An elderly woman w/ pmh migraines w/ aura, HTN, med non-adeherence p/w stuttering distal R arm numbness involving the finger and BP > 200 with recent similar presentations. Symptoms resolved spontaneously and ultimately the patient was not imaged (had recent imaging), and discharged with a presumed dx of TIA vs migraine.
-Key differential points included TIA vs. Migraine vs. Hypertensive Urgency
-Use of the ABCD2 Score to assess future risk of stroke and guide hospital observation vs. discharge from the ED – this patient’s ABCD2 score was 4 points which placed her at at 6% risk of stroke at 7 days
*Options for migraine prophylaxis include calcium channel blockers (Verapamil, Diltiazem), B-blockers, TCAs (though be careful in elderly because of risk of anti-cholinergic side effects); antiepileptics (Depakote)*
-Key tips for suppression of migraines that we can tell our outpatients: importance of consistent diet, exercise, and sleep
-Avoiding triptans in the setting of hypertension