1
|
Li Y, Yolland COB, Rossell SL, Sommer IEC, Toh WL. Multisensory hallucinations and other unusual sensory experiences in the context of migraine: a systematic review. J Neurol 2024; 271:1717-1746. [PMID: 38236395 PMCID: PMC10972994 DOI: 10.1007/s00415-023-12144-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 12/01/2023] [Accepted: 12/01/2023] [Indexed: 01/19/2024]
Abstract
OBJECTIVE AND BACKGROUND Visual auras in migraine have been extensively studied, but less is known about multisensory hallucinations or other unusual sensory experiences, including whether these should be diagnostically considered as part of aura symptoms. The current study aimed to conduct a systematic review and synthesis to bring together existing empirical evidence on these non-visual perceptual experiences, focusing on their phenomenological descriptions and clinical correlates. METHODS Forty-eight relevant studies were included based on a systematic search across PsycINFO APA and Web of Science, for peer-reviewed publications in the English language, from 1980 to the present. These comprised a mix of case reports/series (n = 19) and group design studies (n = 29). RESULTS Reports of complex multisensory hallucinations, beyond typical established aura symptoms, were numerous and varied in nature. Yet there were limited data on how this related to patient distress and functional interference. Other sensory distortions or hypersensitivities across non-visual domains were also evident, and generally more common in those with established aura symptoms. CONCLUSION Our findings provide preliminary evidence that multisensory hallucinations and other unusual perceptual experiences in migraine are likely more common than previously believed. Further investigations are needed to appropriately account for these symptoms within current nosological systems. Increased clinician-patient awareness is important for managing distress (where necessary), and potentially for offering a holistic therapeutic approach to migraine management.
Collapse
Affiliation(s)
- Yixuan Li
- Centre for Mental Health & Brain Sciences, Swinburne University of Technology, P.O. Box 218, Hawthorn, VIC, 3122, Australia
| | - Caitlin O B Yolland
- Centre for Mental Health & Brain Sciences, Swinburne University of Technology, P.O. Box 218, Hawthorn, VIC, 3122, Australia.
- Academic Services, Boundless Learning, Melbourne, VIC, Australia.
| | - Susan L Rossell
- Centre for Mental Health & Brain Sciences, Swinburne University of Technology, P.O. Box 218, Hawthorn, VIC, 3122, Australia
- Department of Psychiatry, St Vincent's Hospital, Melbourne, VIC, Australia
| | - Iris E C Sommer
- Department of Biomedical Sciences of Cells and Systems, University Medical Center Groningen, Groningen, The Netherlands
- Graduate School of Medical Sciences (Research School of Behavioural and Cognitive Neurosciences), University of Groningen, Groningen, The Netherlands
| | - Wei Lin Toh
- Centre for Mental Health & Brain Sciences, Swinburne University of Technology, P.O. Box 218, Hawthorn, VIC, 3122, Australia
- Department of Psychiatry, St Vincent's Hospital, Melbourne, VIC, Australia
- Department of Psychology, Alfred Hospital, Melbourne, VIC, Australia
| |
Collapse
|
2
|
Riederer F, Beiersdorf J, Scutelnic A, Schankin CJ. Migraine Aura-Catch Me If You Can with EEG and MRI-A Narrative Review. Diagnostics (Basel) 2023; 13:2844. [PMID: 37685382 PMCID: PMC10486733 DOI: 10.3390/diagnostics13172844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 08/18/2023] [Accepted: 08/22/2023] [Indexed: 09/10/2023] Open
Abstract
Roughly one-third of migraine patients suffer from migraine with aura, characterized by transient focal neurological symptoms or signs such as visual disturbance, sensory abnormalities, speech problems, or paresis in association with the headache attack. Migraine with aura is associated with an increased risk for stroke, epilepsy, and with anxiety disorder. Diagnosis of migraine with aura sometimes requires exclusion of secondary causes if neurological deficits present for the first time or are atypical. It was the aim of this review to summarize EEG an MRI findings during migraine aura in the context of pathophysiological concepts. This is a narrative review based on a systematic literature search. During visual auras, EEG showed no consistent abnormalities related to aura, although transient focal slowing in occipital regions has been observed in quantitative studies. In contrast, in familial hemiplegic migraine (FHM) and migraine with brain stem aura, significant EEG abnormalities have been described consistently, including slowing over the affected hemisphere or bilaterally or suppression of EEG activity. Epileptiform potentials in FHM are most likely attributable to associated epilepsy. The initial perfusion change during migraine aura is probably a short lasting hyperperfusion. Subsequently, perfusion MRI has consistently demonstrated cerebral hypoperfusion usually not restricted to one vascular territory, sometimes associated with vasoconstriction of peripheral arteries, particularly in pediatric patients, and rebound hyperperfusion in later phases. An emerging potential MRI signature of migraine aura is the appearance of dilated veins in susceptibility-weighted imaging, which may point towards the cortical regions related to aura symptoms ("index vein"). Conclusions: Cortical spreading depression (CSD) cannot be directly visualized but there are probable consequences thereof that can be captured Non-invasive detection of CSD is probably very challenging in migraine. Future perspectives will be elaborated based on the studies summarized.
