Uncommon EEG Pattern in an 8-Year-Old Boy With Recurrent Migraine Aura Without Headache

SYNOPSISA case of an 8-year-old boy with recurrent migraine auras without headache, precipitated by minor head trauma, is reported. Aura was characterized, besides other brain-stem signs, by confusional state. An uncommon electroencephalographic pattern recorded during the episodes, characterized by diffuse continuous beta activity, is described. Recognition of this finding may prevent an inappropriate diagnosis of drugs ingestion.     

Case Series of Headache Characteristics in COVID-19: Headache Can Be an Isolated Symptom

Headache was reported in up to one-third of the hospitalized patients; yet, the clinical characteristics of headache associated with coronavirus disease 2019 (COVID-19) have not been defined. This observational case study included patients who were consulted to headache unit due to headache and had COVID-19 illness. Headache features in 13 PCR-confirmed COVID-19 patients with mild symptoms were reported. Headache was the isolated symptom of the COVID-19 in 3 patients and emerged as an early symptom during the disease course in all patients. Patients specified severe, rapid onset, unrelenting headache with migraine-like features, as well as unusual sensory symptoms such as anosmia, and gastrointestinal symptoms such as diarrhea and loss of appetite and weight. Headache lasted up to 3 days in 70% of the patients and resolved in all patients within 2 weeks. Despite the fact that most of the patients were female and headache characteristics were suggestive of migraine, majority of patients were not suffering from primary headaches. It was concluded that headache could be an isolated symptom of COVID-19, which might possibly be ignored in asymptomatic patients. Headaches associated with COVID-19 included features resembling migraine and/or atypical symptoms including anosmia and diarrhea.     

Objective Diagnosis of Migraine without Aura with Migraine Vascular Index: A Novel Formula to Assess Vasomotor Reactivity

This pilot study was aimed at developing an objective method to diagnose migraine by measuring the difference in vasomotor reactivity between migraineurs and non-migraineurs. Thirty patients diagnosed with migraine without aura and 30 healthy patients were recruited. Vasomotor reactivity of all patients was then assessed by measuring the breath holding index (BHI), hyperventilation index and a novel formula, the migraine vascular index (MVI), of the middle cerebral artery using transcranial Doppler ultrasonography. Migraineurs were found to have significantly lower BHI and MVI values (p < 0.001). Logistic regression analysis revealed that MVI was a significant independent predictor of migraine (p = 0.007). The sensitivity and specificity of MVI in diagnosing migraine with a cutoff value of 1.035 were 86.7% and 86.7%, respectively. In conclusion, MVI measurement is a reliable method for objectively diagnosing migraine. Further research is needed to validate the usage of MVI for migraine diagnosis.     

Headache as the Presenting Symptom in 2 Patients With COVID-19 and a History of Migraine: 2 Case Reports

The coronavirus disease 2019 (COVID-19) pandemic has now affected more than 5 million people globally. Typical symptoms include fever, cough, and shortness of breath. Patients with underlying medical comorbidities such as cardiovascular disease and diabetes are more likely to become severely ill. To date there is limited information on how COVID-19 affects patients with a history migraine. Here, we present the cases of 2 women with a history of migraine whose first symptom of COVID-19 was a severe persistent headache.     

Migraine Stroke: A Possible Complication of Both Migraine With and Without Aura

We describe four migraine patients who developed an ischemic stroke during their typical migraine attacks.
Cerebral infarction as a possible complication of migraine without aura is discussed.
We propose a review of the migraine stroke definition of the International Headache Society.     

A Case of Migraine With Aura Resolving on Warfarin But Not on Apixaban

Several case reports have associated anticoagulants such as heparin and vitamin K antagonists with reduced symptoms in migraine, but no data exist for direct acting oral factor Xa inhibitors. We report the case of a 55‐year‐old female who experienced complete remission of migraine with aura for 12 years while on warfarin, with return of symptoms within 3 weeks of switching to apixaban, and resolution of symptoms once again within days of warfarin resumption. Our case suggests that anticoagulation alone is not sufficient to improve migraine symptoms. Further study of vitamin K‐dependent proteins not involved in anticoagulation, such as the relatively novel growth arrest‐specific gene 6, may clarify the link between warfarin and migraine symptoms.     

MR-Angiography During Spontaneous Attacks of Cluster Headache: A Case Report

SYNOPSIS
Magnetic resonance (MR) angiography was performed during and between two spontaneous and untreatedattacks in a 24-year old male patient with episodic cluster headache. The ipsilateral ophthalmic artery wasobserved to be markedly dilated during both attacks. No changes were seen in the internal carotid artery or any ofthe main arterial branches on either side. A repeat MR-angiography two weeks later when the patient was inclinical remission showed no abnormalities. Our present case report suggests that the MR technique provides auseful method for non-invasive angiography during spontaneous attacks of cluster headache.     

Headache with Aura: A case report of ocular melanoma

Background

Headaches and visual complaints are common conditions encountered in the emergency department. While a patient's age, risk factors, and comorbidities often aid in risk stratification and guide emergency department evaluation, atypical presentations of serious disease may still occur in young otherwise healthy patients

Sustained Visual Aura: A Totally New Variation of Migraine

An unusual case of an abnormally long-lasting (over 12 months) visual migraine aura is reported. The absence of signs of a structural lesion, as shown by neuro-imaging and clinical investigations, make difficult the differential diagnosis between a new variation and a complication of migraine.     

A Prospective Study of Juvenile Migraine With Aura

SYNOPSIS
We studied a group of young migraine with aura patients with whom it was possible to reconstruct the course and the characteristics of the disturbances preceding or accompanying the onset of the headache.
The 47 subjects, 31 female and 16 male, were diagnosed (IHS classification) as Migraine with typical aura (n=40), Familial hemiplegic migraine (n=1l), Basilar migraine (n=6), and Migraine with prolonged aura (n=5).
Visual (43 cases) and sensory disturbances (20 cases) were the most commonly described symptoms; a motor deficit was reported in 10 out of 47 cases. Other disturbances such as vertigo attacks, aphasia, spatial disorientation, loss of consciousness or a decreased level of consciousness with the appearance of automatic movements, were much rarer.
In our cases the visual disturbances were not isolated but were accompanied by other symptoms in 29 cases, and in 5 of the 18 cases in which there were only visual symptoms, the disturbances presented in succession; a "march" of the sensory and motor disturbance was found in 66% and 68% of cases, respectively.
The data from our cases in which the disturbance seems most frequently to originate in the occipital areas (visual disorders) and then to spread to the temporo-parietal regions in part confirms that there is a posterior to anterior dynamic in the cerebral areas involved.     

Oscillocusis: An Unusual Auditory Aura in Migraine

We report a 14-year-old girl with a migraine aura characterized by the sense that ambient sounds were fluctuating in intensity, as if emanating from a radio while the volume control was being altered.These auditory oscillations lasted 5 to 10 minutes and were followed by a typica l migraine headache. By analogy with oscillopsia, we term this unique form of migraine aura "oscillocusis."