Familial Hemiplegic Migraine With Crossed Cerebellar Diaschisis and Unilateral Meningeal Enhancement

A 6-year-old boy with a family history of hemiplegic migraine had a hemiplegic migraine lasting for 6 days complicated by prolonged fever, lethargy, and two brief focal seizures. An acute single photon emission computerized tomogram (SPECT) demonstrated decreased blood flow in the symptomatic cerebral hemisphere as well as crossed cerebellar diaschisis not previously documented in migraine. Another unique finding was the MRI with enhancement of the meninges and pial vessels over the symptomatic cerebral hemisphere. These findings suggest cerebellar and extra-axial involvement as components of hemiplegic migraine.     

Middle Meningeal Artery Dilatation in Migraine

Objective.— To show that migraine pain is not related to dilatation of the dural meningeal arteries.
Background.— The origin of the pain in migraine has not yet been adequately explained and remains the subject of vigorous debate. Current theories implicate changes in the trigeminovascular system, which is defined as comprising the large intracranial vessels, and in particular, the dural meningeal vessels, the dura mater, and their neural connections.
Methods.— The anatomical relationships of the dural meningeal arteries to the dura mater and the inner surface of the calvarium are described.
Results.— The dural meningeal arteries lie in grooves in the inner table of the calvarium, are encased in the unyielding fibrous dura mater, and are consequently unable to dilate.
Conclusion.— The pain of migraine is not related to dilatation of the dural meningeal arteries.     

Bilateral Occipital Lobe Infarction in Acute Migraine: Clinical, Neurophysiological, and Neuroradiological Study.

A woman having common migraine attacks coincident with an asymmetrical bilateral occipital lobe infarction that spared the brainstem and cerebellum underwent these studies: serial electroencephalography, brainstem auditory, visual and somatosensory evoked potentials, magnetic resonance imaging of the brain and cerebral arteriography. The patient's vision improved greatly during a one-year follow-up. The absence of risk factors for stroke suggested that migraine caused the infarction in the posterior circulation network. The pathophysiological mechanisms of stroke in migraine remains speculative.     

Reversible Hemiparesis in a Patient With Migraine

ABSTRACT

A third of patients with migraine may experience accompanying aura, and when this includes motor weakness, the condition is described as hemiplegic migraine. Young women who suffer from migraine with aura have a 6.2-fold increased risk of ischemic stroke. The slow progression and succession of symptoms help to provide the diagnosis of hemiplegic migraine.

This report is adapted from paineurope 2014; Issue 1, ©Haymarket Medical Publications Ltd., and is presented with permission. paineurope is provided as a service to pain management by Mundipharma International, Ltd., and is distributed free of charge to health care professionals in Europe. Archival issues can be accessed via the Web site: http://www.paineurope.com at which European health professionals can register online to receive copies of the quarterly publication.     

MRI Findings in a Case of Ophthalmoplegic Migraine

SYNOPSIS
MRI using gadolinium contrast material can demonstrate lesions in cranial nerves. Tumors and Inflammatory lesions have been described.^1,2 There is little published information on MRI of cranial nerve in patients with migraine headache with ophthalmoplegia.³ We present a case of ophthalmoplegic migraine with a cranial nerve abnormality which was subsequently shown to improve as the patient clinically improved. Implications from this finding are discussed in relation to the pathophysiology of ophthalmoplegic migraine.     

Visual Cortex Excitability in Migraine With and Without Aura

OBJECTIVES: Previous research using transcranial magnetic stimulation has produced equivocal findings concerning thresholds for the generation of visual phosphenes in migraine with aura. These studies were methodologically varied and did not systematically address cortical excitability in migraine without aura. We therefore studied magnetophosphene thresholds in both migraine with aura and migraine without aura compared with headache-free controls. METHODS: Sixteen subjects with migraine with aura and 12 subjects with migraine without aura were studied and compared with 16 sex- and age-matched controls. Using a standardized transcranial magnetic stimulation protocol of the occipital cortex, we assessed the threshold stimulation intensity at which subjects just perceived phosphenes via a method of alternating course and fine-tuning of stimulator output. RESULTS: There were no significant differences across groups in the proportion of subjects seeing phosphenes. However, the mean threshold at which phosphenes were reported was significantly lower in both migraine groups (migraine with aura=47%, migraine without aura=46%) than in controls (66%). Moreover, there was no significant correlation between individual phosphene threshold and the time interval to the closest migraine attack. CONCLUSION: Our findings confirm that the occipital cortex is hyperexcitable in the migraine interictum, both in migraine with and without aura.     