Collapse
Affiliation(s)
- Franz Riederer
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, CH 3010 Bern, Switzerland (C.J.S.)
- Department of Neurology, University Hospital Zurich, Medical Faculty, University of Zurich, CH 8091 Zurich, Switzerland
| | - Johannes Beiersdorf
- Karl Landsteiner Institute for Clinical Epilepsy Reserach and Cognitive Neurology, AT 1130 Vienna, Austria;
| | - Adrian Scutelnic
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, CH 3010 Bern, Switzerland (C.J.S.)
| | - Christoph J. Schankin
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, CH 3010 Bern, Switzerland (C.J.S.)
| |
Collapse
|
3
|
Indelicato E, Boesch S. CACNA1A-Related Channelopathies: Clinical Manifestations and Treatment Options. Handb Exp Pharmacol 2023; 279:227-248. [PMID: 36592223 DOI: 10.1007/164_2022_625] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
In the last decade, variants in the Ca2+ channel gene CACNA1A emerged as a frequent aetiology of rare neurological phenotypes sharing a common denominator of variable paroxysmal manifestations and chronic cerebellar dysfunction. The spectrum of paroxysmal manifestations encompasses migraine with hemiplegic aura, episodic ataxia, epilepsy and paroxysmal non-epileptic movement disorders. Additional chronic neurological symptoms range from severe developmental phenotypes in early-onset cases to neurobehavioural disorders and chronic cerebellar ataxia in older children and adults.In the present review we systematically approach the clinical manifestations of CACNA1A variants, delineate genotype-phenotype correlations and elaborate on the emerging concept of an age-dependent phenotypic spectrum in CACNA1A disease. We furthermore reflect on different therapy options available for paroxysmal symptoms in CACNA1A and address open issues to prioritize in the future clinical research.
Collapse
Affiliation(s)
- Elisabetta Indelicato
- Center for Rare Movement Disorders Innsbruck, Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria.
| | - Sylvia Boesch
- Center for Rare Movement Disorders Innsbruck, Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| |
Collapse
|
4
|
Nagarajan E, Bollu PC, Manjamalai S, Yelam A, Qureshi AI. White Matter Hyperintensities in Patients with Sporadic Hemiplegic Migraine. J Neuroimaging 2019; 29:730-736. [PMID: 31304994 DOI: 10.1111/jon.12656] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Accepted: 06/26/2019] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND AND PURPOSE To identify the differences in overall occurrence, location, and disease burden of white matter hyperintensities (WMH) in patients with sporadic hemiplegic migraine (SHM) and patients with migraine headaches. METHODS We included patients who met diagnostic criteria proposed by the third International Classification of Headache Disorders (ICHD-3) for SHM and migraine headache. WMHs were identified using T2 fluid-attenuated inversion recovery axial sequence and classified based upon the location. The disease burden was assessed using Scheltens visual rating scale. RESULTS Fifty patients met the diagnostic criteria for SHM and 100 patients for migraine headache. Patients in the study group were similar to the control group in terms of age (47.7 ± 12.2 years vs. 48.17 ± 9.7 years; P = .814) and gender (M: F; 14:36 vs. M: F 25:75; P = .693). WMH were found in 28 (56%) patients with SHM and 44 (44%) in patients with migraine headache. The proportion of patients with WMH was not different between the two groups (P = .166). On univariate analysis, the proportion of patients with WMH in parietal, occipital, and infratentorial regions was higher in patients with SHM. White matter burden determined by visual rating scale and proportion of patients with lesions ≥5 mm in diameter was also significantly higher in patients with SHM. On multivariate analysis, the WMH occurrence in the parietal lobe (P = .043) was found to be significantly higher in SHM. CONCLUSIONS The WMH occurrence in patients with SHM is significantly more in the parietal lobe when compared to those with migraine headaches. WMH burden was also higher in patients with SHM, and larger white matter lesions occurred more frequently in these patients with SHM (compared to ordinary migraineurs).
