Migraine Aura (Continued)

There were not a lot of responses to my HU post.

It seems that many people experience migraine aura without the headache, including several people that used to have the headaches but now only experience the aura.

I did do a bit of digging; I didn’t find a lot of peer-reviewed science, but there was a reasonable amount of anecdote and experience.

Most medical sites give the cause as abnormal brain activity affecting nerve signals, but this is obviously wrong; the abnormal brain activity would seem also to be a symptom, which itself must have an underlying cause. 

Migraine auras do have an association with catheter ablations; the trans-septal puncture is thought to be the cause.  A majority of people experience an aura within a day or so of the procedure and rarely experience too many.  Even in the worst affected patients, the auras tend to stop after a few weeks as the puncture heals.

Triggers are routinely discussed online.  Typical examples are stress, depression, anxiety, excitement, shock, tiredness / insufficient sleep, shoulder or neck tension, poor posture, physical overexertion, low blood sugar and jet lag.  I think there is quite a lot of overlap with AF in there, but this does not suggest that migraines are a precursor of AF.

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Another migraine aura

I have posted recently about migraine auras.  I used to have regular migraines as a youngster, but these reduced in frequency and intensity over the years.  After my catheter ablation, I experienced a migraine aura, but without the headache; I knew to expect this, so wasn’t worried.

I had a migraine Aura again in early July, which did not lead to headache.  I also experienced one on holiday a couple of weeks ago and again yesterday.   Looking back over the last few years, it has been rare for a migraine to progress to headache; I had decided the cause was low blood sugar/dehydration and at the start of an aura, I would drink fluids, eat something sugary and take a paracetamol.  Since my ablation, I have done none of this and have still not had a headache.  I am now wondering whether the current migraines are not related to my youthful ones, and perhaps are related to AF.

I have posted this on the AFA discussion forum to see if anyone else has experienced anything similar.

https://healthunlocked.com/afassociation/posts/141415816/migraine-aura

Cycling at Work Again

I again took the bike to work.  I went for a steady 20 mile ride around inland Norfolk.

I was quite happy with the 18 mph average, especially as it was quite windy.  It was interesting that the HR went to 177 at the start of the ride.  Unlike recent high HR max readings, this was not a spike but a slow rise to 177 and slow recovery.  I don’t think I noticed this at the time because I was following navigation on the Garmin.  I suspect that this is nothing sinister and due to the strong wind being directly ahead at this point.

Holiday in Spain

Calella panarama.jpg

We went to Calella, just north of Barcelona, for a family beach holiday.  The last time I was in this area, it was between my two ablations.  I was on amiodarone and completely covered up out of the sun.  This time I was medication free, but still heavily coated in factor 50.

After three years of sticking to the government alcohol guidelines, I weakened a little and had a pint and/or a glass of wine or two each night with a meal; not excessive by Brits in Spain standards, but a little more than the weekly limits of 14 units.

After a few days I was starting to get interference in my Kardia readings, which continued when not drinking.  I believe dehydration could be a contributory factor; I was never too good with beach holidays, but perhaps I am now unable to cope.

I also had another migraine aura, during the holiday; no headache, just the blindspot followed by the lights.  Heart related? No idea.  I have another couple of months before my annual check with the cardiologist, so I will continue to collect data.

Migraine aura

18-11-08 HU

I have had migraines as long as I can remember.  They were more frequent, perhaps monthly in adolescence, but dropped to around twice per year in my late teens and less than annually in adulthood. They have always started the same way with a blind spot in the centre of my vision.  A few minutes later, the sight there returns and I get a visual disturbance just to the right and below centre. I know that if I take a couple of paracetamol before this appears I can avoid the headache.

This aura is difficult to describe, but it is a little like a jagged teardrop on its side, filled with little square boxes. Each box is filled with lines, some vertical and some horizontal, like a TV test card. The lines are alternately very black and dazzling white but sometimes give an impression of being blue or red. Each line flashes, with the black and white changing places a couple of times a second. Shortly after the aura I will start to feel ill with headache and nausea.

Last Friday afternoon, I had my first migraine since before my AF diagnosis (more than there years), although I did have an aura just after my RF ablation. This post-ablation aura was completely different in shape to my normal migraine and did not lead to a headache.

Friday’s aura was back to normal, except the blue light was much more than a tinge; it had the look of flashing emergency lights. I was working from home, so I thought I would lie down for half an hour in a darkened bedroom. This was very effective as it prevented the headache and also gave me two and a half hours sleep.

I don’t think that there is a relationship between migraine headaches and AF, although it is possible there are some common factors.  I do find it interesting that the first migraine I have had after ablation was slightly different, but I hope it is another three years before I get a confirmation.

Also posted in the AF forum

https://healthunlocked.com/afassociation/posts/141195698/migraine-aura

Resting Heart Rate

My RHR is still recovering.

In the eighties, during an extended period of being ridiculously fit (which was probably a major contributor to my AF) my resting pulse was 48, but over recent years has been a consistent 57.  On diagnosis of AF, bisoprolol reduced this to the mid-40s again, but the ablations increased this to around 80.  Coming off the betablockers in November 2017 increased the rate to nearly 100.

Between then and August 2018, the rate dropped steadily to around 75, where it plateaued for a while.  Since March this year it has continued to drop slowly.  Last night in bed, my resting pulse was 60; the first time it has been this low since the first ablation.

I check my ECG every evening with the Kardia; I generally do it in the late evening while relaxing watching TV.  This generally gives me a reading slightly above resting.

Here is a graph of the change over time.

19-07-08 HR

I don’t know whether this is an increase in fitness or just a continued recovery from ablation inflammation (or both?).  Although it is very small, there is a definite steady trend to a lower HR over the last few months.

