Patient's Query
Hello doctor,
I had a viral infection before few months, where I was too sick with cold symptoms and GI problems. After I recovered, I had a sudden onset of tachycardia, hypotension, and had a full cardiovascular workup. I was put on Midodrine. That has resolved.
Since then, I have had debilitating migraines almost daily for four months. I have severe tinnitus, brain zap like feelings, and in the last three days, I have developed severe tingling and jitteriness all over my body. It started in my tongue. I had an MRI of the neck and spine, which showed minor white matter changes. But this is really impacting my life quite negatively. I also have major muscle knots in my shoulders and neck. I am currently on Emgality and Xanax as needed.
Please guide.
Hi,
Welcome to Icliniq.com.
You had post-viral autonomic disturbances like tachycardia and hypotension that was recovered. After that, you had a severe daily migraine, and for the same, you were started on injection Emgality and Xanax. And now you have tinnitus and since last three days tingling and jitteriness.
Did you notice any improvement after Emgality injection? How frequently do you take Emgality injection? Do you have a feeling of fearfulness and palpitations? What about sleep, appetite, and weight gain or loss? Do you consume alcohol or any other drugs? Have you done an MR venogram at that time?
I hope this helps you.
Thank you.
Patient's Query
Thank you doctor,
I take Emgality once a month, but I consider stopping it because of hair loss. I will have a couple of days of muted migraines, where I still have severe tinnitus and difficulty concentrating without pain. I have lost weight. Right now, my only fear is that I have something more severe going on neurologically like MS or even ALS or something potentially lethal or debilitating. I do not drink, smoke, or use any recreational drugs. And I had an MR venogram.
Hello,
Welcome back to icliniq.com.
I think you should stop Emgality. You should start on another migraine preventive medication like Propranolol or Flunarizine. You should not even think about MS or ALS as your symptoms are not matching and your MRI is almost normal with some bon specific white matter changes those can be seen in migraine.
Do the following investigations:
1. MR venogram.
2. Otologist opinion.
3. Thyroid profile test.
4. Hemogram.
5. Renal function test.
6. Liver function test.
7. ESR (erythrocyte sedimentation rate).
8. CRP (C-reactive protein).
Start tablet Escitalopram + Clonazepam (10+ 0.5 mg) once a day at evening.
I hope this helps you.
Thank you.
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Answered byDr. Prakashkumar P Bhatt
Medically reviewed byDr. Vinodhini J.
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