Collapse
Affiliation(s)
| | - Pradeep C Bollu
- Department of Neurology, University of Missouri, Columbia, Missouri
| | | | - Anudeep Yelam
- Department of Neurology, University of Missouri, Columbia, Missouri
| | - Adnan I Qureshi
- Department of Neurology, University of Missouri, Columbia, Missouri.,Zeenat Qureshi Stroke Institute, St. Cloud, Minnesota
| |
Collapse
|
5
|
Multimodal imaging findings during severe attacks of familial hemiplegic migraine type 2. J Neurol Sci 2018; 392:22-27. [DOI: 10.1016/j.jns.2018.06.019] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 06/09/2018] [Accepted: 06/23/2018] [Indexed: 11/24/2022]
|
6
|
Viana M, Afridi S. Migraine with prolonged aura: phenotype and treatment. Naunyn Schmiedebergs Arch Pharmacol 2017; 391:1-7. [PMID: 29143861 DOI: 10.1007/s00210-017-1438-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Accepted: 11/03/2017] [Indexed: 01/03/2023]
Abstract
We review the published literature on migraine with prolonged aura (PA), specifically with regards to the phenotype and treatment options. PA is not uncommon. A recent study found that about 17% of migraine auras are prolonged and that 26% of patients with migraine with aura have experienced at least one PA. The characteristics of PA are similar to most typical auras with the exception of a higher number of aura symptoms (in particular sensory and/or dysphasic). There are no well-established treatments at present which target the aura component of migraine. Other than case reports, there have been open-label studies of lamotrigine and greater occipital nerve blocks. The only randomised, blinded, controlled trial to date has been of nasal ketamine showing some reduction in aura severity but not duration. A small open-labelled pilot study of amiloride was also promising. Larger randomised, controlled trials are needed to establish whether any of the existing or novel compounds mentioned are significantly effective and safe.
Collapse
Affiliation(s)
- Michele Viana
- Headache Science Center, C. Mondino National Neurological Institute, Via Mondino 2, 27100, Pavia, Italy.
| | - Shazia Afridi
- Department of Neurology, Guy's and St Thomas' NHS Trust, London, UK
| |
Collapse
|
7
|
Naeije G, Fogang Y, Ligot N, Mavroudakis N. Occipital transcranial magnetic stimulation discriminates transient neurological symptoms of vascular origin from migraine aura without headache. Neurophysiol Clin 2017; 47:269-274. [DOI: 10.1016/j.neucli.2017.05.093] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2016] [Accepted: 05/09/2017] [Indexed: 10/19/2022] Open
|
8
|
Indelicato E, Nachbauer W, Eigentler A, Donnemiller E, Wagner M, Unterberger I, Boesch S. Ten years of follow-up in a large family with familial hemiplegic migraine type 1: Clinical course and implications for treatment. Cephalalgia 2017; 38:1167-1176. [PMID: 28856914 DOI: 10.1177/0333102417715229] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Background Familial hemiplegic migraine (FHM) is a rare, genetic form of migraine with aura. The severity of the aura imposes an effective prophylaxis that is currently based on standard anti-migraine drugs. To this concern, only short-term reports are currently available. Methods Eight patients from a multigenerational FHM type 1 family harbouring a T666M mutation in the CACNA1A gene were referred to our ataxia outpatient clinic. Medical history, general and neurological examination as well as therapeutic approaches were recorded regularly on a routine basis for an average period of 13 years (range 9-15 years). Brain imaging studies and EEG data were also collected. Results Our long-term follow-up revealed that ictal manifestations, which usually improve after the adolescence, may reoccur later in the adulthood. Permanent neurological signs as assessed by means of clinical evaluation as well as follow-up MRIs, EEGs and neuropsychological testing remained stable. Interval therapy with non-selective calcium antagonists reduced the burden of migraine attacks and was well tolerated in the long term.
