It can be a frightening and disconcerting experience to speak to someone and realize that what is coming out of our mouths sounds a bit like a golden retriever.
This is one of the many symptoms of Migraine with Aura that sidelined my personal life. It was also breaking news when Serene Branson suffered transient aphasia in the middle of her live news report.
Aphasia is an acquired condition in which the patient loses the ability to do one or more of the following: speak or understand speech, read or write, perform or understand mathematical tasks.
Aphasia can occur suddenly or over a period of time. In the Migraineur, it is usually a symptom of aura and comes on suddenly. It feels a bit like this – One moment you are speaking and understanding a conversation, and the next moment *POOF*you’re in another country, confused and completely out of your element and out of control.
Thankfully unless the Migraine patient suffers a condition called persistent aura, or permanent damage occurs due to a Migrainous stroke, aphasia is temporary. It comes and it goes. Physicians call this Transient Aphasia, because it is not a permanent deficit. It does not require therapy to overcome.
What happens during an attack of aphasia?
It is now understood that Migraine aura is the result of an electrical wave that pulses across the brain called Spreading Cortical Depression. As the unusual electrical wave spreads across the brain, our neurons fire in an abnormal way and our brains can become confused. We see things that aren’t there. We may feel, hear or smell things that aren’t there too. Even our sense of time and space may be altered. As the spreading cortical depression hits the parts of our brains responsible for these and other functions (such as language) we experience strange aura symptoms.
There are two different parts of the brain responsible for language. They are called Broca’s area and Wernicke’s area. Each area controls different parts of language — 1. Function, and 2. Understanding.
Broca’s area is responsible for function — speaking, reading and writing words and numbers. (Words and numbers are all part of language) Aphasia in this area of the brain is often called non-fluent aphasia or expressive aphasia, because the individual has lost the ability to speak words or sentences, although the ability to understand language has not been affected. The patient will struggle to find the right word or number, and not be successful. The reason these patients have aphasia has nothing to do with loss of motor skills in forming words — it is a neurological phenomenon.
Wernicke’s area is responsible for understanding words and numbers. Aphasia in this area of the brain is often called fluent aphasia or sensory aphasia, because although the patient can speak using mostly normal words, they are often nonsensical – as if the words’ meanings had been re-arranged. The person speaking has no idea they aren’t using language correctly and will often be shocked when later presented with a recording of their conversation. They also cannot understand what anyone else is saying to them.
There are many different ways to classify aphasia, but those classifications are usually restricted to permanent deficits. When the aphasia is caused by Migraine, it is usually and simply called transient aphasia. A patient suffering aphasia is called Aphasic.
Migraine patients often may not simply suffer aphasic symptoms from one or the other area, but mixed types. Additionally, one aphasic experience may not be as severe as the next — or vice versa. Just as each aura is different, each experience with aphasia may be different too. Knowing how our brains work normally and during a Migraine is often helpful however, in relieving stress from the unknown.
Knowledge truly is power! I sometimes have aphasia — what can I do?
Carry a wallet card explaining your condition: These cards can be purchased from various aphasia websites, or you can simply create one yourself that says something like: “Hello, my name is ______ and I sometimes suffer transient aphasia as part of Migraine aura or side effect of a medication I am taking. This means I may not be able to understand or speak to you right now. To help me, please call ________.” Don’t forget to warn the person (or doctor) whose phone number you’re using that they may receive a call. Help them by providing them with instructions you would like them to give the caller such as: How to contact someone for transportation home. Where your medical information is located. Where you store your medications so a helper can get them to you. How to contact your spouse or physician.
Carry an instruction sheet that includes the information above, as well as contact information for significant others who can help you.
Carry a small pad and pencil with you.
Carry a smart phone with GPS tracking enabled. An example of one program that allows “friends” to see where you are is: Google Latitude
Consider creating a one button text code to a loved one that indicates your situation when you’re alone.
Remember to create an auto dial number for ICE on your phone (In Case of Emergency) and direct it toward someone close to you who is usually available. Emergency personnel depend on these numbers and will look for them. Multiple ICE numbers can be followed by #1, #2, etc. May also code APHASIA with an emergency number in your phone too. This will help emergency personnel or helpers to assist you.
Remember — no matter how confused and alone you feel, You. Are. Not. Alone.
What can my loved ones do to help me?
Keep paper and writing tools handy “just in case”.
Use gestures if necessary.
Speak slowly and carefully and give plenty of time for single word responses.
Use drawings or pictures to be understood
Educate yourself about Migraine and aphasia so you can advocate for your loved one when they have lost their own voice.
Plan ahead and practice — what will you do if you receive a call from someone trying to help your loved one?
Be ready with hugs of encouragement. Don’t lose patience. Give plenty of time for your loved one to try to communicate with you.
Be sure to summarize a thought or idea you think they have and give them the opportunity to nod or shake their head to indicate their agreement or disagreement.
Remember this is a temporary situation beyond their control. They are alone and scared.
After the attack is over, review together what happened and make any changes to your plan necessary for the next time.
Aphasia and Migraine medications
Aphasia is sometimes a part of Migraine aura (often mistakenly called Complex Migraine — an antiquated term) but it can also be a side effect of preventive medication you may be taking for your attacks. Be sure you cross check all your prescriptions for this potential, no matter how rare they may list it. Gabapentin and pregabalin are two examples of medications that list aphasia as a potential side effect. Do you know of any others?
If you have recently (last 6 months) changed your preventive and suddenly are experiencing transient aphasia, consider talking with your doctor about it. Any changes in your normal Migraine pattern needs to be discussed anyway. Your aphasia may be a symptom from your medication and changing meds may be warranted to see if the symptom disappears on its own. Your own aphasia may be short and not affect your life much at all. Then again, it may be serious and even necessitate major life changes like it did with me. Either way, it is a severe symptom that you will want to be sure and minimize. This means education and becoming proactive.