A case of ophthalmoplegic migraine with ipsilateral CT-documented hypodense lesions

A comparative study of magnetic resonance imaging and computed tomography in the evaluation of migraine

Seventy-four patients with classic migraine were examined by magnetic resonance imaging (MRI) and contrast enhanced head CT scanning. Patients chosen for the study ranged in age from 9 to 39 years with a mean age of 28 years. All had documented symptoms of classic migraine for over two years. Nineteen of the seventy-four patients (26%) had multiple foci of bright signal in the brain on T2 weighted MRI. None of these parenchymal abnormalities were detected on CT scans. Twenty-six patients (35%) had both MRI and CT demonstration of focal or generalized ventricular enlargement or sulcal prominence. These atrophic findings were shown equally well by both modalities. Ten patients (14%) with atrophic changes showed concomitant small bright foci of T2 signal abnormality. An additional migraine patient with homonymous hemianopsia had a large occipital lobe infarct which was seen as a region of bright T2 signal abnormality on MRI. Typical CT characteristics of an acute infarct were demonstrated.

[Clinical symptoms and classification of migraine.]

Since the beginning of the history of man migraine has been described in all civilizations. It would therefore seem helpful if migraine were to be classified, for diagnostic reasons and in order to study the scientific hypotheses, according to the manifold clinical symptoms, as well as the lack of typical pathophysiological, morphological and biochemical findings. In this review the new classification of headache forms according the the International Headache Society (1988) is presented in comparison to earlier classifications, with special attention to migraine. On the basis of this classification, the individual forms of migraine are described from the viewpoint of the clinical symptoms. The classification of the International Headache Society represents a good basis for reclassifying headaches, which is still under discussion.