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Pandey H, Sharma N, Alam MA, Khan FA, Dhoundiyal S. Approaching headaches and facial pains in eye care practice. Int Ophthalmol 2023:10.1007/s10792-023-02741-y. [PMID: 37195565 DOI: 10.1007/s10792-023-02741-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Accepted: 05/06/2023] [Indexed: 05/18/2023]
Abstract
Headaches and facial pains are among the most frequent ailments seen in outpatient or emergency settings. Given the fact that some of the primary headaches and facial pains mimic the characteristic patterns seen in ocular diseases and related conditions, it is fairly common for these situations to be sent to an ophthalmology or optometry clinic and misdiagnosed as ocular headaches. This may result in a delay in starting an appropriate therapy, therefore extending the patient's illness. This review article aims to help the practitioners in understanding common causes of headaches and facial pains, approaching such cases in eye OPD and differentiating them for similar ocular conditions to impart an appropriate treatment or referral.
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Affiliation(s)
- Harshita Pandey
- Department of Paramedical and Allied Health Sciences, School of Medical and Allied Sciences, Galgotias University, Greater Noida, India
| | - Neha Sharma
- Department of Pharmacy, School of Medical and Allied Sciences, Galgotias University, Uttar Pradesh, Greater Noida, India
| | - Md Aftab Alam
- Department of Pharmacy, School of Medical and Allied Sciences, Galgotias University, Uttar Pradesh, Greater Noida, India.
| | - Faiyaz Ahmed Khan
- Integral Institute of Allied Health Sciences and Research, Integral University, Lucknow, India
| | - Shivang Dhoundiyal
- Department of Pharmacy, School of Medical and Allied Sciences, Galgotias University, Uttar Pradesh, Greater Noida, India
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O’Hare L, Asher JM, Hibbard PB. Migraine Visual Aura and Cortical Spreading Depression-Linking Mathematical Models to Empirical Evidence. Vision (Basel) 2021; 5:30. [PMID: 34200625 PMCID: PMC8293461 DOI: 10.3390/vision5020030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 05/15/2021] [Accepted: 05/24/2021] [Indexed: 01/10/2023] Open
Abstract
This review describes the subjective experience of visual aura in migraine, outlines theoretical models of this phenomenon, and explores how these may be linked to neurochemical, electrophysiological, and psychophysical differences in sensory processing that have been reported in migraine with aura. Reaction-diffusion models have been used to model the hallucinations thought to arise from cortical spreading depolarisation and depression in migraine aura. One aim of this review is to make the underlying principles of these models accessible to a general readership. Cortical spreading depolarisation and depression in these models depends on the balance of the diffusion rate between excitation and inhibition and the occurrence of a large spike in activity to initiate spontaneous pattern formation. We review experimental evidence, including recordings of brain activity made during the aura and attack phase, self-reported triggers of migraine, and psychophysical studies of visual processing in migraine with aura, and how these might relate to mechanisms of excitability that make some people susceptible to aura. Increased cortical excitability, increased neural noise, and fluctuations in oscillatory activity across the migraine cycle are all factors that are likely to contribute to the occurrence of migraine aura. There remain many outstanding questions relating to the current limitations of both models and experimental evidence. Nevertheless, reaction-diffusion models, by providing an integrative theoretical framework, support the generation of testable experimental hypotheses to guide future research.
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Affiliation(s)
- Louise O’Hare
- Division of Psychology, Nottingham Trent University, Nottingham NG1 4FQ, UK
| | - Jordi M. Asher
- Department of Psychology, University of Essex, Colchester CO4 3SQ, UK; (J.M.A.); (P.B.H.)
| | - Paul B. Hibbard
- Department of Psychology, University of Essex, Colchester CO4 3SQ, UK; (J.M.A.); (P.B.H.)
