[2023-04-10] Was it a stroke or a migraine?
In a recent conversation, a friend told me about a health scare that her mother had experienced. While the mom's healthcare team had concluded that she had had a TIA (transient ischemic attack) or temporary blockage of blood flow in the brain, subsequently, they couldn't find evidence to support this theory.
The story sounded familiar. In 2011, I had what doctors initially thought was a TIA. When I saw a neurologist a week after the incident, she upped the diagnosis to a minor stroke. Three months later, however, after a battery of tests, that same neurologist was much less sure of what I had had.
The conversation with my friend reminded me of the value of sharing health stories. Informed patients ask better questions of their healthcare team. I know that I would have asked better questions of the neurologist had I known of possibilities other than a stroke to explain the symptoms I had experienced. But I didn't have any understanding of TIAs or strokes, and deferred to the doctor.
I wrote a blog post in September 2011 when "the incident" (as I came to call it) occurred and another piece in December 2011 when I saw the neurologist after undergoing numerous tests. Here's how I described the events that took place on September 6, 2011.
The summer of 2011 was particularly demanding. I knew it would be when I accepted, in May, to lead Strategic and Operating Review for Natural Resources Canada. By the time September rolled around, I had taken only five days of leave since the previous Christmas.
On September 2, I went to work with a terrible cold. My coworkers asked what I was doing there. Important meetings, I told them. I wasn't one to let a cold keep me down. Besides, the long weekend was just around the corner. How hard would it be to make it through one day with three days of rest on the horizon?
But I didn't rest that weekend. I put in quite a few hours doing work for the office.
On September 6, I returned to work, feeling much better. I experienced an aura in the morning and had to ask one of my employees to come into my office to look at my computer because I couldn't see properly. The aura passed. I attended a baby shower for an employee over the lunch hour, grabbing a few bites of food before running off to a meeting.
My husband picked me up at the end of the day, and we drove out to the dog park, as we were in the habit of doing. After 30 minutes at the park, we headed home, but not before stopping at the grocery store.
We finally got home at 8:00 PM. When I got out of the car, I noticed how hungry I was, as I hadn’t eaten well that day. I felt weak and tired.
I walked into my house and up the stairs. As I reached the landing, the heavy bag I was carrying slipped out of my hand. That's odd, I thought. I picked up the bag and carried it into the kitchen. Chris walked in behind me. I was standing in the middle of the room. He took one look at my face and asked: "Jen, what's wrong?" I wasn't sure. In my mind, I was having a perfectly coherent conversation. I feel really tired, I was thinking. But I simply stared at him.
"Jen, what's wrong?" he repeated, with more urgency in his voice. I'm just feeling really tired, I thought. But I couldn't say it. My God, I must be really scaring him, I thought. And then I realized that I couldn't talk, and I felt scared for myself.
A few seconds later, I was able to mumble the word "stroke." By then, though, Chris was calling 911. It was shocking to hear him say to the 911 operator: "I think my wife had a stroke."
With the ambulance on the way, he hung up the phone and asked: "How old are you?" The answer was easy; saying it was hard. "For, for, for-ty fi-ve," I said. I had to concentrate to pronounce my words.
I walked down to the front steps of my house and sat down to wait for the ambulance. With each passing minute, I was able to speak with greater ease.
When the paramedics arrived a few minutes later, I was able to speak almost normally. I felt that I was still stumbling over my words and that I had to concentrate on my speech, though the paramedics said I sounded perfectly articulate. Based on my symptoms, they thought I had suffered a TIA. They gave me a tube of sweet paste to consume, as my blood sugar was low.
When I met the neurologist a week later, she concluded that I had had a minor stroke (not a TIA) since my symptoms—mostly tingling in my right hand—had lasted more than 24 hours. And when she assessed me, she concluded that my right side was weaker than my left.
As a result of the suspected stroke, I was put on baby aspirin and the cholesterol-lowering drug Lipitor. I was also sent for a whole range of tests: CT scan, blood tests to check my cholesterol levels, ultrasound of my carotid arteries, a 48-hour heart monitor, ultrasound of my heart and an MRI.
These were pre-MyChart days. Even though my MRI was done within a few weeks of the incident, I would have to wait three months to get the results from my neurologist. I picked up the story in my second blog post.
I went to see my neurologist recently. Based on my MRI and other test results, she is less convinced that I had a stroke. Instead, she believes I may have had a migraine with complications, given that I experienced an aura the morning of the incident and that migraines run in my family. She pointed out that experiencing an aura without a headache (which is what I typically get) is still a migraine, one she called an acephalgic migraine.