The Prevalence of Cerebral Damage Varies With Migraine Type: A MRI Study

Studies on the prevalence of MRI signal abnormalities in the brains of migraineurs have yielded controversial results. In order to provide further data on this issue we reviewed the MRI scans of 38 migraine patients without current neurologic symptoms (mean age 35.8 +/- 11.9 years). In addition, we compared the findings in those 24 migraineurs under 50 years without major cerebrovascular risk factors (mean age 30.1 +/- 9.0 years) to that in 14 headache and risk factor free volunteers (mean age 37.8 +/- 5.3 years). Overall, focal areas of hyperintense signal were seen in 15 (39%) patients. They were present on both proton density and T2-weighted spin-echo sequences. Lesion prevalence varied according to the type of headache (18% in migraine without aura, 53% in migraine with typical aura, 38% in basilar migraine). The subset of migraine patients under 50 years exhibited MRI signal abnormalities more than twice as often as controls (33% vs. 14%). Punctate white matter hyperintensities were the predominant finding and were seen in 10 of 15 individuals with MRI lesions. More striking signal abnormalities consisted of symmetrical areas of hyperintensity lateral to the posterior horns in two 24 year old patients and of extensive white matter damage with lacunar infarcts in a 59 year old woman. Our findings confirm a higher prevalence of MRI lesions in a mixed group of migraineurs than in headache free individuals. Signal abnormalities are most often non-specific, however their occurrence relates to the type of migraine.     

Persistent and Repetitive Visual Disturbances in Migraine: A Review

Visual disturbances in migraineurs, such as visual aura, are typically episodic, that is, associated with the headache attack, and overlaid by head pain and other symptoms that impact the patient. In some patients, however, visual symptoms are dominant due to frequency (migraine aura status), duration (persistent migraine aura and other persistent positive visual phenomena), or complexity (visual snow syndrome). These syndromes are more rare and challenging to classify in clinical practice resulting in a lack of systematic studies on pathophysiology and treatment. We aim at describing clinical features and pathophysiological concepts of typical migraine aura with a focus on cortical spreading depression and differentiation from non‐typical migraine aura. Additionally, we discuss nomenclature and the specifics of migraine aura status, persistent migraine aura, persistent positive visual phenomena, visual snow, and other migrainous visual disturbances. The term migraine with prolonged aura might be a useful bridge between typical aura and persistent aura. Further studies would be necessary to assess whether a return of the classification category eventually helps diagnosing or treating patients more effectively. A practical approach is presented to help the treating physician to assign the correct diagnosis and to choose a medication for treatment that has been successful in case reports of these rare but disabling conditions.     

Migraine With Neurological Features in a Scuba Diver With a Patent Foramen Ovale

Neurologic complications of decompression sickness have been observed for over half of a century. Little is known, however, about the risk of diving in patients that suffer from migraine with aura (MWA). We report the case of a pediatric patient with a history of migraine with aura, who was later found to have a PFO, who developed headache with neurological symptoms during a scuba diving lesson.     

Cerebrovascular Reactivity in Migraine With and Without Aura

Abnormal cerebrovascular regulation has been implicated in the pathogenesis of migraine. Our aim in this study was to evaluate cerebrovascular reactivity to different stimulations in migraine with and without aura. Using bilateral transcranial Doppler, the changes of flow velocity during hypercapnia and mental and motor activity were measured in the middle cerebral adages of 15 controls and 30 patients with migraine with aura (n=l5) or without aura (n=15) in an attack-free period. Vascular response to all tests was similar in controls and patients. In patients with unilateral headache, no side-to-side difference was found. These findings suggest that no alteration of cerebrovascular reactivity exists outside attacks in migraine with and without aura. Further studies with transcranial Doppler considering all intracranial vessels and the comparison with other techniques of flow investigation with better regional resolution are needed to confirm these data.     

Migraine in Patients With Stroke and Antiphospholipid Antibodies

SYNOPSIS
The association between migraine and antibodies against antiphospholipids is controversial. We investigated the prevalence and the clinical feature of migraine in patients with ischemic stroke and antiphospholipid antibodies. Data were obtained from the medical records of 162 consecutive patients with ischemic stroke over a 2-year period. Ten patients with antiphospholipid antibodies were prospectively identified. A history of migraine was present in 6 of these patients and in only 5 of the 152 patients with negative results for antiphospholipid antibodies (chi-square=47.68; P <.0001). In the former, migraine had been for a long time the only clinical problem before the occurrence of the ischemic stroke. These findings suggest that migraine is frequent and can be an early and a prominent symptom in the antiphospholipid antibodies syndrome. Further studies are needed to fully elucidate the association of migraine and antiphospholipid antibodies. A better knowledge of this association could allow an early identification of patients at high risk of stroke.