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Transient CNS Deficits and Migrainous Auras in Individuals Without a History of Headache
Author(s) -
Naeije Gilles,
Gaspard Nicolas,
Legros Benjamin,
Mavroudakis Nicolas,
Pandolfo Massimo
Publication year - 2014
Publication title -
headache: the journal of head and face pain
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.14
H-Index - 119
eISSN - 1526-4610
pISSN - 0017-8748
DOI - 10.1111/head.12307
Subject(s) - migraine , headaches , medicine , aura , migraine with aura , transcranial magnetic stimulation , etiology , anesthesia , pediatrics , neurological examination , stimulation , psychiatry
Objective To demonstrate that benign transient focal neurological symptoms represent equivalents of migraine auras without headache. Background Benign focal neurological symptoms suggesting cerebral dysfunction are common and usually prompt an extensive diagnostic workup, but their etiology is often not elucidated. We hypothesized that benign transient focal neurological symptoms represent equivalents of migraine auras without headache, even in subjects who have never experienced migraine headaches. Methods We led a cross‐sectional study and identified individuals who presented at least 1 episode of unexplained transient focal neurological symptoms suggestive of cerebral dysfunction, but no history of migraine headache, among physicians and inpatients of an academic hospital. Cortical hyperexcitability, assessed by occipital transcranial magnetic stimulation (o TMS ), was used as a marker of possible migraine auras without headache. Results Frequency of transient focal neurological symptoms suggestive of cerebral dysfunction among the physicians who responded was 9% (21/233), vs 0.09% (6/690) of inpatients. Most episodes resembled typical visual migrainous auras. Motor, sensory, and language dysfunction were more common among inpatients than among physicians. oTMS induced phosphenes in 12/16 (75%) subjects and in none of 10 controls. Conclusion Benign focal neurological symptoms were common in our population and likely represent migraine aura without headache. Non‐visual symptoms are less common and lead to medical consultation. o TMS is abnormal in most cases, supporting the diagnosis of migraine aura without headache and helping separate this benign condition from transient ischemic attacks.