Acephalgic migraine explained

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]

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

Notes and References

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

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