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Migraine-Like Visual Auras Among Traumatized Cambodians with PTSD: Fear of Ghost Attack and Other Disasters. Cult Med Psychiatry 2018; 42:244-277. [PMID: 29019040 DOI: 10.1007/s11013-017-9554-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
This article profiles visual auras among traumatized Cambodian refugees attending a psychiatric clinic. Thirty-six percent (54/150) had experienced an aura in the previous 4 weeks, almost always phosphenes (48% [26/54]) or a scintillating scotoma (74% [40/54]). Aura and PTSD were highly associated: patients with visual aura in the last month had greater PTSD severity, 3.6 (SD = 1.8) versus 1.9 (SD = 1.6), t = 10.2 (df = 85), p < 0.001, and patients with PTSD had a higher rate of visual aura in the last month, 69% (22/32) versus 13% (7/55), odds ratio 15.1 (5.1-44.9), p < 0.001. Patients often had a visual aura triggered by rising up to the upright from a lying or sitting position, i.e., orthostasis, with the most common sequence being an aura triggered upon orthostasis during a migraine, experienced by 60% of those with aura. The visual aura was often catastrophically interpreted: as the dangerous assault of a supernatural being, most commonly the ghost of someone who died in the Pol Pot period. Aura often triggered flashback. Illustrative cases are provided. The article suggests the existence of local biocultural ontologies of trauma as evinced by the centrality of visual auras among Cambodian refugees.
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Abstract
Migraine in children can manifest in ways that are markedly different from adult migraines. In children, migraine variants are often unaccompanied by headache and include conditions such as cyclic vomiting and abdominal migraine. Children who experience these conditions are often thought to have a disorder of the gastrointestinal tract, and when evaluation is unremarkable they may be diagnosed as having a conversion reaction. Complicated migraines, on the other hand, are often accompanied by focal neurological symptoms such as ataxia, hemiparesis, or altered level of consciousness that evoke great consternation in the examining clinician. Certain episodic syndromes that may hold interest to pediatricians are also discussed in this article, mostly to emphasize the ambiguity that still surrounds these disorders, such as migraine triggered by trauma. The cardinal rule that most of these disorders are diagnoses of exclusion and can only be confirmed after extensive evaluation, either by the pediatrician or pediatric neurologist, is emphasized. [Pediatr Ann. 2018;47(2):e50-e54.].
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Lozeron P, Tcheumeni NC, Turki S, Amiel H, Meppiel E, Masmoudi S, Roos C, Crassard I, Plaisance P, Benbetka H, Guichard JP, Houdart E, Baudoin H, Kubis N. Contribution of EEG in transient neurological deficits. J Neurol 2017; 265:89-97. [DOI: 10.1007/s00415-017-8660-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Revised: 10/30/2017] [Accepted: 10/31/2017] [Indexed: 01/03/2023]
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Wang J, Zhang B, Shen C, Zhang J, Wang W. Headache symptoms from migraine patients with and without aura through structure-validated self-reports. BMC Neurol 2017; 17:193. [PMID: 29025401 PMCID: PMC5639773 DOI: 10.1186/s12883-017-0973-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Accepted: 10/09/2017] [Indexed: 01/03/2023] Open
Abstract
Background Headache symptoms self-reported by migraine patients are largely congruent with the clinician-used diagnostic criteria, but not always so. Patients’ self-reports of headache symptoms might offer additional clues to characterize migraine with (MA) and without (MO) aura more precisely. Methods Firstly, we invited 324 participants with a life-long headache attack to answer an item-matrix measuring symptoms of primary headaches, then we performed both exploratory and confirmatory factor analyses to their answers and refined a headache symptom questionnaire. Secondly, we applied this questionnaire to 28 MA and 52 MO patients. Results In participants with a life-long headache, we refined a 27-item, structure-validated headache symptom questionnaire, with four factors (scales) namely the Somatic /Aura Symptoms, Gastrointestinal and Autonomic Symptoms, Tightness and Location Features, and Prodromal/Aggravating Symptoms. Further, we found that MA patients reported higher than did MO patients on the Somatic/Aura Symptoms and Tightness and Location Features scales. Conclusions Compared to MO, MA was conferred with more prominent tightness and location features besides its higher somatic or aura symptoms. Patients’ self-reports of headache symptoms might offer more clues to distinguish two types of migraine besides their clinician-defined criteria.