Cycling again

Over the last few weeks we have had atrocious weather and I have been suffering with a cold.  I have also had a few household repairs to do and have been neglecting my bikes a little.

This all changed when the sun finally came out on Thursday and after a week of tedious work problems, I decided that I deserved an early finish and a bike ride.

19-06-27 Strava

There was quite a bit of traffic and stopping at lights, so I was very pleased to see that I had hit my first road average of 16 mph (according to Garmin Connect) since the operation.

This was followed two days later with a slow and steady 31 miles around the local trails.

19-06-29 Strava.png

This was expected to be the hottest of the year so far; there were lots of runners, walkers etc out on the trails.  There was also a colour run in Rother Valley Country park following the earlier park run.  There was so much traffic that I was not really able to work up a sweat for most of the route.

I stopped for a drink and snack in Poolsbrook country park (I recommend the bacon sandwiches) and my old bike got quite a lot of admiration from a few cyclists of a similar vintage.

I had a “rest” in the afternoon; I was intending to paint the decking, but the heat was so intense I found things to do indoors.  I was back on the bike on Sunday for a club run with the slower group; a steady 63 mile around the local flatlands.

19-06-30 Strava

It was hot, but not excessively so.  There were six in the group and we had a fine time.  The speed was a little bit disappointing, but I was not holding the group back, so all good.

I was back to work on Monday and had to travel early to Head Office.  I was expecting to be finished quite early and with no-one else stopping over I would have been at a bit of a loose end.  So I packed the bike in the boot.

19-07-01 Strava

The weather was warm but very windy and blowing almost directly from the East, so the coast road gave quite a good impression of a wind tunnel.  My average was 16.4; prior to my illness I was averaging 20 mph around these roads, but I expect I would have been a little faster without the effects of the wind.  Strangely, the locals consider this to be relatively hilly, whereas the ratio of climb to miles was comparable with my canal rides.

After a slow start to the month, I managed to fit in nearly 150 miles over the last week.  On Friday, Saturday and Sunday I drank a couple of glasses of wine.  In spite of the alcohol, the cycling and the heat I had no heart symptoms and very little fatigue.

I am very pleased with my current level of fitness and prospects for improvement.

 

Overindulgence

Last weekend was my fortieth anniversary of leaving school.  A room was hired in a pub in the next village along from the school we went to.  Food was ordered and a mixtape of music from 1979 was prepared.

I arrived early to help the organiser set up the room, and was pleased to discover that the pub was selling a pleasant tasting beer.

It was a good evening, many former classmates turned up, including some that I had not seen for years and a couple that I had no memory of.

Unfortunately, the beer was too good and the night went on until the early hours.  I got a little carried away and drank too much (too much for a person without any health issues, let alone someone in my circumstances.  I realised quite late on that I was actually drunk, the first time in about four or five years.

I went to bed wondering and worrying what effect it would have on me in the morning.  I woke up fine, with no headache or noticeable ill effects.  I checked my pulse and it seemed fine.  I tried the Kardia and received a “normal” diagnosis.

This all compares favourably with the previous week when I had a mass of ectopics for no good reason.

Ectopics

Prior to AF, I had a rock steady heartbeat.  It was very slow and even, I never experienced any ectopics.  After my ablations the p-wave returned, although it seemed quite suppressed and the rhythm was steady.  I experienced quite a few ectopics, so I recorded them and looked at the change over time.

Before the second ablation I had very few, this increased after the second ablation.  On average I was getting just over one a minute.  This calmed down early this year, to one every three or four minutes.  But I had a very strange reading one evening for no apparent reason.  Here is a Kardia trace.

19-05-29 HR AF

I think this is a huge number of ectopics rather than AF.  I took nine readings over the next hour, one more said “Possible AF”, one was “Unclassified” and the rest showed as many ectopics but were classified “Normal”

There was no reason whatsoever for this.  I was not particularly stressed, I had a relaxing couple of days teaching.  I had not been drinking, I wasn’t tired, and although I was in a hotel overnight, I hadn’t overindulged in expense account food either.

Everything was back to normal the following day.

No recent improvement

It is now 19 months since my hybrid ablation was completed and I am now way outside the blanking period.  Although this is generally agreed to last three months, I was definitely improving noticeably up to one year afterwards and arguably for another couple of months after that.  However, since December last year, I seem to have plateaued.

I have not tried to get back to my previous levels of exertion, I am cycling similar distances to before, but on flatter routes and 2 mph slower.  I have experienced the occasional high HR spike; it is possible that these are unrelated to my condition.  I didn’t dare risk ignoring it, because I delayed diagnosis for two year through thinking my HR meter was at fault.  I am deliberately remaining at a ceiling of 165 HR during rides, even though my previous healthy maximum was 185.

My resting heart rate is finally down to a reasonable level, 63 compared with a previous healthy rate of 57 (and 48 in my twenties when I was seriously fit).  I am guessing that this is not going to reduce any further.  I suspect that I am just less fit than four years ago, as well as being older and slightly heavier.

On Saturday, I tried the first ride in years with a ridiculous hill, one with a maximum gradient of 18% that was taxing when I was fit.  Even then, it used to take me 7 minutes, in contrast to my clubmate Danny, who held the local record of 4:53.  My fastest time made me the 148th rider out of 550 who had attempted it, so not good, but not actually that bad, really.

19-05-18 Bage hill

It didn’t go particularly well; it took me 8:41 (equivalent to the 350th rider) and although I tried to keep my HR low, I am not sure I could have gone harder.  On the plus side, I did feel good on the flat later in the ride and even felt a small improvement on the shorter, less steep hills, although I am still well below my peak.  Hopefully I am just a little out of practice.