Antiplatelet therapy for optical migraines s/p AVR

[pedimed]

Hi all,
I thought I would share this as I know many of us have had this experience and it is a frequent topic of conversation on this site.

I am 35y/o and had an aortic root aneurysm repair and AVR with St. Jude mechanical valve in 2007. Over the past year or so I had begun to have daily optical migraines. They would progress many times to numbness and tingling on one side or the other of my face, and hand/arm and aphasia. After trying many things, and MRI was done adn was normal. I then met with a neurologist to discuss, he happens to be a stroke expert. He has a theory that in patients with mechanical heart valves is that these optical migraines may be caused by microemboli traveling to the retinal vessels, and that a small amt of an antiplatelet drug, such as asprin or similar may help these symptoms.

I finally was able to try an 81mg asprin along with my other medications (Warfarin and Verapamil) and (knocking on wood) have not had any of these episodes over the past month.

Granted it is always possible other factors are at play but the correlation seems pretty clear, and coincides with his explanation of what is occuring...

I have attached an article he authored that discusses this possibility...

I feel the need to mention that if anyone is considering adding anything, especially aspirin, that they consult their cardiologist first.

Leah

 

[realkarl]

I had migraines with an preceding aura a couple of times a month before my valve replacement surgery, but stopped having them after. I started 81mg aspirin the day after surgery. I sometimes have the preceding aura, but they no longer develop into migraines (in more than 1/2 year now). Maybe the aspirin is the reason..

 

[catwoman]

A friend who is a retired professor at a college of optometry told me several years ago that the optical migraines are related to interrupted blood flow and are common after OHS (this was cited in the pdf article). Mine started 2 days post-op. My dad has had them for a long time, consulted with a neuro-ophthalmologist; he's never had OHS.
I've taken the 81mg aspirin -- no longer taking it -- and still had episodes while on it. Perhaps my PVCs could be related. I dunno. My PCP and cardio aren't concerned about them.

 

[tobagotwo]

Optical migraines, also called visual migraines or atypical migraines are very common both before and after valve surgery. However, they're not at all limited to mechanical valve owners.

Some thoughts...

There are questions whether they are related to microemboli, which may presumably come from any valves (but are much more associated with mechanical valves), or from vasospasms caused by stress, reactions to blood pressure medications, or other unattributed sources. As it spans valve types, doesn't seem to show up in other places or lead to eventual strokes, and it's difficult to show evidence of microembolisms (eye scans rarely show any residue that might be expected), the microembolism theory may be too simple. And Coumadin should be doing a great job of keeping all embolisms, regular or micro in check, at least the great bulk of the time. The skinny is that right now, no one knows.

So, if aspirin is doing it for you, that's great. It's certainly worth trying. Do be mindful of possible intestinal bleeding from aspirin while on Coumadin.

However, aspirin, and even aspirin with Plavix or warfarin doesn't do it for a lot of us. Similarly, Magnesium can help some people enormously with arrythmias, but doesn't work for everyone.

But for those it works for - go for it. Helping some beats the heck out of helping none.

Best wishes,

 

[hall]

Ok, so I am the odd ball. I had optical migrains since I was a child. I saw half moon zig-zag designs that are bright only on one side. I do not believe I have had one since my AVR. I have a tissue valve.

 

[tobagotwo]

Actually, a fair number of people say that their valve surgery cured their optical migraines, whether they'd had them for a long time, or only for a short while before the surgery. So you're not such an odd duck after all.

And others who never had them before seem to suddenly pop up with them after the surgery. I had them intermittently for a couple of years before the OHS, and still get them now, although not often.

The only conclusion that seems to fit all the occurrences is that they are often somehow related to valve problems in general. Not much meat to that.

Best wishes,

 

[pedimed]

Thanks all for your experiences.. Ironically, the morning after I wrote this I got another one! LOL.. of course Regardless it seems to be helping. It is interesting the myriad different things that wokr or do not work for people.. It is all so multifactorial.
Best,
Leah

 

[tobagotwo]

I would look at stress as a major factor for this. While stress is not likely to be the entire reason, it certainly seems to be a trigger. Stress can cause vasospasms, and this might combine with the "x-factor" to kick these episodes off.

