Non-headache presentations of migraine -- Dr Nick Silver

Don’t know if this has already been posted. Came across it when looking up about fibromyalgia for a friend.

Original web link:

PDF “Reader” version (better for printing) on the mvertigo server:


Brenda, what a great article!! It describes my problems exactly! Thank you so much for posting. I am going to print it off and take to my neuro next month.

Brenda - that is really excellent stuff. Thanks for posting.

Great information! Thanks.

Great find Brenda.

I’ve edited your original post above to provide more info and a link to this article on our server in a “Reader” format.

This is quite something:

“The World Health Organisation have attempted to assess the disability caused by various conditions and they rank migraine as one of the four most disabling conditions known to man. The hallmark of incapacity associated with this condition is reflected in that migraine is ranked equally alongside other conditions where persons cannot function, such as dementia, psychosis and quadriplegia.”

Best … Scott 8)

This has to be one of the most informative articles I have ever read, and the one that describes my situation exactly. Down to the list of symptoms that leads doctors to believe you are crazy! I had to laugh at that because I thought my list was helpful… :smiley: And I saw it as the only way I could get a Dr. to see all the facts, because after 3 symptoms, the Docs pretty much shut down.

Thanks Brenda, that’s really interesting.

Has anyone on here had a consultation with Dr Silver? I’d be really interested to hear about it.

Beech – tracey c sees Dr Silver. S :slight_smile:

I learned something new from this article (thanks Brenda!) that was very reassuring: periodic limb movements are migraine related. I had wondered if they might be related to Parkinson’s Disease, as I have some PD in my family.

A few years ago I even wrote to an “Ask the Doctor” service on a PD website to inquire if he knew of a connection between PD and periodic limb movements in sleep (I was very involved in caring for my mother at that time - she had PD - and I had on previous occasions submitted other questions about her to this very well respected Parkinson’s specialist). He said there was no known connection, but I still worried that maybe they just didn’t know about it yet! I knew that periodic limb movements in sleep were sometimes treated with a PD medication, so I couldn’t help but wonder…

So when I read Dr Silver’s article and it said they are definitely connected with migraine, I was SO relieved! And the article also states that SSRI’s and tricyclic antidepressants would not be a good choice for me as they could exacerbate my condition - which may be another reason my neurologist started right off with Topamax for me, since I’d informed him about the twitching that sometimes had been full out kicking in my sleep (poor hubby).

Interestingly, my primary care doc - the doc I went to about the kicking problem, years before I started on the MAV journey - suggested I try MAGNESIUM and calcium at bedtime, because that helps a lot of people with this problem. If not, then we could consider stronger meds (I really wanted to avoid PD medication, but I’d injured my hip from kicking so hard, and that’s what finally got me to see the doc about this problem). Anyway, as anyone who’s been around this board awhile knows, magnesium is frequently recommended for migraine prevention. Since I’ve been taking that combination at bedtime, the kicking has been muted and has been limited to mostly twitching (all according to hubby’s report - I’m always asleep for all of this limb action, and have no awareness of it at all).

So thanks for easing my mind on this, Brenda! :smiley:

Beechleaf - Dr Silver is my neurologist. To be honest everything he told me I already had of this site! I’d printed the stuff off and taken it with me - he was really surprised and was happy that I’d got the lifestyle management in place. If you want to know anything about him give me a PM and I’ll answer.
Take care
Tracey x

Pretty much everything in this article applied to me. When I went to the first appt to my new neuro, I had some difficulty trying to explain everything that was going on with me - some stuff I forgot. When I read this article I forwarded the link to him (he responds quite well to email). He read it and said it was excellent and that Dr. Silver was very renoun and respected in this field. Made me feel better!

Interesting article. Tracey, can I ask what Dr. Silver has recommended you take for your migraines?


The sudden limb movements at night are something that’s developed recently in my case. And by “recently,” I mean since I changed not MAV drug–I remain on 75 mG nortriptaline–but the drug I take for (atypical) temporal lobe epilepsy! (Off carbamazepine, on Vimpat.) Along with “chasing rabbits in my sleep,” other MAV symptoms have increased: headache, queasiness, mild vertigo, fatigue, some brainfog. My wife’s freaked, because restless leg syndrome apparently is associated with increased mortality. I have no idea whether that applies when the movements are associated with MAV. I do know that my sweetie gets woken and kept up by this.

David, sorry to hear you are having worse MAV symptoms with the new drug. Why did you change? I thought you were doing well on your combination of drugs. I have suffered with RLS for about 5 years. They say it can be caused by low iron, calcium and magnesium, folic acid and the B vits.

Have read that a cure is to put a bar of soap in your bed! Will be trying that one tonight :smiley:


The magnesium is really the important piece from what I’ve read - I’ve been taking 250 mg at bedtime. I’ve actually stopped taking calcium supplements at bedtime since I have yogurt every evening, so I’m getting calcium and magnesium at roughly the same time (not exactly together, but I prefer to get my calcium that way because I have GI issues that the yogurt is good for).

But the reading I’ve done since my primary doc recommended this a few years ago seems to suggest that studies have been showing it’s the magnesium that has shown benefit for periodic limb movements in sleep and not the calcium, so I’d start with just the magnesium if I was going to try a remedy without consulting a doctor. Less is more anyway.

Christine, Dr Silver has me on Lyrica at 200mg twice a day. Because that hasn’t completely switched me off, he has added in Topiramate (started on 25mg once a day). If the Topiramate doesn’t work or I can’t tolerate it then I have to try Zonisamide followed by the final choice of Propranolol.
Hope this helps.
Take care

Thanks Tracey, I didnt realize he was in the UK, that may be useful for the future.


— Begin quote from "tracey c"

Beechleaf - Dr Silver is my neurologist. To be honest everything he told me I already had of this site! I’d printed the stuff off and taken it with me - he was really surprised and was happy that I’d got the lifestyle management in place. If you want to know anything about him give me a PM and I’ll answer.
Take care
Tracey x

— End quote

Thanks Tracey, I will drop you a PM later :slight_smile:

Thank you for finding this article and posting it here.

I always, pathetically, well up with tears in my eyes when I read something written by a doc, that describes everything I’ve had for years… It makes me realise I haven’t been going insane and makes me want to print eveything off and post it out to every one I’ve ever been in contact with :slight_smile:

Yay for Dr NC Silver.

David - I don’t know much about restless leg syndrome, but I do know that it is different from periodic limb movements in sleep: restless leg syndrome is something you are definitely aware of (because people are so bothered by it they feel they have to move their legs), but the latter (my condition) is something that a bed partner has to tell you about because you are asleep during those movements.

So if your wife believes restless leg syndrome is associated with increased mortality and you don’t actually have restless leg syndrome, then maybe she can un-freak now!