Presentation
We report a 14-year-old girl who presented with yearly attacks of bilateral internal ophthalmoplegia, nausea and headache, since the age of nine. The episodic isolated bilateral mydriasis in this child is believed to be a migraine equivalent. [ncbi.nlm.nih.gov]
Vestibular responses were normal in all except 2 cases which presented signs of central vestibular impairment at the level of the vestibulocerebellar pathways. [karger.com]
An aura presents as a progressive neurologic deficit or disturbance with subsequent complete recovery. [hmsphysiology.pbworks.com]
Headache was present in 40% of cases in this series. In both of Fisher's studies, many patients had headache; thus, all were not totally acephalgic (only aura). [medlink.com]
Gastrointestinal
- Abdominal Pain
[…] migraine, migraine with abdominal pain, and recurrent abdominal pain of childhood. [medlink.com]
Abdominal migraine Out of 98 children with Abdominal migraine, 69 had central or peri umbilical pain, 29 with generalized pain. [headache.imedpub.com]
Although not common, the most prevalent migraine equivalent is “abdominal migraine”, which is characterized by recurrent episodes of vomiting and abdominal pain without headache. [headaches.org]
Eyes
- Scotoma
The classic scintillating scotoma with fortification spectrum is suggestive of migraine. Residual visual field defects may indicate another underlying process, such as cerebrovascular disease or a vascular malformation. [aao.org]
The following observations were made regarding auras: The typical visual aura started with a flickering uncolored zig-zag line in the center of the visual field and gradually progressed toward the periphery of one hemifield, often leaving a scotoma. [hmsphysiology.pbworks.com]
In his first series, Fisher reported 120 patients with neurologic accompaniments of migraine classified according to the following symptoms: visual accompaniments (excluding patients who had only ordinary scintillating scotoma) (25); visual symptoms and [medlink.com]
[…] typical migraines. [8] [9] Individuals who experience acephalgic migraines in childhood are highly likely to develop typical migraines as they grow older. [10] Among women, incidents of acephalgic migraine increase during perimenopause. [7] Scintillating scotoma [en.wikipedia.org]
The Varying Frequency of Migraines, and Health Risks I have had migraine equivalents (aura without headache) once or twice a year for the last 20 years: I get a scintillating scotoma that fades within half an hour. [consults.blogs.nytimes.com]
- Scintillating Scotoma
The classic scintillating scotoma with fortification spectrum is suggestive of migraine. Residual visual field defects may indicate another underlying process, such as cerebrovascular disease or a vascular malformation. [aao.org]
In his first series, Fisher reported 120 patients with neurologic accompaniments of migraine classified according to the following symptoms: visual accompaniments (excluding patients who had only ordinary scintillating scotoma) (25); visual symptoms and [medlink.com]
scotoma is the most common symptom [11] which usually happens concurrently with Expanding Fortification Spectra. [12] Also frequently reported is monocular blindness. [13] Acephalgic migraines typically do not persist more than a few hours and may last [en.wikipedia.org]
The Varying Frequency of Migraines, and Health Risks I have had migraine equivalents (aura without headache) once or twice a year for the last 20 years: I get a scintillating scotoma that fades within half an hour. [consults.blogs.nytimes.com]
There are many other migraine equivalents [ 19, 20 ] (old terminology for episodic syndromes) described in the literature like hemianopia, scintillating scotomas, ophthalmoplegias, blurring of vision, amaurosis fugax, diplopia, oculosympathetic palsy, [headache.imedpub.com]
Neurologic
- Headache
Migrainous headache is determined by pathogenetic mechanisms that are also able to affect the peripheral and/or central vestibular system, so that vestibular symptoms may substitute and/or present with headache. [ncbi.nlm.nih.gov]
Headache followed the aura in 93 percent. