Acephalgic migraine

Acephalgic migraine (also called acephalalgic migraine, 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 aura, nausea, photophobia, hemiparesis and other migraine symptoms but does not experience headache.^[1] While 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] Though there are some individuals—more commonly male—who only experience acephalgic migraine, frequently patients also experience migraine with headache.^[6] Generally, the condition is more than twice as likely to occur in females than males.^[7] Although not listed as such in the International Classification of Headache Disorders, pediatric acephalgic migraines are listed along with other childhood periodic syndromes by W.A. Al-Twaijri and M.I. Shevell as "migraine equivalents", which can be good predictors of the future development of typical migraines.^[8][9] Individuals who experience acephalgic migraines only 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] Also frequently reported is monocular blindness.^[12] Acephalgic migraines typically do not persist more than a few hours and may last for as little as 15 seconds.^[13] 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][14] The concurrence of other symptoms such as photophobia and nausea can help determining the proper diagnosis.^[14] Occasionally, patients with acephalgic migraine are misdiagnosed as suffering epilepsy with visual seizures, but the reverse misdiagnosis is more common.^[15]

Treatment

The prevention and treatment of acephalgic migraine is broadly the same as for classical migraine but, as the symptoms are usually less severe, treatment is less likely to be required.

See also

• ICHD classification and diagnosis of migraine

References

1. ^ ^{a b c} 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 0781775132. 
2. ^ Pryse-Phillips, William (2003). Companion to clinical neurology (2nd ed.). Oxford University Press US. p. 587. ISBN 0195159381. 
3. ^ Bradley, Walter George (2004). Neurology in clinical practice. 2 (4th ed.). Taylor & Francis. p. 2074. ISBN 9997625897. 
4. ^ Bernstein, Carolyn; Elaine McArdle (2009). The Migraine Brain: Your Breakthrough Guide to Fewer Headaches, Better Health. Simon and Schuster. p. 36. ISBN 141654769X. 
5. ^ Engel, Jerome; Timothy A. Pedley, Jean Aicardi, Marc A Dichter (2008). Epilepsy: a comprehensive textbook. 1 (2nd ed.). Lippincott Williams & Wilkins. p. 2695. ISBN 0781757770. 
6. ^ Miller, Neil R.; Frank Burton Walsh, Valérie Biousse, William Fletcher Hoyt (2005). Walsh and Hoyt's clinical neuro-ophthalmology. 1 (6th ed.). Lippincott Williams & Wilkins. p. 1289. ISBN 0781748119. 
7. ^ ^{a b} Loder, Elizabeth; Dawn A. Marcus (2004). Migraine in women. PMPH-USA. p. 21. ISBN 1550091808. 
8. ^ Al-Twaijri, Waleed A.; Micheal I. Shevell (2002 May). "Pediatric migraine equivalents: occurrence and clinical features in practice". Pediatric Neurology 26 (5): 365–8. 
9. ^ Lipton, Richard B.; Marcelo Eduardo Bigal (2006). Migraine and other headache disorders. Neurological disease and therapy. 85. Informa Health Care. p. 204. ISBN 0849336953. 
10. ^ Greenberg, Mark S. (2006). Handbook of neurosurgery (6th ed.). Thieme. p. 45. ISBN 313110886X. 
11. ^ Gilroy, John (2000). Basic neurology (3rd ed.). McGraw-Hill Professional. p. 127. ISBN 0071054677. 
12. ^ 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 0879936576. 
13. ^ Amos, John F. (1987). Diagnosis and management in vision care. Butterworths. p. 16. ISBN 0409950823. 
14. ^ ^{a b} Lee, David A.; Eve J. Higginbotham (1999). Clinical guide to comprehensive ophthalmology. Thieme. p. 532. ISBN 0865777667. 
15. ^ Panayiotopoulos, Chrysostomos P. (2007). A Clinical Guide to Epileptic Syndromes and Their Treatment (2nd ed.). Springer. pp. 107–108. ISBN 1846286433.