Acephalgic migraine

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Acephalgic migraine (also called migraine aura without headache, amigrainous migraine, isolated visual migraine, and optical migraine) is a neurological syndrome. It is a relatively uncommon variant of migraine in which the patient may experience some migraine symptoms such as aura, nausea, photophobia, and hemiparesis, but does not experience headache. [1] It is generally classified as an event fulfilling the conditions of migraine with aura with no (or minimal) headache. [2] [3] It is sometimes distinguished from visual-only migraine aura without headache, also called ocular migraine. [4]

Contents

Symptoms and misdiagnosis

Acephalgic migraines can occur in individuals of any age. [5] Some individuals, usually males, only experience acephalgic migraine, but frequently patients also experience migraine with headache. [6] Generally, the condition is more than twice as likely to occur in females than males. [7] Pediatric acephalgic migraines are listed along with other childhood periodic syndromes by W.A. Al-Twaijri and M.I. Shevell as "migraine equivalents" (although not listed as such in the International Classification of Headache Disorders ), which can be good predictors of the future development of typical migraines. [8] [9] Individuals who experience acephalgic migraines in childhood are highly likely to develop typical migraines as they grow older. [10] Among women, incidents of acephalgic migraine increase during perimenopause. [7]

Scintillating scotoma is the most common symptom [11] which usually happens concurrently with Expanding Fortification Spectra. [12] Also frequently reported is monocular blindness. [13] Acephalgic migraines typically do not persist more than a few hours and may last for as little as 15 seconds. [14] On rare occasions, they may continue for up to two days. [1]

Acephalgic migraines may resemble transient ischemic attacks or, when longer in duration, stroke. [1] [15] The concurrence of other symptoms such as photophobia and nausea can help in determining the proper diagnosis. [15] Occasionally, patients with acephalgic migraine are misdiagnosed as having epilepsy with visual seizures, but the reverse misdiagnosis is more common. [16]

Treatment

The prevention and treatment of acephalgic migraine is broadly the same as for classical migraine, but the symptoms are usually less severe than those of classic migraine, so treatment is less likely to be required. Some specialists have prescribed the use of antiplatelet treatments such as daily aspirin as a preventive treatment for certain patients with acephalgic migraines. [17] Other treatments used on a case-by-case basis include magnesium and lamotrigine. [18]

See also

Related Research Articles

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Migraine is a genetically influenced complex neurological disorder characterized by episodes of moderate-to-severe headache, most often unilateral and generally associated with nausea and light and sound sensitivity. Other characterizing symptoms may include vomiting, cognitive dysfunction, allodynia, and dizziness. Exacerbation of headache symptoms during physical activity is another distinguishing feature. Up to one-third of migraine sufferers experience aura, a premonitory period of sensory disturbance widely accepted to be caused by cortical spreading depression at the onset of a migraine attack. Although primarily considered to be a headache disorder, migraine is highly heterogenous in its clinical presentation and is better thought of as a spectrum disease rather than a distinct clinical entity. Disease burden can range from episodic discrete attacks to chronic disease.

<span class="mw-page-title-main">Headache</span> Pain in the head, neck, or face

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<span class="mw-page-title-main">Micropsia</span> Medical condition

Micropsia is a condition affecting human visual perception in which objects are perceived to be smaller than they actually are. Micropsia can be caused by optical factors, by distortion of images in the eye, by changes in the brain, and from psychological factors. Dissociative phenomena are linked with micropsia, which may be the result of brain-lateralization disturbance.

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Alice in Wonderland syndrome (AIWS), also known as Todd's syndrome or dysmetropsia, is a neurological disorder that distorts perception. People with this syndrome may experience distortions in their visual perception of objects, such as appearing smaller (micropsia) or larger (macropsia), or appearing to be closer (pelopsia) or farther (teleopsia) than they are. Distortion may also occur for senses other than vision.

<span class="mw-page-title-main">Polyuria</span> Excess urination

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Vertiginous epilepsy is infrequently the first symptom of a seizure, characterized by a feeling of vertigo. When it occurs, there is a sensation of rotation or movement that lasts for a few seconds before full seizure activity. While the specific causes of this disease are speculative there are several methods for diagnosis, the most important being the patient's recall of episodes. Most times, those diagnosed with vertiginous seizures are left to self-manage their symptoms or are able to use anti-epileptic medication to dampen the severity of their symptoms.