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Affiliation(s)
- Jiawei Wang
- Department of Clinical Psychology and Psychiatry/School of Public Health, Zhejiang University College of Medicine, Hangzhou, China
| | - Bingren Zhang
- Department of Clinical Psychology and Psychiatry/School of Public Health, Zhejiang University College of Medicine, Hangzhou, China
| | - Chanchan Shen
- Department of Clinical Psychology and Psychiatry/School of Public Health, Zhejiang University College of Medicine, Hangzhou, China
| | - Jinhua Zhang
- Department of Neurology, Zhejiang Provincial People's Hospital, Hangzhou, China
| | - Wei Wang
- Department of Clinical Psychology and Psychiatry/School of Public Health, Zhejiang University College of Medicine, Hangzhou, China.
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Buture A, Khalil M, Ahmed F. Iatrogenic visual aura: a case report and a brief review of the literature. Ther Clin Risk Manag 2017; 13:643-646. [PMID: 28553121 PMCID: PMC5440068 DOI: 10.2147/tcrm.s134178] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Iatrogenic migraine aura following transseptal catheterization has only rarely been reported in the literature. We report the case of a 60-year-old female who presented with new onset of migraine with visual aura 1 day after transseptal cryoballoon catheter ablation for atrial fibrillation. The patient had a 5-year history of typical migraine without aura and had never experienced visual aura before the cardiac intervention. The neurological examination, fundoscopy, and blood tests were normal. The magnetic resonance imaging of the brain showed small vessel ischemia without evidence of vessel ischemic changes in the occipital lobes and large blood vessel disease. A change in the characteristics of existing migraine could occur following an iatrogenic episode, which in this case was catheter ablation for atrial fibrillation. A new onset of aura is considered an indication for a brain scan as it may signify underlying new pathology.
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Affiliation(s)
- Alina Buture
- Neurology Department, Hull Royal Infirmary, Hull, UK
| | - Modar Khalil
- Neurology Department, Hull Royal Infirmary, Hull, UK
| | - Fayyaz Ahmed
- Neurology Department, Hull Royal Infirmary, Hull, UK
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Hartl E, Angel J, Rémi J, Schankin CJ, Noachtar S. Visual Auras in Epilepsy and Migraine - An Analysis of Clinical Characteristics. Headache 2017; 57:908-916. [DOI: 10.1111/head.13113] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2017] [Revised: 03/12/2017] [Accepted: 03/12/2017] [Indexed: 01/03/2023]
Affiliation(s)
- Elisabeth Hartl
- Department of Neurology, Epilepsy Center; University of Munich; Munich Germany
| | - Jose Angel
- Department of Neurology; University of Regensburg; Regensburg Germany
| | - Jan Rémi
- Department of Neurology, Epilepsy Center; University of Munich; Munich Germany
| | - Christoph J. Schankin
- Department of Neurology, Inselspital; Bern University Hospital, University of Bern; Switzerland
| | - Soheyl Noachtar
- Department of Neurology, Epilepsy Center; University of Munich; Munich Germany
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Valença MM, de Oliveira DA. The Frequent Unusual Headache Syndromes: A Proposed Classification Based on Lifetime Prevalence. Headache 2015; 56:141-52. [PMID: 26335933 DOI: 10.1111/head.12646] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND There is no agreement on a single cutoff point or prevalence for regarding a given disease as rare. The concept of what is a rare headache disorder is even less clear and the spectrum from a very frequent, frequent, occasional to rare headache syndrome is yet to be established. OBJECTIVE An attempt has been made to estimate the lifetime prevalence of each of the headache subtypes classified in the ICHD-II. METHOD Using the ICHD-II, 199 different headache subtypes were identified. The following classification was made according to the estimated lifetime prevalence of each headache disorder: very frequent (prevalence >10%); frequent (between 1 and 10%); occasional (between 0.07 and 1%); and unusual or rare (<0.07%). RESULTS One hundred and fifty-four of 199 (77%) were categorized as unusual headache disorders, 7/199 (4%) as very frequent, 9/199 (5%) as frequent, and 29/199 (15%) as occasional forms of headache disorder. CONCLUSION The unusual headache syndromes do not appear to be as infrequent in clinical practice as has been generally believed. About three-fourths of the classified headache disorders found in the ICHD-II can be considered as rare. This narrative review article may be regarded as an introduction to the concept of unusual headaches and a proposed classification of all headaches (at least those listed in the ICHD-II).