Collapse
Affiliation(s)
- Elisabetta Indelicato
- 1 Department of Neurology, Medical University Innsbruck, Anichstrasse, Innsbruck, Austria
| | - Wolfgang Nachbauer
- 1 Department of Neurology, Medical University Innsbruck, Anichstrasse, Innsbruck, Austria
| | - Andreas Eigentler
- 1 Department of Neurology, Medical University Innsbruck, Anichstrasse, Innsbruck, Austria
| | - Evelin Donnemiller
- 2 Department of Nuclear Medicine, 27280 Medical University Innsbruck , Anichstrasse, Innsbruck, Austria
| | - Michaela Wagner
- 3 Department of Neuroradiology, 27280 Medical University Innsbruck , Anichstrasse, Innsbruck, Austria
| | - Iris Unterberger
- 1 Department of Neurology, Medical University Innsbruck, Anichstrasse, Innsbruck, Austria
| | - Sylvia Boesch
- 1 Department of Neurology, Medical University Innsbruck, Anichstrasse, Innsbruck, Austria
| |
Collapse
|
9
|
Massano D, Julliand S, Kanagarajah L, Gautier M, Vizeneux A, Elmaleh M, Alison M, Lejay E, Romanello S, Teisseyre L, Delanoe C, Titomanlio L. Headache with focal neurologic signs in children at the emergency department. J Pediatr 2014; 165:376-82. [PMID: 24928695 DOI: 10.1016/j.jpeds.2014.04.053] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2013] [Revised: 03/18/2014] [Accepted: 04/29/2014] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To identify predictors of secondary headache in children consulting at the pediatric emergency department (ED) for headache with a focal neurologic deficit. STUDY DESIGN In this prospective cohort study, we enrolled children aged 6-18 years presenting to the ED of a tertiary care hospital with moderate to severe headache and focal neurologic deficit. Enrollment took place between March 2009 and February 2012. Children with a history of trauma, fever, or neurosurgical intervention were excluded from the study. The final diagnosis was made after 1 year of follow-up. Our primary aim was to identify any differences in the frequency of clinical signs between children with a final diagnosis of primary headache and those with a final diagnosis of secondary headache. RESULTS Of the 101 patients included in the study, 66% received a final diagnosis of primary headache (94% migraine with aura), and 34% received a final diagnosis of secondary headache (76.5% focal epilepsy). On multivariate analysis, children with bilateral localization of pain had a higher likelihood (aOR, 8.6; 95% CI, 3.2-23.2; P<.001) of having secondary headache. CONCLUSION Among children presenting to the ED with focal neurologic deficits, a bilateral headache location was associated with higher odds of having a secondary cause of headache. Additional longitudinal studies are needed to investigate whether our data can aid management in the ED setting.
