Saturday, 23 November 2013

Migraine Aura Without Headache - The Complications

Migraine Without Headache
It is also known as migraine aura without headache or Silent Migraines. Migraine aura without headache should be considered as a diagnosis in anyone who has recurrent episodes of transient symptoms, especially those that are visual or neurological or involve vertigo. Visual and neurological symptoms due to migraine are not unusual and most commonly occur in older persons with a history of migraine headaches. Migraine aura without headache should be diagnosed only when transient. Migraine auras are reversible and recurrent episodes of neurological symptoms that resolve within 1 hour. They are associated with migraine but may not precede a headache, according to "Migraine aura without headache:
Benign, but a diagnosis of exclusion" by ROBERT S. KUNKEL, MD Consultant, Headache Center, Department of Neurology, The Cleveland Clinic Foundation (Page 529)(a).
Complications of migraine headaches can be divided into the following, according to the International Headache Society's classification of headaches.
1. Chronic migraine
Chronic migraines is defined as headaches in the absence of medication overuse, occurring on ≥15 days per month for ≥3 months, of which headaches on ≥8 days must fulfill the criteria for migraine is that they continue over a long period of time. It is also known as transformed migraine, as chronic migraines can evolve (or transform) from episodic to almost daily headaches with mild symptoms (15)

2. Status migrainosus
Status migrainosus is defined as a condition of migraine episodes that persist for less than 3 days, but in most case, there are periods of relative relief, but these generally last no longer than four hours. With symptoms similar general migraine. Dihydroergotamine and the triptans, has found to reduce the number of headache episodes that persist after initial treatment or fail to respond to self-administered therapy(16)

3. Persistent aura without infarction (PAWI)
Persistent aura without infarction (PAWI) is a rare complications of migraines with neurological and ophthalmological examinations. The visual symptoms is a result of decreased left fronto-parieto-occipital and right occipital blood perfusion.(17)

4. Migrainous infarction
Migrainous infarction is a rare complication after usual attacks of migraine with aura. Some studies suggested that "possible" cases of migrainous infarction should undergo an extended diagnostic workup to rule out symptomatic migraine due to extra/intra-cranial vascular pathology (artery dissection/malformations, venous thrombosis) and to exclude a causal role for other conditions(18)

5. Migraine seizures
A migraine seizure is an epileptic seizure that follows a migraine with aura, meeting the definition for a migraine with aura, and an epileptic seizure must occur within one hour of the migraine aura. Some researchers suggested thatthe occurrence of common susceptibility loci for epilepsy and migraine on chromosomes 14q12-q23 and 12q24.2-q24.3, implicating a shared genetic etiology for these 2 diseases(19). Other suggested the hypothesis of modification in threshold of cortical hyperexcitability from migraine to epilepsy.(20). Symptoms of the complication include some sort of visual change or loss, zigzagging lines, bright flashes, etc.

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