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Affiliation(s)
- Marcelo M Valença
- Department of Neuropsychiatry, Neurology and Neurosurgery Unit, Federal University of Pernambuco, Brazil.,Neurology and Neurosurgery Unit, Hospital Esperança, Brazil
| | - Daniella A de Oliveira
- Department of Neuropsychiatry, Neurology and Neurosurgery Unit, Federal University of Pernambuco, Brazil
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Abstract
Synesthesia is a neurological condition in which an inducer stimulus in one sense leads to a concurrent percept in a second sense. The immune hypothesis of synesthesia links synesthesia to immune-related conditions such as migraine. More specifically, migraine with aura may be linked to grapheme-color synesthesia as both involve cortical hyperexcitability. In this study, 161 female synesthetes, and 92 female nonsynesthetes, completed an online questionnaire about synesthesia and migraine. We found no general link between migraine and synesthesia nor between migraine with aura and grapheme-color synesthesia. Exploratory analyses, however, showed that certain types of synesthetic inducer (non-linguistic visual experiences, scent, taste, emotion and personality) were associated with visual disturbances in headache among female participants, and touch as a concurrent was associated with migraine with aura. On the basis of our exploratory analyses, we hypothesize that specific subtypes of synesthesia are related to migraine. The relationship between these two conditions is likely to become clearer as research on the underlying causes of synesthesia and migraine progresses.
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Affiliation(s)
- Clare N. Jonas
- School of Psychology, University of East London, UK; School of Psychology and Neuroscience, University of St Andrews, UK
| | - Paul B. Hibbard
- Department of Psychology, University of Essex, UK; School of Psychology and Neuroscience, University of St Andrews, UK
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Malone CD, Bhowmick A, Wachholtz AB. Migraine: treatments, comorbidities, and quality of life, in the USA. J Pain Res 2015; 8:537-47. [PMID: 26316804 PMCID: PMC4540217 DOI: 10.2147/jpr.s88207] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
This study sought to characterize the experience of stress, treatment patterns, and medical and disability profile in the migraineur population to better understand how the experience of migraines impacts the social and psychological functioning of this group. A 30-minute self-report survey was presented via a migraine-specific website with data collection occurring between May 15 and June 15, 2012. Recruitment for the study was done through online advertisements. In total, 2,907 individuals began the survey and 2,735 met the inclusion criteria for the study. The sample was predominantly female (92.8%). Migraine-associated stress was correlated with length of time since first onset of symptoms (P<0.01) and number of symptoms per month (P<0.01). Disorders related to stress, such as depression (P<0.01) and anxiety (P<0.01), were also positively correlated with the measured stress resulting from migraines. Migraine-associated stress must be understood as a multidimensional experience with broader impacts of stress on an individual correlating much more highly with negative mental and physical health profiles. Stress resulting from frequent migraine headaches may contribute to the development of medical and psychological comorbidities and may be a part of a cyclical relationship wherein stress is both a cause and effect of the social and medical impairments brought about by migraine.
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Affiliation(s)
- Christopher D Malone
- Department of Psychiatry, University of Massachusetts Medical School, Worcester, MA, USA
| | | | - Amy B Wachholtz
- Department of Psychiatry, University of Massachusetts Medical School, Worcester, MA, USA
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Singman EL, Matta NS, Silbert DI. Convergence insufficiency associated with migraine: a case series. ACTA ACUST UNITED AC 2015; 64:112-6. [PMID: 25313120 DOI: 10.3368/aoj.64.1.112] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND AND PURPOSE The appearance of convergence insufficiency in migraineurs suggests a possible link between migraine and convergence insufficiency. PATIENTS AND METHOD Relevant patients reporting to our neuro-ophthalmology clinic complained of symptoms consistent with convergence insufficiency and had a history of migraine. Patients underwent thorough neuro-ophthalmic evaluations including history, physical exam, and cranial imaging. Four illustrative cases are presented in this report. RESULTS Convergence insufficiency may develop after migraine. In some cases, it may be a persistent cause of reduced visual functioning. In patients with persistent asthenopia, orthoptic therapy has proven successful. CONCLUSIONS A history of migraine should be sought in patients complaining of reading difficulties secondary to new onset convergence insufficiency. Furthermore, migraineurs should be asked about whether they suffer asthenopia. Finally, a larger scale, prospective study should be considered to further explore a possible link between migraine and convergence insufficiency.