Best wishes,

 

[pedimed]

Bob, this made me smile.. you hit on something I neglect to apreciate as much as I need to.. Indeed for me, a busy and stressful full time job certainly is likely als to be a significant contributing factor in my optical migraines as well as my overall health.... I am also working on improving my fluid intake (dehydration can be causal..), and sleep!
Best,
Leah

 

[RANDYJEAN]

I love this forum! Every time I have a question, boom! There's the answer...or at least a discussion.

I've had optical migraines all my life, and my theory has always been that they were hormonally related. Yes, I know men get them, too--and men have their own hormones, right? But check out my history:

First time I ever experienced them...puberty.
When I was about 21, I went on birth control pills and on the first day of my period, I ALWAYS had an optical migraine.
Quit taking birth control pills after 1-1/2 years, and never had the migraines again until....late forties...hello, menopause!

I related this to my gyno, and he pooh-poohed the whole theory. Said it had nothing to do with hormones. And now, I'm thinking...okay, yeah...because I've had FIVE optical migraines since Saturday (which would be 10 days post surgery).

From what I gather in reading some of the older threads here, plus this one, there doesn't seem to be a real answer; just that it's nothing to worry about, huh?

But interesting...my valve problem stemmed from a congenital heart murmur, so maybe that's why I've had these optical migraines my whole life.

~Randy

 

[tobagotwo]

Well, there's no reason that you can't be just as correct about the hormones. Stress and hormones go hand in hand. And not everyone who has atypical/optical/visual migraines has valve issues. There are so many things that kick up again at menopause. You, of course, got both...

Best wishes,

 

[pedimed]

Menstrual migraine is actually quite a common phenomenon.. so as Bob mentioned, very possible this was a trigger...

 

[traveler]

I've had migraines with flashing lights for as long as I can remember. They seem more often but less severe following valve and aneurysm surgery. I don't know the reason but its nice that they're over much sooner.

 

[OldNick]

My wife and I, both in late seventies, have the lights and zig-zag patterns, but normally, no pain. Mine started about a year after OHS following endocarditis, to install St. Jude mechanical aortic and mitral valves. My wife has had no heart surgery. We have never defined a triggering mechanism for either of us, though I sometimes feel that stress could be a contributing factor.

Our solution is usually to drink a caffeinated soda; for us, it is usually Mello Yello. I know that caffeine is supposed to be a no-no, or a cause of migraine, but when I related this to my PCP, he said use whatever works.

 

[Marcia58]

I started getting migraines with a preceding aura when I hit pubertty. Over the years, I found that a daily magnesium supplement lessened their frequency and severity. Since my OHS, I still get the occasional aura, but never the headache.

BTW, my neurologist told me the official name for those flashing, shimmering auras. You ready? They're "scintillating scotomas"!

 

[Bill B]

I've had migraines with flashing lights for as long as I can remember. They seem more often but less severe following valve and aneurysm surgery. I don't know the reason but its nice that they're over much sooner.

I've had this since I was 13 and it has not gotten better or worse since the AVR last year. Just had one tonight. Mine are related to stress (I've been doing my taxes).

I never heard them referred to as "optical" migraines, but rather classic migraines with visual aura. The shiny, zig-zag visual disturbance you describe is an aura that precedes the headache, although some people don't have noticebale headaches. My headaches are quite mild, and I just feel a bit tired. Sometimes I just have an aura and nothing else. Some migriane patients have auras involving other senses. Mine have always been visual. The other name for the visual aura is "scintillating scatoma": http://en.wikipedia.org/wiki/Scintillating_scotoma The basic mechanism causing this is a spasm of the blood vessel near the visual center in the brain, and the headache that follows is from rebound vasodilation.

The disturbances described by Leah and in that article sound similar but different in ways from common migraines. Interesting. I'm glad she has gotten relief by antiplatelet therapy.