working on eye and head exercises as well as strength and coordination. So far I have a hard time trying to walk backwards at a normal pace and I can’t even raise my knee and tap a cone with my foot at a normal pace. How does someone who was super fit going to the gym 6 days a week and practicing for a mini sprint triatholon go from that to having issues tapping a cone?

11/25/24 I went to see my second neurologist. I explained all my issues and told them I was on my 10th headache medication that’s not working. He basically told me I have multiple things going on but can’t diagnose me because he’s unsure of what is causing my problems and to just followup with my first neurologist office. I brought up the concern about an AVM and he told me AVMs don’t cause any symptoms and that if it did I should be having problems on the right side.

12/3/24 I followed up with the PA and he put me on Amitriptyline and Nurtec, which still no relief of any of my symptoms.

12/6/24 I followed up with another neurologist, this time I still got the I can’t diagnose you and maybe it could be functional neurological disorder (FND) and to follow up with a psychiatrist since I already have a therapist and am doing PT. He was even unsure about the FND because of my symptoms being constant for the last 6 weeks, where I don’t have any good days or bad days. I brought up the concern about an AVM and he told me AVMs don’t cause any symptoms and that if it did I should be having problems on the right side. The only other thing he suggested was upping my 10mg dose of Amitriptyline to 25mg to try to get rid of my headache.

So now I’m very frustrated because I can’t work, still out on sick leave because of this, and I can’t workout like I normally would. I don’t know which way to turn because no one has even tried to run test to rule anything out. Do I try to find a specialist who knows a lot about AVMs, do I try to get a second opinion on FND, or do I sched an appointment with this Neuro-ophthalmologist/neuro-otologist, that my physical therapist recommended that she believes will probably run some test?

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Welcome! There’s a lot in there!

I’d say if you’re concerned about an AVM or other brain vascular abnormality, find a neurosurgeon who is familiar with such things and get their input.

I disagree that AVMs come with no symptoms! Most neuros will tell you that migraine is not related but there are sooo many people here with at least migraine-like symptoms that there’s no way that’s true either! Having said that, nobody will tell you that having surgery will resolve migraines: the objective of surgery is to reduce the risk of a stroke only. The brain is so sensitive that the idea of doing something invasive like surgery to resolve migraine or migraine-like symptoms would be crazy. No, surgery, if it is ever recommended, is likely to focus only on the stroke risk.

Very best wishes,

Richard

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Thank you for taking the time to read my post. I’m taking you up on your advice and speak with a neurosurgeon.

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Do let us know how you get on. It is often that people don’t get to the root of things first time, so you’re not alone.

Best wishes,

Richard

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Welcome, and I certainly echo what Richard has to say. There are certainly a few really good medical possibilities around MD, and I would push for an angiogram. Not being a Dr. but if a CT indicated a possible AVM from my lay person vantage point, that would be next. I had a CT that indicated a bleed and the immediate next stop was Angio to figure out why. Hopefully we are able to pass along some of our experiences that are helpful for you. Take Care, John.

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I most definitely will. So far I have one lined up 12/27 because I was able to get an appointment online. I did reach out to two other places but of course they are closed on the weekends so I’ll see if any of them respond today or tomorrow with something sooner. Thank you again.

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I definitely appreciate the input and thank you. That’s what I was trying to push for but was going about it the wrong way. Being at home on sick leave not being able to work (in law enforcement) has caused me to really do some research. Will keep y’all posted on this.

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@EvilChaos333 I am so sorry that you are not getting the help you need. As I found out there are many types of MRIs and each sees different things. MRVs sees the veins and if we have clots and the MRAs types looking for the AVMs.
Please be careful on Amitriptyline it has lots of bad side effects.
as someone who started to get migraine since 1990 and wasnt diagnosed correctly at first.
When I had my cvst stroke I started to see the head of stroke, head of pain and Neuro radiology at Stanford all in 2011 to present. Also another neuro friend of mine who is the top epileptic neuro surgeon at UCSF who also gets migraines who diagnosed me said a low percentage of people these meds just don’t work on.
my migraines got worse post stroke and post avm
you can have your scans reviewed remotely by the top avm Dr who used to be at UCSF but is now at BARROW in phoenix Dr Michael Lawton .
Thank you for your service
Angela

Thank you for taking the time to read and respond as well and for your input. Well I learned something new about MRIs. I thought they were all the same.