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Affiliation(s)
- Eric L Singman
- From Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland and
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He Y, Li Y, Nie Z. Typical aura without headache: a case report and review of the literature. J Med Case Rep 2015; 9:40. [PMID: 25884682 PMCID: PMC4344793 DOI: 10.1186/s13256-014-0510-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2014] [Accepted: 12/29/2014] [Indexed: 01/03/2023] Open
Abstract
Introduction Typical aura without headache (TAWH), which has been rarely reported both at home and abroad, is a rare type of migraine with aura. Case presentation This is a report on a 64-year-old Chinese migraineur who has had recurrent typical visual aura without headache attacks for more than 30 years, and has been misdiagnosed as having had transient ischemic attacks (TIA) many times. He mainly experienced episodes of ‘homonymous blurred vision’ or photopsia, which presented as different shapes located at the side or above his visual field, for example, patchy, cord-like, zigzag, curtain-like or irregular shapes. The shape was inconsistent during each attack, however, the color was mainly gray or light blue. The visual symptoms gradually disappeared in about 30 minutes. Our patient has never suffered a headache attack during or after the visual aura. Normal results were observed in his neurological and eye examinations, complete blood test, electroencephalogram and neuroimaging examination. Conclusions TAWH is an uncommon phenomenon of migraine. Migraine with visual aura mainly presents positive and dynamic symptoms. It has a benign course and can be diagnosed after exclusion of other organic diseases such as TIA and epilepsy.
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Affiliation(s)
- Yusheng He
- Department of Neurology, Affiliated Tongji Hospital of Tongji University, 389 XinCun Road, Shanghai, 200065, China.
| | - Yancheng Li
- Department of Neurology, Affiliated Tongji Hospital of Tongji University, 389 XinCun Road, Shanghai, 200065, China.
| | - Zhiyu Nie
- Department of Neurology, Affiliated Tongji Hospital of Tongji University, 389 XinCun Road, Shanghai, 200065, China.
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Kowacs PA, Utiumi MA, Piovesan EJ. The visual system in migraine: from the bench side to the office. Headache 2015; 55 Suppl 1:84-98. [PMID: 25659971 DOI: 10.1111/head.12514] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/24/2014] [Indexed: 11/26/2022]
Abstract
BACKGROUND Throughout history, migraine-associated visual symptoms have puzzled patients, doctors, and neuroscientists. The visual aspects of migraine extend far beyond the aura phenomena, and have several clinical implications. METHODS A narrative review was conducted, beginning with migraine mechanisms, then followed by pertinent aspects of the anatomy of visual pathways, clinical features, implications of the visual system on therapy, migraine on visually impaired populations, treatment of visual auras and ocular (retinal) migraine, effect of prophylactic migraine treatments on visual aura, visual symptoms induced by anti-migraine or anti-headache drugs, and differential diagnosis. RESULTS A comprehensive narrative review from both basic and clinical standpoints on the visual aspects of migraine was attained; however, the results were biased to provide any useful information for the clinician. CONCLUSION This paper achieved its goals of addressing and condensing information on the pathophysiology of the visual aspects of migraine and its clinical aspects, especially with regards to therapy, making it useful not only for those unfamiliar to the theme but to experienced physicians as well.
