Indeed, in the case I'm dealing with the chap was left with a permanent 
homonymous quandrantonopia, with the scotoma being similar to his usual 
visual aura. Although there was macular sparing I imagine it must be quite 
disabling, but very rare I suspect.

AF

----- Original Message ----- 
From: <[log in to unmask]>
To: "Adrian Fogarty" <[log in to unmask]>; 
<[log in to unmask]>
Sent: Monday, July 31, 2006 10:44 PM
Subject: Re: Re: Migraine/Triptan therapy

Saw a lad of 12 two weeks ago with hemiplegic migraine that lasts up to 9 
days.
It was his third episode when I saw him.
Surely he is going to stroke out one day poor  lad.
Some fancy MRI flow study is needed or some such clever stuff.

APV
Scarfborough

Thanks Vic!
>
>Has anyone seen or heard of significant complications arising as a result 
>of
>untreated migraine? I'm thinking in particular of migrainous infarction but
>it must be rare as hen's teeth (and I see most of the literature out there
>groups migraine in with all the other "benign" causes of headache). Don't
>suppose there's any evidence surrounding prevention of such complications
>either although one might argue that triptans should in theory be more
>specific at aborting the vasospasm.
>
>AF
>
>----- Original Message -----
>From: "Vic" <[log in to unmask]>
>To: <[log in to unmask]>
>Sent: Friday, July 28, 2006 7:55 PM
>Subject: Re: Migraine/Triptan therapy
>
>I suffer from Migraine occasionally and make sure I carry a triptan around
>in the car, in my bag, at home, and on holiday. I find I have 20 minutes
>from the start of the right inferotemporal scintillating scotoma to the
>onset of the headache and a triptan aborts it completely if taken at that
>stage. Now I know lots of people react differently so this is just personal
>experience but I know it has helped others.
>
>I really suffered as a kid, but basically I was bullied by big brother 
>(some
>of you know him - he's in medicine too). My migraines resolved largely when
>I realised at the age of seven that I could win the fight if I kicked him 
>in
>the gonads (Stress relief, empowerment etc). I started with migraines again
>as a GP, then read the label of this new Red Bull drink I'd taken a fancy
>to. Then a few years ago I started having daily migraines. I was actually
>having one when a young lad came in with his mother. He was getting
>migraines too. Mum asked if I had a list of things he shouldn't eat and I
>went on Google to find one. I found this
>http://altmedicine.about.com/od/popularhealthdiets/a/migrainediet.htm
>I had started having banana smoothies for breakfast. If I don't have more
>than three bananas a week I'm fine. I've given the printout to hundreds of
>patients now and they almost all report that the migraines get a lot less
>frequent. As for the others - they just have to learn to kick the bugger in
>the balls!
>
>Vic Calland
>
>-----Original Message-----
>From: Accident and Emergency Academic List
>[mailto:[log in to unmask]] On Behalf Of Adrian Fogarty
>Sent: 28 July 2006 07:47
>To: [log in to unmask]
>Subject: Migraine/Triptan therapy
>
>What is the accepted wisdom on the management of acute migraine these days?
>Do most people stick with the tried-and-tested methods of analgesia,
>anti-emetics and fluids? Or do many of you now use triptans, and if so, in
>which particular patients or perhaps as a routine? Am finding it very
>difficult to find any good evidence or consensus on this particular
>question. Any advice gratefully received.
>
>AF
>