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Abdominal migraine(AM) is a functional disorder that usually manifests in childhood and adolescence, without a clear pathologic mechanism or biochemical irregularity. Children frequently experience sporadic episodes of excruciating central abdominal pain accompanied by migrainous symptoms like nausea, vomiting, severe headaches, and general pallor. Abdominal migraine can be diagnosed based on clinical criteria and the exclusion of other disorders.

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Illusory palinopsia is a subtype of palinopsia, a visual disturbance defined as the persistence or recurrence of a visual image after the stimulus has been removed. Palinopsia is a broad term describing a heterogeneous group of symptoms, which is divided into hallucinatory palinopsia and illusory palinopsia. Illusory palinopsia is likely due to sustained awareness of a stimulus and is similar to a visual illusion: the distorted perception of a real external stimulus.

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References

  1. 1 2 3 Goroll, Allan H.; Albert G. Mulley (2009). Primary Care Medicine: Office Evaluation and Management of the Adult Patient (6th ed.). Lippincott Williams & Wilkins. p. 1152. ISBN   978-0-7817-7513-7.
  2. ↑ Pryse-Phillips, William (2003). Companion to clinical neurology (2nd ed.). Oxford University Press US. p. 587. ISBN   0-19-515938-1.
  3. ↑ Bradley, Walter George (2004). Neurology in clinical practice. Vol. 2 (4th ed.). Taylor & Francis. p. 2074. ISBN   0-7506-7469-5.
  4. ↑ Bernstein, Carolyn; Elaine McArdle (2009). The Migraine Brain: Your Breakthrough Guide to Fewer Headaches, Better Health. Simon and Schuster. p. 36. ISBN   978-1-4165-4769-3.
  5. ↑ Engel, Jerome; Timothy A. Pedley; Jean Aicardi; Marc A Dichter (2008). Epilepsy: a comprehensive textbook. Vol. 1 (2nd ed.). Lippincott Williams & Wilkins. p. 2695. ISBN   978-0-7817-5777-5.
  6. ↑ Miller, Neil R.; Frank Burton Walsh; Valérie Biousse; William Fletcher Hoyt (2005). Walsh and Hoyt's clinical neuro-ophthalmology. Vol. 1 (6th ed.). Lippincott Williams & Wilkins. p. 1289. ISBN   0-7817-4811-9.
  7. 1 2 Loder, Elizabeth; Dawn A. Marcus (2004). Migraine in women. PMPH-USA. p. 21. ISBN   1-55009-180-8.
  8. ↑ Al-Twaijri, WA; Shevell, MI (May 2002). "Pediatric migraine equivalents: occurrence and clinical features in practice". Pediatric Neurology. 26 (5): 365–8. doi:10.1016/S0887-8994(01)00416-7. PMID   12057796.
  9. ↑ Lipton, Richard B.; Marcelo Eduardo Bigal (2006). Migraine and other headache disorders. Neurological disease and therapy. Vol. 85. Informa Health Care. p. 204. ISBN   0-8493-3695-3.
  10. ↑ Greenberg, Mark S. (2006). Handbook of neurosurgery (6th ed.). Thieme. p. 45. ISBN   3-13-110886-X.
  11. ↑ Gilroy, John (2000). Basic neurology (3rd ed.). McGraw-Hill Professional. p. 127. ISBN   0-07-105467-7.
  12. ↑ G. D. Schott (2007). "Exploring the visual hallucinations of migraine aura: the tacit contribution of illustration". Brain. 130 (6): 1690–1703. doi: 10.1093/brain/awl348 . PMID   17264093.
  13. ↑ Irwin, Richard S.; Frederick J. Curley; Ronald F. Grossman (1997). Diagnosis and treatment of symptoms of the respiratory tract (2nd ed.). Wiley-Blackwell. p. 607. ISBN   0-87993-657-6.
  14. ↑ Amos, John F. (1987). Diagnosis and management in vision care. Butterworths. p. 16. ISBN   0-409-95082-3.
  15. 1 2 Lee, David A.; Eve J. Higginbotham (1999). Clinical guide to comprehensive ophthalmology. Thieme. p. 532. ISBN   0-86577-766-7.
  16. ↑ Panayiotopoulos, Chrysostomos P. (2007). A Clinical Guide to Epileptic Syndromes and Their Treatment (2nd ed.). Springer. pp. 107–108. ISBN   978-1-84628-643-8.
  17. ↑ "Migraine aura without headache: Causes, triggers, and more". www.medicalnewstoday.com. 2021-08-11. Retrieved 2023-08-28.
  18. ↑ "Silent Migraine: A Guide". American Migraine Foundation. Retrieved 2023-08-28.
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