Collapse
Affiliation(s)
- Davide Massano
- Pediatric Emergency Department, Robert Debré Hospital-Assistance Publique Hôpitaux de Paris, Paris Diderot University, Paris, France; Pediatric Migraine and Neurovascular Diseases Clinic, Robert Debré Hospital-Assistance Publique Hôpitaux de Paris, Paris Diderot University, Paris, France
| | - Sebastien Julliand
- Pediatric Emergency Department, Robert Debré Hospital-Assistance Publique Hôpitaux de Paris, Paris Diderot University, Paris, France
| | - Lakshmi Kanagarajah
- Department of Radiology, Basildon University Hospital, Essex, United Kingdom
| | - Maxime Gautier
- Pediatric Migraine and Neurovascular Diseases Clinic, Robert Debré Hospital-Assistance Publique Hôpitaux de Paris, Paris Diderot University, Paris, France
| | - Audrey Vizeneux
- Pediatric Migraine and Neurovascular Diseases Clinic, Robert Debré Hospital-Assistance Publique Hôpitaux de Paris, Paris Diderot University, Paris, France
| | - Monique Elmaleh
- Pediatric Radiology Department, Robert Debré Hospital-Assistance Publique Hôpitaux de Paris, Paris Diderot University, Paris, France
| | - Marianne Alison
- Pediatric Radiology Department, Robert Debré Hospital-Assistance Publique Hôpitaux de Paris, Paris Diderot University, Paris, France
| | - Emilie Lejay
- Pediatric Emergency Department, Robert Debré Hospital-Assistance Publique Hôpitaux de Paris, Paris Diderot University, Paris, France
| | - Silvia Romanello
- Pediatric Migraine and Neurovascular Diseases Clinic, Robert Debré Hospital-Assistance Publique Hôpitaux de Paris, Paris Diderot University, Paris, France
| | - Laurence Teisseyre
- Pediatric Migraine and Neurovascular Diseases Clinic, Robert Debré Hospital-Assistance Publique Hôpitaux de Paris, Paris Diderot University, Paris, France
| | - Catherine Delanoe
- Neurophysiology Unit, Robert Debré Hospital-Assistance Publique Hôpitaux de Paris, Paris Diderot University, Paris, France
| | - Luigi Titomanlio
- Pediatric Emergency Department, Robert Debré Hospital-Assistance Publique Hôpitaux de Paris, Paris Diderot University, Paris, France; Pediatric Migraine and Neurovascular Diseases Clinic, Robert Debré Hospital-Assistance Publique Hôpitaux de Paris, Paris Diderot University, Paris, France.
| |
Collapse
|
10
|
Safier R, Cleves-Bayon C, Vaisleib I, Siddiqui A, Zuccoli G. Magnetic resonance angiography evidence of vasospasm in children with suspected acute hemiplegic migraine. J Child Neurol 2014; 29:789-92. [PMID: 23594822 DOI: 10.1177/0883073813483364] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2013] [Accepted: 02/28/2013] [Indexed: 11/17/2022]
Abstract
Hemiplegic migraine is a rare subtype of migraine that is differentiated by motor weakness in the aura phase. The purpose of this case series was to examine the magnetic resonance angiogram findings of patients suffering from suspected acute hemiplegic migraine. This was a retrospective institutional board review protocol study of 8 patients. All patients received full brain magnetic resonance imaging under a 1.5-T magnet. The scans were subsequently evaluated by a neuroradiologist and 2 neurologists who were blinded to the study. The magnetic resonance angiogram findings of this study showed the presence of vasospasm within the intracranial vasculature during suspected acute hemiplegic migraine. This case series suggests that routine use of magnetic resonance angiography might be beneficial in both managing patients with acute hemiplegic migraine and helping to further understand the pathophysiology of this complicated disease process.
Collapse
Affiliation(s)
- Robert Safier
- Division of Child Neurology, Children's Hospital of Pittsburgh of the University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Catalina Cleves-Bayon
- Division of Child Neurology, Children's Hospital of Pittsburgh of the University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Inna Vaisleib
- Division of Child Neurology, Children's Hospital of Pittsburgh of the University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Ali Siddiqui
- Division of Neuroradiology, Children's Hospital of Pittsburgh of the University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Giulio Zuccoli
- Division of Neuroradiology, Children's Hospital of Pittsburgh of the University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| |
Collapse
|
11
|
Diagnostics to look beyond the normal appearing brain tissue (NABT)? A neuroimaging study of patients with primary headache and NABT using magnetization transfer imaging and diffusion magnetic resonance. Clin Neuroradiol 2013; 23:277-83. [PMID: 23397207 DOI: 10.1007/s00062-013-0203-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2012] [Accepted: 01/20/2013] [Indexed: 10/27/2022]
Abstract
OBJECTIVE Novel diagnostics can allow us to "look beyond" normal-appearing brain tissue (NABT) to unravel subtle alterations pertinent to the pathophysiology of primary headache, one of the most common complaints of patients who present to their physician across the medical specialties. Using both magnetization transfer imaging (MTI) and diffusion weighted imaging (DWI), we assessed the putative microstructural changes in patients with primary headache who display the NABT on conventional magnetic resonance imaging (conventional MRI). METHODS Subjects were 53 consecutive patients with primary headache disorders (40 = migraine with aura; 9 = tension headache; 4 = cluster headache) and 20 sex- and age-matched healthy volunteers. All subjects underwent evaluation with MRI, MTI, and DWI in order to measure the magnetization transfer ratio (MTR) and the apparent diffusion coefficient (ADC), respectively, in eight and six different regions of interest (ROIs). RESULTS Compared to healthy controls, we found a significant 4.3 % increase in the average ADC value of the occipital white matter in the full sample of patients (p = 0.035) and in patients with migraine (p = 0.046). MTR values did not differ significantly in ROIs between patients and healthy controls (p > 0.05). CONCLUSIONS The present study lends evidence, for the first time to the best of our knowledge, for a statistically significant microstructural change in the occipital lobes, as measured by ADC, in patients with primary headache who exhibit a NABT on MRI. Importantly, future longitudinal mechanistic clinical studies of primary headache (e.g., vis-à-vis neuroimaging biomarkers) would be well served by characterizing, via DWI, occipital white matter microstructural changes to decipher their broader biological significance.