What were you initially diagnosed with? For me, it just seems like everyone here is sticking with the “well since you had vertigo and migraines before this is what it is.”

I stopped the amitriptyline because it was doing what it did to me like 10-12 years ago…gain weight. I initially took if for severe endometriosis pain and it worked wonderfully but the 50lb weight gain was unacceptable. This time, within a week I noticed I was getting hungrier than my normal. Plus without being as active as I normally am, I would blow up quick. I also do believe I had to ween myself off of it last time, with a natural home remedy I found, because I was using it for a good while. I’m not trying to go through that again. I did try to take the rizatriptan they also prescribed with the amitriptyline but that didn’t help either. I use to use sumatriptan and my headaches would go away within an hr but not it’s been almost 8 weeks and it’s not breaking. Nothing is making it better and it sporadically gets “angry” at times and I don’t know why. I call it angry because it goes from it’s constant pressure feeling in my temples to this sharp somewhat throbbing pain that migrates to front of my head. When I wake up now it’s already “angry” with a good bit of pressure. I did notice when I hold my breath for the steroid inhaler I take for my exercise induced asthma, which hasn’t bothered me in years but this year has came back bad, my headache gets “angry”. I also noticed, yesterday when I worked out, doing goblet squats and goblet lunges I became pretty disoriented afterwards.

Every time I did my research, BARROW, kept popping up. I even thought about using them. I did just look up their requirements for the second opinion. The only issue with my case is that I’m not diagnosed yet and it says that you have to have a diagnosis first. So I don’t know how much they could help me at this time but I will definitely keep his name in mind, if I need it down the road.

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@EvilChaos333 Hello I was first diagnosed with the blood clots in March of 2011 which caused the stroke and coma - I was having severe headaches , seizures ( catatonic type) blurring vision , trouble sleeping. neck pain - I just thought my migraines were changing and did not complain to anyone for three months until the day before my stroke to a friend and put my neuros phone into my phone but never called.
Then in November of 2011 they found the DAVF after I complained of whooshing and passing out. turned out mine was retrograde and making my blood flow backwards. The earliest they could do the angio and treatment was Jan 2012 . I did have another stroke but recovered right away thankfully.
To give you some reference about how rare davf are my Dr at Stanford Dr Marks who is now retired was one of the top Drs in AVM and he only saw about 12 of us a year and people came even from out of state as I meant one myself one day waiting for him.
When I asked him how they choose what treatment to use he said it was based on his years of experience what would work in each case - and prior to me no one had had a stroke from his surgery and really my brain was still recovering from the massive stroke from the previous year and I was under for 7 hours which I think was too long for me.

So my personal advice is to not use a young Dr you want someone who has done a bunch of us.

If you have anything in your brain you want to interview the Dr and ask them all sorts of questions. I usually write them down ahead of time and bring a friend or family member.

I know when I had my blood clots I was told not to work out esp with weights and the only things I was allowed to do was walking and light swimming.

You might want to see an eye Dr to check your optic nerve and if that has pressure they will order an MRI or send you to a neuro and get the ball rolling.

also I have endometriosis too and I also have something called Ehlers Danlos which we are supposed to avoid surgery so after my stroke they switched me to Natural Compounding Progesterone and all my Endo pain went away! I wish they gave it to me in my 20s anyway I have my Dr fill my script for 3 months via Belmar Compounding Pharm in Colorado and they ship and they will even provide you a list of Drs in your area that use them,

At the pain clinic at Stanford I have literally had every kind of pain pill and shot they offer. They do offer botox shots which do help the severity of my migraines , my stroke head pain and my TOS pain. They also were in the beginning giving me shots in the Occipital area of the head with lidocaine and ripocaine. But I became allergic but I am super sensitive and am allergic to many pain pills etc so don’t be alarmed by this.

Hugs
Angela