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Affiliation(s)
- Pedro A Kowacs
- Neurological Institute of Curitiba (INC), Curitiba, Brazil; Neurology Section, Hospital Clinics of the Federal University at Paraná (HC-UFPR), Curitiba, Brazil
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Vongvaivanich K, Lertakyamanee P, Silberstein SD, Dodick DW. Late-life migraine accompaniments: A narrative review. Cephalalgia 2014; 35:894-911. [PMID: 25505036 DOI: 10.1177/0333102414560635] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2014] [Accepted: 10/27/2014] [Indexed: 12/15/2022]
Abstract
BACKGROUND Migraine is one of the most common chronic neurological disorders. In 1980, C. Miller Fisher described late-life migraine accompaniments as transient neurological episodes in older individuals that mimic transient ischemic attacks. There has not been an update on the underlying nature and etiology of late-life migraine accompanimentsd since the original description. PURPOSE The purpose of this article is to provide a comprehensive and extensive review of the late-life migraine accompaniments including the epidemiology, clinical characteristics, differential diagnosis, and treatment. METHODS Literature searches were performed in MEDLINE®, PubMed, Cochrane Library, and EMBASE databases for publications from 1941 to July 2014. The search terms "Migraine accompaniments," "Late life migraine," "Migraine with aura," "Typical aura without headache," "Migraine equivalents," "Acephalic migraine," "Elderly migraine," and "Transient neurological episodes" were used. CONCLUSION Late-life onset of migraine with aura is not rare in clinical practice and can occur without headache, especially in elderly individuals. Visual symptoms are the most common presentation, followed respectively by sensory, aphasic, and motor symptoms. Gradual evolution, the march of transient neurological deficits over several minutes and serial progression from one symptom to another in succession are typical clinical features for late-life migraine accompaniments. Transient neurological disturbances in migraine aura can mimic other serious conditions and can be easily misdiagnosed. Careful clinical correlation and appropriate investigations are essential to exclude secondary causes. Treatments are limited and still inconsistent.
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Affiliation(s)
- Kiratikorn Vongvaivanich
- Comprehensive Headache Clinic, Neuroscience Center, Bangkok Hospital, Bangkok Hospital Group, Thailand
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Pacheva IH, Ivanov IS. Migraine variants--occurrence in pediatric neurology practice. Clin Neurol Neurosurg 2013; 115:1775-83. [PMID: 23688445 DOI: 10.1016/j.clineuro.2013.04.012] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2013] [Revised: 04/01/2013] [Accepted: 04/15/2013] [Indexed: 12/22/2022]
Abstract
UNLABELLED Migraine is common in pediatric neurology practice, while migraine variants are rare and pose diagnostic problems. OBJECTIVE The aim was to establish the occurrence of migraine variants in pediatric neurology practice and among migraine, and to discuss their presentation. PATIENTS AND METHODS The files of 2509 newly diagnosed patients, aged 0-18 years, treated as in- and out-patients in the Neuropediatric Ward at the Plovdiv Medical University Hospital between 2002 and 2006 were examined retrospectively. Migraine forms were diagnosed according to ICHD-II. Benign paroxysmal torticolis and alternating hemiplegia of childhood were also accepted as migraine variants according to proposed diagnostic criteria in the appendix of ICHD-II. Some specific forms like acute confusional migraine (ACM), Alice in wonderland syndrome (AWS), ophthalmoplegic migraine were also diagnosed although not included as migraine variants in the ICHD-II classification. RESULTS 111 patients met diagnostic criteria for migraine. Patients with migraine variants comprised 24.3% of migrainous cases. Basilar type migraine was the most common (6.3% of all migrainous patients), followed by benign paroxysmal vertigo (5.4%), hemiplegic migraine (3.6%), ACM (2.7%), benign paroxysmal torticolis (2.7%), typical aura without headache (1.8%), abdominal migraine (1.8%), AWS (0.9%), ophthalmoplegic migraine (0.9%) and cyclical vomiting (0.9%). Alternating hemiplegia of childhood and retinal migraine was not found. Some patients either presented or were classified as different migraine variants. CONCLUSION Basilar type migraine was the most common migraine variant. ACM and AWS should be regarded as distinct entities in the ICHD as migraine with complex aura. Benign paroxysmal torticollis also deserves its place as a migraine variant. Cases of ophthalmoplegic migraine with spontaneous remission and no cranial nerve enhancement on MRI should be considered as migraine form. Analyzing migraine variants will contribute to better awareness and adequate diagnosis.
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Affiliation(s)
- Iliyana H Pacheva
- Department of Pediatrics and Medical Genetics, Medical University, Plovdiv, Bulgaria.
