Acephalgic migraine
{{Short description|Neurological syndrome involving a migraine without headache}}
Acephalgic migraine (also called migraine aura without headache, amigrainous migraine, isolated visual migraine, optical migraine, and silent migraine) is a neurological syndrome. It is a relatively uncommon variant of migraine in which the patient may experience some migraine symptoms such as aura, nausea, photophobia, and hemiparesis, but does not experience headache.{{cite book | title = Primary Care Medicine: Office Evaluation and Management of the Adult Patient | edition= 6th | last = Goroll |first = Allan H. |author2= Albert G. Mulley | publisher = Lippincott Williams & Wilkins | year = 2009 | isbn = 978-0-7817-7513-7 | page = 1152}} It is generally classified as an event fulfilling the conditions of migraine with aura with no (or minimal) headache.{{cite book | title = Companion to clinical neurology | last = Pryse-Phillips | first = William | edition = 2nd | publisher = Oxford University Press US | year= 2003 | isbn = 0-19-515938-1 | page = 587}}{{cite book | title = Neurology in clinical practice | volume = 2 | isbn = 0-7506-7469-5 | edition = 4th | first = Walter George | last = Bradley | publisher = Taylor & Francis | year = 2004 | page = 2074}} It is sometimes distinguished from visual-only migraine aura without headache, also called ocular migraine.{{cite book | title = The Migraine Brain: Your Breakthrough Guide to Fewer Headaches, Better Health | first = Carolyn | last = Bernstein |author2= Elaine McArdle | publisher = Simon and Schuster | year = 2009 | isbn = 978-1-4165-4769-3 | page = 36}}
Symptoms and misdiagnosis
Acephalgic migraines can occur in individuals of any age.{{cite book | title = Epilepsy: a comprehensive textbook |volume = 1| last = Engel | first = Jerome |author2=Timothy A. Pedley|author3=Jean Aicardi|author4=Marc A Dichter | edition= 2nd | publisher = Lippincott Williams & Wilkins | year = 2008 | isbn = 978-0-7817-5777-5 | page = 2695}} Some individuals, usually males, only experience acephalgic migraine, but frequently patients also experience migraine with headache.{{cite book | title = Walsh and Hoyt's clinical neuro-ophthalmology | volume = 1 | last = Miller | first = Neil R. |author2=Frank Burton Walsh|author3=Valérie Biousse|author4=William Fletcher Hoyt | edition = 6th | publisher = Lippincott Williams & Wilkins | year = 2005 | isbn = 0-7817-4811-9 | page = 1289}} Generally, the condition is more than twice as likely to occur in females than males.{{cite book | title = Migraine in women | first = Elizabeth | last = Loder |author2= Dawn A. Marcus | publisher = PMPH-USA | year = 2004 | isbn = 1-55009-180-8 | page = 21}} Pediatric acephalgic migraines are listed along with other childhood periodic syndromes by W.A. Al-Twaijri and M.I. Shevell as "migraine equivalents" (although not listed as such in the International Classification of Headache Disorders), which can be good predictors of the future development of typical migraines.{{cite journal|last=Al-Twaijri|first=WA|author2=Shevell, MI|title=Pediatric migraine equivalents: occurrence and clinical features in practice.|journal=Pediatric Neurology|date=May 2002|volume=26|issue=5|pages=365–8|doi=10.1016/S0887-8994(01)00416-7|pmid=12057796}}{{cite book | last = Lipton | first = Richard B. | title = Migraine and other headache disorders | volume = 85 | series = Neurological disease and therapy |author2= Marcelo Eduardo Bigal | publisher = Informa Health Care | year = 2006 | page = 204 | isbn = 0-8493-3695-3}} Individuals who experience acephalgic migraines in childhood are highly likely to develop typical migraines as they grow older.{{cite book | title = Handbook of neurosurgery | first = Mark S. | last = Greenberg | edition = 6th | publisher = Thieme | year = 2006 | isbn = 3-13-110886-X | page = 45}} Among women, incidents of acephalgic migraine increase during perimenopause.
Scintillating scotoma is the most common symptom{{cite book | last = Gilroy | first = John | title = Basic neurology | edition = 3rd | publisher = McGraw-Hill Professional | year = 2000 | isbn= 0-07-105467-7 | page = 127}} which usually happens concurrently with Expanding Fortification Spectra.{{cite journal|author=G. D. Schott|journal=Brain|year=2007|volume=130|issue=6|doi=10.1093/brain/awl348
|title=Exploring the visual hallucinations of migraine aura: the tacit contribution of illustration|pages=1690–1703|pmid=17264093|doi-access=free}} Also frequently reported is monocular blindness.{{cite book | last = Irwin | first = Richard S. | title = Diagnosis and treatment of symptoms of the respiratory tract |author2=Frederick J. Curley|author3=Ronald F. Grossman | edition = 2nd | publisher = Wiley-Blackwell | year = 1997 | isbn = 0-87993-657-6 | page = 607}} Acephalgic migraines typically do not persist more than a few hours and may last for as little as 15 seconds.{{cite book | last = Amos | first = John F. | title = Diagnosis and management in vision care | publisher = Butterworths | year = 1987 | isbn = 0-409-95082-3 | page = 16}} On rare occasions, they may continue for up to two days.
Acephalgic migraines may resemble transient ischemic attacks or, when longer in duration, stroke.{{cite book | title = Clinical guide to comprehensive ophthalmology | last = Lee | first = David A. |author2=Eve J. Higginbotham | publisher = Thieme | year = 1999 | isbn = 0-86577-766-7 | page = 532}} The concurrence of other symptoms such as photophobia and nausea can help in determining the proper diagnosis. Occasionally, patients with acephalgic migraine are misdiagnosed as having epilepsy with visual seizures, but the reverse misdiagnosis is more common.{{cite book | title = A Clinical Guide to Epileptic Syndromes and Their Treatment | first = Chrysostomos P. | last = Panayiotopoulos | edition = 2nd | publisher = Springer | year = 2007 | isbn = 978-1-84628-643-8 | pages = 107–108}}
Treatment
The prevention and treatment of acephalgic migraine is broadly the same as for classical migraine, but the symptoms are usually less severe than those of classic migraine, so treatment is less likely to be required. Some specialists have prescribed the use of antiplatelet treatments such as daily aspirin as a preventive treatment for certain patients with acephalgic migraines.{{Cite web |date=2021-08-11 |title=Migraine aura without headache: Causes, triggers, and more |url=https://www.medicalnewstoday.com/articles/migraine-aura-without-headache |access-date=2023-08-28 |website=www.medicalnewstoday.com |language=en}} Other treatments used on a case-by-case basis include magnesium and lamotrigine.{{Cite web |title=Silent Migraine: A Guide |url=https://americanmigrainefoundation.org/resource-library/silent-migraine/ |access-date=2023-08-28 |website=American Migraine Foundation |language=en-US}}
See also
References
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