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] [18] Other treatments used on a case-by-case basis include magnesium and lamotrigine. [19]

See also

Related Research Articles

<span class="mw-page-title-main">Migraine</span> Disorder resulting in recurrent moderate-severe headaches

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 nausea, 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, consisting of as little as several lifetime attacks, to chronic disease.

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

Headache, also known as cephalalgia, is the symptom of pain in the face, head, or neck. It can occur as a migraine, tension-type headache, or cluster headache. There is an increased risk of depression in those with severe headaches.

<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.

<span class="mw-page-title-main">Alice in Wonderland syndrome</span> Neurological disorder that distorts perception of objects size and distance

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

Polyuria is excessive or an abnormally large production or passage of urine. Increased production and passage of urine may also be termed diuresis. Polyuria often appears in conjunction with polydipsia, though it is possible to have one without the other, and the latter may be a cause or an effect. Primary polydipsia may lead to polyuria. Polyuria is usually viewed as a symptom or sign of another disorder, but it can be classed as a disorder, at least when its underlying causes are not clear.

Photophobia is a medical symptom of abnormal intolerance to visual perception of light. As a medical symptom, photophobia is not a morbid fear or phobia, but an experience of discomfort or pain to the eyes due to light exposure or by presence of actual physical sensitivity of the eyes, though the term is sometimes additionally applied to abnormal or irrational fear of light, such as heliophobia. The term photophobia comes from the Greek φῶς (phōs), meaning "light", and φόβος (phóbos), meaning "fear".

<span class="mw-page-title-main">Visual snow syndrome</span> Visual impairment

Visual snow syndrome (VSS) is a form of visual hallucination that is characterized by the perception of small, flickering dots throughout the entire visual field. It is present in all conditions of illumination. The dots remain individual and do not clump together or change in size. Visual snow exists in one of two forms: the pulse type and the broadband type.

<span class="mw-page-title-main">Aura (symptom)</span> Symptom of epilepsy and migraine

An aura is a perceptual disturbance experienced by some with epilepsy or migraine. An epileptic aura is a seizure.

<span class="mw-page-title-main">Ischemic optic neuropathy</span> Medical condition

Ischemic optic neuropathy (ION) is the loss of structure and function of a portion of the optic nerve due to obstruction of blood flow to the nerve. Ischemic forms of optic neuropathy are typically classified as either anterior ischemic optic neuropathy or posterior ischemic optic neuropathy according to the part of the optic nerve that is affected. People affected will often complain of a loss of visual acuity and a visual field, the latter of which is usually in the superior or inferior field.

<span class="mw-page-title-main">Empty sella syndrome</span> Medical condition

Empty sella syndrome is the condition when the pituitary gland shrinks or becomes flattened, filling the sella turcica with cerebrospinal fluid instead of the normal pituitary. It can be discovered as part of the diagnostic workup of pituitary disorders, or as an incidental finding when imaging the brain.

Vestibular migraine (VM) is vertigo with migraine, either as a symptom of migraine or as a related neurological disorder.

The classification of all headaches, including migraines, is organized by the International Headache Society, and published in the International Classification of Headache Disorders (ICHD). The current version, the ICHD-3 beta, was published in 2013.

Migralepsy is a rare condition in which a migraine is followed, within an hour period, by an epileptic seizure. Because of the similarities in signs, symptoms, and treatments of both conditions, such as the neurological basis, the psychological issues, and the autonomic distress that is created from them, they individually increase the likelihood of causing the other. However, also because of the sameness, they are often misdiagnosed for each other, as migralepsy rarely occurs.

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.

Idiopathic childhood occipital epilepsy of Gastaut (ICOE-G) is a pure but rare form of idiopathic occipital epilepsy that affects otherwise normal children and adolescents. It is classified amongst benign idiopathic childhood focal epilepsies such as rolandic epilepsy and Panayiotopoulos syndrome.

<span class="mw-page-title-main">Computed tomography of the head</span> Cross-sectional X-rays of the head

Computed tomography of the head uses a series of X-rays in a CT scan of the head taken from many different directions; the resulting data is transformed into a series of cross sections of the brain using a computer program. CT images of the head are used to investigate and diagnose brain injuries and other neurological conditions, as well as other conditions involving the skull or sinuses; it used to guide some brain surgery procedures as well. CT scans expose the person getting them to ionizing radiation which has a risk of eventually causing cancer; some people have allergic reactions to contrast agents that are used in some CT procedures.

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 off clinical criteria and the exclusion of other disorders.

<span class="mw-page-title-main">Illusory palinopsia</span> Subtype of palinopsia

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.

A migrainous infarction is a rare type of ischaemic stroke which occurs in correspondence with migraine aura symptoms. Symptoms include headaches, visual disturbances, strange sensations and dysphasia, all of which gradually worsen causing neurological changes which ultimately increase the risk of an ischaemic stroke. Typically, women under the age of 45 who experience migraine with aura (MA) are at the greatest risk for developing migrainous infarction, especially when combined with smoking and use of oral contraceptives.

Menstrual migraine is the term used to describe both true menstrual migraines and menstrually related migraines. About 7%–14% of women have migraines only at the time of menstruation. These are called true menstrual migraines. Most female migraineurs experience migraine attacks throughout the menstruation cycle with an increased number perimenstrually, these are referred to as menstrually related or menstrually triggered migraine.

References

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  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.
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  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. ↑ "What Should You Know About Acephalgic Migraine?". MigraineAgain.com. Retrieved 2023-08-28.
  19. ↑ "Silent Migraine: A Guide". American Migraine Foundation. Retrieved 2023-08-28.
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