Collapse
|
12
|
Pelzer N, Stam AH, Haan J, Ferrari MD, Terwindt GM. Familial and sporadic hemiplegic migraine: diagnosis and treatment. Curr Treat Options Neurol 2013. [PMID: 23203776 DOI: 10.1007/s11940-012-0208-3] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OPINION STATEMENT Hemiplegic migraine (HM) is a rare subtype of migraine with aura, characterized by transient hemiparesis during attacks. Diagnosis is based on the International Classification of Headache Disorders criteria (ICHD-II). Two types of HM are recognized: familial (FHM) and sporadic hemiplegic migraine (SHM). HM is genetically heterogeneous. Three genes have been identified (CACNA1A, ATP1A2, and SCN1A) but more, so far unknown genes, are involved. Clinically, attacks of the 3 subtypes cannot be distinguished. The diagnosis can be confirmed but not ruled out by genetic testing, because in some HM patients other, not yet identified, genes are involved. The presence of additional symptoms (such as chronic ataxia or epilepsy) may increase the likelihood of identifying a mutation. Additional diagnostics like imaging, CSF analysis, or an EEG are mainly performed to exclude other causes of focal neurological symptoms associated with headache. Conventional cerebral angiography is contraindicated in HM because this may provoke an attack. Because HM is a rare condition, no clinical treatment trials are available in this specific subgroup of migraine patients. Thus, the treatment of HM is based on empirical data, personal experience of the treating neurologist, and involves a trial-and-error strategy. Acetaminophen and NSAIDs often are the first choice in acute treatment. Although controversial in HM, triptans can be prescribed when headaches are not relieved sufficiently with common analgesics. An effective treatment for the severe and often prolonged aura symptoms is more warranted, but currently no such acute treatment is available. Prophylactic treatment can be considered when attack frequency exceeds 2 attacks per month, or when severe attacks pose a great burden that requires reduction of severity and frequency. In no strictly preferred order, flunarizine, sodium valproate, lamotrigine, verapamil, and acetazolamide can be tried. While less evidence is available for prophylactic treatment with topiramate, candesartan, and pizotifen, these drugs can also be considered. The use of propranolol in HM is more controversial, but evidence of adverse effects is insufficient to contraindicate beta-blockers.
Collapse
Affiliation(s)
- Nadine Pelzer
- Department of Neurology, Leiden University Medical Center, P.O. Box 9600, 2300, RC Leiden, The Netherlands
| | | | | | | | | |
Collapse
|
13
|
Ohmura K, Suzuki Y, Saito Y, Wada T, Goto M, Seto S. Sporadic hemiplegic migraine presenting as acute encephalopathy. Brain Dev 2012; 34:691-5. [PMID: 22136990 DOI: 10.1016/j.braindev.2011.11.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2011] [Revised: 10/27/2011] [Accepted: 11/04/2011] [Indexed: 10/28/2022]
Abstract
A 10-year-old boy with psychomotor developmental delay and cerebellar vermis atrophy developed right hemiplegia with vomiting, unconsciousness, convulsions, and late-onset fever. Slow delta activity was noted over the left hemisphere on electroencephalography, and neuroimaging revealed swelling of the left temporo-occipital cerebral cortex with restricted diffusivity, successive transient cortical atrophy, and hyperperfusion over the left cerebral hemisphere. Interleukin-6 was elevated in the cerebrospinal fluid. The acute symptoms resolved completely within 3 weeks after onset, but hypoperfusion persisted in the left posterior cortex thereafter. Another episode with transient left hemiplegia appeared 7 months later, followed by recurrence of migraine attacks. Analysis of the CACNA1A gene revealed a mutation of c.1997 C>T (p.T666M). None of his family members had migraine. This case represents an unusual evolution of sporadic hemiplegic migraine with manifestations of acute encephalopathy, for which the role of migraine-related inflammatory process is assumed.
