Saturday, 23 November 2013

Migraine Aura Without Headache - The Phases and Types of Symptoms

Migraine Aura Without Headache
It is also known as migraine 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)

I. Symptoms
A. Since it is a chronic condition with recurrent attacks, pain is usual very intensive and divided into 4 possible phases(1)
1. The prodrome
The prodrome symptoms happen in 40–60% of those with migraines is an occurrence of early symptoms indicate the start of a migraine headache attacks, including altered mood, irritability, depression or euphoria, fatigue, yawning, excessive sleepiness, craving for certain food, etc.. In the study of a total of 893 migraine patients (IHS 1.1-1.7) were evaluated at first visit. Prodrome frequency, duration, and characteristics were analyzed in the total migraine population IHS 1.1-1.7 and IHS 1.1-1.6 migraine conducted by Leslie Kelman MD, found that A total of 32.9% of IHS migraine 1.1-1.6 patients reported prodrome symptoms with an average of 9.42 hours. IHS 1.1-1.7 migraine reported 29.7% and 6.8 hours, respectively. The most commonest symptoms were tiredness, mood change, and gastrointestinal symptoms; all three of these symptoms were present together in 17% of the patients with prodrome. The duration of prodrome was less than 1 hour in 45.1%, 1-2 hours in 13.6%, 2-4 hours in 15.0%, 4-12 hours in 13.1%, and greater than 12 hours in 13.2%. IHS 1.1-1.7 patients showed similar findings.(2)

2. The aura
The aura, happens to approximately 20 -40% Migraine sufferers. In general, the symptoms of comprised focal neurological phenomena appear gradually over five to 20 minutes and last fewer than 60 minutes. But in some cases, a sudden onset of severe bilateral facial pain radiating bilaterally into the medial cervical region after defecation. The pain was accompanied by scotomas in the right visual field and hypaesthesia in both upper limbs of that required medical attention.

3. The pain phase
The headache phase of the migraine attack usually begins within 60 minutes of the end of the aura phase. The pain of the headache is intense, throbbing from moderate to severe, may be bilateral or unilateral at the onset, and occur on one side or alternate sides from one attack to the next.

4. The postdrome
After the pain phase, 68% of the sufferers may experience the postdrome of which can be lasted for average of 24 hours, including tiredness (71.8%), head pain (33.1%), cognitive difficulties (11.7%), ‘hangover’ (10.7%), gastrointestinal symptoms (8.4%), mood change (6.8%), and weakness (6.2%) with commonest symptoms being tiredness and low-grade headache(3)

B. The symptoms
Migraine Without Headache shares all the symptoms of other migraine headache but with no headache pain, but some researchers believe Migraine Without Headache are Episodic Neurologic Symptoms(a), sharing the following features: (1) They are intermittent; (2) they are recurrent; (3) they are usually brief, lasting minutes to hours; (4) the patient is usually asymptomatic between attacks; and (5) the symptoms are usually stereotyped for an individual patient (b), with the auras slowly develop over a few minutes and last less than 60 minutes, according to the International Headache Society, migraine auras
1. Visual symptoms
a. Flashing lights
b. dots or spots in vision
c. Partial alteration in one's field of vision
d. Blind spots
e. Tunnel vision
f. Double vision
g. Blindness
h. Vision images appear distorted
i. Etc.
2. Neurological symptoms
a. Sensation of tingling
b. Burning, pricking
c. Numbness
d. Pricking 
e. Vertigo
f. Amnesia
g. Confusion
h. Irritability
i. Hearing loss 
j. Euphoria
k. Weakness on one side of the body
l. Etc. 

3. Physical symptoms
1. Cyclic vomiting
2. Thirst
3. Increased urination
4. Fatigue
5. Recurrent abdominal pain
6. Coronary artery spasm
7. circulatory disorder
8. Etc.

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