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Goodwin D. Transient complete homonymous hemianopia associated with migraine. ACTA ACUST UNITED AC 2011; 82:298-305. [PMID: 21524601 DOI: 10.1016/j.optm.2010.12.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2010] [Revised: 10/31/2010] [Accepted: 12/28/2010] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Because of the transient and rare nature, objective visual and neuroimaging evaluation during an acute, spontaneous attack of a migrainous aura causing a complete homonymous hemianopia has not been reported. CASE REPORT A healthy 27-year-old white woman with a history of typical aura with migraine presented during an episode of no light perception in the right hemifield of both eyes. Ophthalmic testing and neuroimaging were unremarkable. The visual field defect started to resolve 1 hour after initial symptoms, and significant improvement was seen after 4 hours. One year later, the patient had no visual field defects and had not experienced another episode of homonymous hemianopia. DISCUSSION More than one third of migrainous patients experience visual symptoms. Typical aura with migraine is diagnosed usually by history. Laboratory testing and neuroimaging are necessary if an alternative cause is suspected, i.e., the aura begins after age 40 years, negative features are predominant, or the aura is very short or prolonged. Correct diagnosis is critical, because conditions that mimic migrainous aura have potentially devastating consequences. Migraine with aura patients may have persistent visual field defects and are at an increased risk for stroke compared with nonmigraine patients. This case improves our knowledge of the nature of a transient homonymous hemianopia associated with migraine.
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Affiliation(s)
- Denise Goodwin
- Pacific University College of Optometry, Forest Grove, OR 97116, USA.
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Maggioni F, Mainardi F, Malvindi ML, Zanchin G. The borderland of migraine with aura: episodic unilateral mydriasis. J Headache Pain 2010; 12:105-7. [PMID: 20862508 PMCID: PMC3072480 DOI: 10.1007/s10194-010-0255-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2010] [Accepted: 09/03/2010] [Indexed: 11/30/2022] Open
Abstract
We present the case of a patient who had a 3-year history of episodes of transitory unilateral mydriasis with omolateral blurred vision followed by headache. Thereafter, during the last 4 years, the patient developed a migraine with visual aura, without further episodes of transitory mydriasis. We suggest that the transitory mydriasis previously present could be considered as an unusual form of migrainous aura. A possible pathogenetic mechanism is proposed.
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Affiliation(s)
- F Maggioni
- Headache Centre, Department of Neurosciences, University of Padua, Padua, Italy.
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Abel H. Migraine headaches: diagnosis and management. ACTA ACUST UNITED AC 2009; 80:138-48. [PMID: 19264290 DOI: 10.1016/j.optm.2008.06.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2007] [Revised: 05/15/2008] [Accepted: 06/13/2008] [Indexed: 11/17/2022]
Abstract
BACKGROUND Patients often complain to their optometrist about their headaches, of which migraines are a common type. They may ask if their pain is from visual causes or whether the visual auras they experience are normal. METHODS The literature on migraine is reviewed to provide the optometrist with current information to manage these patients. RESULTS Included in the review are migraine epidemiology, pathophysiology, categorization, clinical presentation, diagnosis, and treatment. CONCLUSION Optometrists can help their migraine patients with a thorough examination, advice, proper referrals, and optical management when appropriate.
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Affiliation(s)
- Hilla Abel
- NY Empire Medical, 98-76 Queens Blvd., Rego Park, NY 11374, USA.
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Kompanje EJ. A Case of Strawberry Induced Migraine Aura Without Headache Described in 1627. Headache 2008; 48:974-5. [DOI: 10.1111/j.1526-4610.2008.01134.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Shareef AH, Dafer RM, Jay WM. Neuro-ophthalmologic manifestations of primary headache disorders. Semin Ophthalmol 2008; 23:169-77. [PMID: 18432543 DOI: 10.1080/08820530802012937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Headaches are the most common disorders of the central nervous system affecting 46% of the adult population worldwide. Headaches may be lifelong illnesses, often associated with substantial disability for the individual and the population as a whole. The International Classification of Headache Disorders (ICHD-II) codifies headache disorders into fourteen categories, predominantly primary headaches and secondary headache disorders. Primary headache disorders, mainly migraine and trigeminal autonomic cephalgias (TACs), are frequently associated with neuro-ophthalmologic manifestations. Ophthalmologists are often the first physicians to be involved in the deciphering of headache-related visual disturbances. This article reviews two major primary headache disorders, migraine and trigeminal autonomic cephalgias, and discusses their neuro-ophthalmic complications, clinical presentation, and treatment.
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