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Personal Reflections...
The Face

My reflections on facing Parkinson's...literally.

A changed facial expression. Because the facial muscles that normally create expression don't move as well, people with PD sometimes appear to look uninterested or sad when they are not. This is known as hypomimia.

Believe it or not, what has bothered me more than the tremor associated with Parkinson's is  this subtle yet steady changed my face has experienced in recent years.  Originally we were thinking the dystonia was causing my right eyebrow to appear frozen much lower than my left eyebrow, giving my face a lopsided appearance.  Sometimes it's not as noticeable, but on bad days I can barely open the right eye.  I've said that I feel like I'm becoming a Human Picaso Painting.
It's frustrating to think that people think I'm just really ticked off all of the time and looking at them as if I'm very cross when, in reality, it's just the stiffness of Parkinson's.  The face really just locks into a rather cross stare.  Try to remember that those of us with Parkinson's really are smiling on the inside and we're really not ticked off (okay, sometimes I when the kids leave their wet towels on the wood floors...then the ticked off face is for REAL). Although the ridigity, stiffness and/or drooping in the right side of my face can be contributed to the Parkinson's and Dystonia, there is yet another contributing factor:
In November of 2004, after several years of experiencing ptosis in my right eye and having been hospitalized for the third time in a year for severe migraines, my neurologist has added yet another diagnosis to my medical records. In addition to Young Onset Parkinson's, he now says I also suffer from:
Opthalmoplegic Migraines.
 This is COMPLETELY UNRELATED TO MY PARKINSON'S DISEASE, yet my Parkinson's symptoms can worsen and become more pronounced during a Migraine attack. Our Parkinson's symptoms tend to respond negatively to any type of stress, whether it's environmental, emotional or physical. We also have to be careful how we treat my migraines because of the Parkinson's medication and/or negative side effects on my Parkinson's due to Migraine medication.
  • This is a very rare variety of migraine headaches often involving symptoms associated with the paresis of the third, fourth and sixth cranial nerves.  In a majority of the cases, this condition occurs in childhood, with cases ranging from infants to adolescents, and in rare cases in some adults (aren't I lucky).  The third cranial nerve is the one affected most. 
  • A unilateral (may be alternating or bilateral in some) headache may last for hours or days, and patient may have dilation of the pupils (mydriasis), coupled with the inability to move the eye upward, downward, or medially, as well as a drooping (ptosis) of the upper eyelid.  I also experienced a severe sensitivity to all lights and sounds during the attack, severe vomiting resulting in dehydration, numbness in my face and ultimately my Parkinson's symptoms (even though unrelated) would become much worse during attacks and recovery.
  • The symptoms often follow the headache, but they may also precede it, as they did in my case.  Recovery occurs in 4-6 weeks; however, there may be incomplete recovery after multiple attacks and permanent Paralysis and eye muscle palsy is possible after subsequent attacks.  The cause is unknown, and other disorders (e.g., tumors, aneurysms, diabetes, Glaucoma, vascular anomalies, and neuromuscular disorders) must be ruled out using tests such as MRI (shows structure) or MRA (shows circulation) of the brain.
  • I will be taking two daily doses of the drug Neurontin and a daily dose of Slow Magnesium now to hopefully keep these Opthalmoplegic Migraines from reoccuring.



The picture above, taken in Fall of 2003, shows my right eyebrow effected by what I thought was a symptom of my Parkinson's, but we now believe is a result of Opthalmoplegic Migraines. This was taken on a particularly bad day last October, when not only my eyebrow is drooping but I can hardly open my right eye. This was also taken around the time I was first hospitalized as a result of these Migraines. Each time they've occured, it almost appears as if I've had a stroke; however, further testing each time has led to my ultimate diagnosis of this severe type of Migraine. 
My 14 year old son says it looks like I'm constantly raising one eyebrow as if I'm thinking about a difficult math problem (he knows math was never my best subject); however, this is actually an involuntary drooping of my eyebrow that is usually worse in early morning or when I'm over-tired or it's a "bad day".  The medical term for drooping eyebrow is Ptosis.
When I was hospitalized in November of 2004, the drooping was so severe I was unable to open my right eye at all (sorry, no pictures of it this time), my speech was slurred and I had complete numbness in the right side of my face. 
The picture to the right shows some of the paralysis in my right eye (notice the right eye seems lower and not as "bright" as the left eye) that began to reappear just a few days prior to the Migraine I experienced in early November. I thought this was a result of my Parkinson's, but 4 days later I would be in the hospital with yet another Migraine. We now know this "paralysis" in my right eye, along with nausea, dizziness and a worsening of my Parkinson's symptoms, are just some of the warning signs my body gives me that another Migraine attack is in my near future.

Ptosis in November 2004
This recent Ptosis (droopy upper eye lid/lopsided brow) preceeded my recent Migraine by 4 days.

Ptosis in July 2005
This picture shows my eye several hours before a migraine attack in July 2005.