I spent the evening following my appointment researching migraines on the Internet. One site provided interesting descriptions that fit the symptoms I experienced.
Dysphasic Aura... If the speech areas of the brain are affected in migraine aura, difficulty speaking can result, called dysphasia. The usual problem is being unable to get words out, yet being able to think them clearly in your head.
Familial Hemiplegic Migraine... There are families who carry a gene for Familial Hemiplegic Migraines. During their migraine episodes, they can get severe weakness of one side, and may lose speech and vision as well.
I had read about the experience of US reporter Serene Branson who was thought to have had a stroke while reporting on air. In the video of her live coverage from the Grammy’s, she quickly loses her ability to speak. But in the days following the incident, doctors who examined Branson were able to confirm that she had had a migraine with aura. One article noted: "Symptoms of migraine with aura can mimic those of a stroke, including weakness, motor-function loss and numbness and tingling." In an interview after the incident, Branson said she knew what she had wanted to say during her on-air report but couldn’t get the words to come out properly.
When I read about Branson’s story in the days following my own incident, I thought it sounded familiar but rejected the possibility that this is what I had had because I hadn’t developed a headache at the time. And I had thought that a migraine was essentially a bad headache.
My neurologist also suggested another possibility: that I had had inflammation in my brain due to a virus; that too made sense because I had a bad cold just before the episode.
What’s interesting in researching migraines—even the acephalgic or silent type—is that they can be triggered by stress, fatigue, skipping meals, and insufficient exercise—in other words, lack of self-care. One article I read noted:
migraine aura is most likely to occur when your brain is under some sort of mild or moderate stress e.g. you are tired, dehydrated, missed your lunch/breakfast/tea, or are under pressure to get work done and are rushing around. If you can keep yourself less tired, hydrated, eat regularly and reduce stress, migraine aura is less likely to happen.
Another site, providing advice on preventing migraines, suggested:
Results from diet changes, getting enough sleep, and stress reduction may decrease or even eliminate migraines and may be as successful as medications for prevention or alleviation of certain people's symptoms. Migraine aura with its many manifestations is most likely to occur when your brain is under some sort of stress. If you stay rested, maintain regular sleep patterns, remain vigilant about staying hydrated, eat regularly and avoid migraine triggering foods...your migraines may decrease.
The conclusion of that site is that migraine sufferers need to find ways to reduce stress as much as possible.
So stroke, migraine or viral infection, the antidote appears to be the same: reduce stress and take better care of myself.
As much as I told myself in 2011 that I needed to take better care of myself, I would go on to take on increasingly more stressful jobs for the remainder of my career. I continued to work long hours and to sacrifice sleep for work.
I did, however, make one important change in my habits—something I sustained for the remainder of my work life. I avoided getting too hungry or thirsty at work. Wherever I went during my workday, I took something to drink and, often, something to eat. Even while assistant deputy minister of communications at Health Canada, I routinely took food with me to meetings or ate my lunch while meeting with staff. It wasn't perfect self-care, but it was better than going the whole day without eating or drinking properly. Another change I made was to take headache medicine at the first sign of an aura, something I did as recently as this morning.
I have never again experienced an incident like the one I had in September 2011. Occasionally, I've felt a little odd and said to myself, out loud, "Can I talk?" When I could hear words come out of my mouth, I was reassured.
In 2011, I shared the details of my experience to serve as a cautionary tale, not because I wanted attention. In fact, in the first few days after the stroke, I didn't want to admit what had happened. I was embarrassed that, at only 45, I had experienced something that I thought happened only to older people.
However, as people learned of my story, some would tell me of similar situations they had faced. Had I known about auras, migraines, TIAs and strokes, I might have shared with the healthcare professionals who saw me in 2011 that I had just gotten over a bad cold, that I had had an aura the morning of my incident, and that I had eaten poorly that day.
I came to realize that the simple answer isn't always the accurate answer. I was lucky to receive good news from the neurologist in December 2011.
Of course, sometimes the simple answer is the accurate answer, as I would discover after a visit to the same emergency department nine years later. In July 2020, I would have preferred to have been told that I was having a gallbladder attack rather than ovarian cancer. Again, though, had I been more aware of the signs and symptoms of ovarian cancer, I might have sought medical treatment sooner.
That's why I will always advocate for sharing health stories, if only with our own family members and close friends. As I've shared before, "Knowledge is power. Knowledge shared is power multiplied."