Collapse
Affiliation(s)
- Kayo Ohmura
- Department of Pediatrics, Kishiwada City Hospital, Kishiwada, Japan.
| | | | | | | | | | | |
Collapse
|
14
|
|
15
|
Multimodal neuroimaging in a child with sporadic hemiplegic migraine: A contribution to understanding pathogenesis. Cephalalgia 2010; 31:751-6. [DOI: 10.1177/0333102410392068] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: Hemiplegic migraine (HM) is a rare variety of migraine with aura, characterized by motor deficits during the aura, often beginning in childhood. The hemiplegic attacks can be severe and prolonged but the prognosis is usually good. Data on neuroimaging, including diffusion-weighted imaging (DWI) and spectroscopy, during prolonged attacks of HM are quite limited, particularly in children. Case: An eight-year-old female had a prolonged attack of sporadic HM characterized by right-sided hemiplegia, global aphasia, fever and impairment of consciousness. MRI nine hours after hemiplegia onset was negative, while the following MRI scans (days 4 and 11) documented a progressive increase in cortical swelling in the left hemisphere with mild hyperintensity on DWI and mild reduction of apparent diffusion coefficient values. Proton MRI spectroscopy (MRS) (day 15) showed a decrease in the N-acetylaspartate/creatine ratio in the left hemisphere. 99mTc-ECD single-photon emission tomography (SPET) (day 27) showed marked left hemispheric hypoperfusion. The patient recovered completely after 40 days and neuroimaging follow-up (MRI and SPET) after six months was normal. The patient carried a missense mutation of the ATP1A2 gene. Conclusion: Multimodal neuroimaging (MRI, DWI, MRS, SPET) in a prolonged HM attack supports evidence for a primary neuronal dysfunction.
Collapse
|
16
|
Abstract
The differential diagnosis for an acute hemiparesis in a child includes stroke, Todd paralysis, and hemiplegic migraine. In the context of an illustrative case, this review highlights the differences in clinical presentation among these entities and an approach to the diagnostic workup. Migraine with aura in children is reviewed, including migraine equivalents such as abdominal migraine and the particular presentation of hemiplegic migraine. An approach to the prophylactic and acute treatment for children with migraine with aura is offered.
Collapse
Affiliation(s)
- Amy A Gelfand
- Division of Child Neurology, UCSF Department of Neurology, Box 0114, 505 Parnassus Ave, M-798, San Francisco, CA 94143-0114, USA.
| | | | | |
Collapse
|
17
|
Grecco MP, Pieroni M, Otero M, Ferreiro JL, Figuerola MDL. Sporadic hemiplegic migraine and CREST syndrome. J Headache Pain 2010; 11:171-3. [PMID: 20130953 PMCID: PMC3452292 DOI: 10.1007/s10194-010-0188-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2009] [Accepted: 01/06/2010] [Indexed: 11/28/2022] Open
Abstract
Hemiplegic migraines are characterised by attacks of migraine with aura accompanied by transient motor weakness. There are both familial and sporadic subtypes, which are now recognised as separate entities by the International Classification of Headache Disorders, edition II (ICHD-II). The sporadic subtype has been associated with other medical conditions, particularly rheumatological diseases. We report the case of a woman with sporadic hemiplegic migraine associated with CREST syndrome (calcinosis, Raynaud's phenomenon, esophageal dysmotility, sclerodactyly and telangiectasia). Since there is a close relationship between migraine and Raynaud's phenomenon, it could be speculated that the sporadic hemiplegic migraines in our patient might be secondary to CREST syndrome.
Collapse
|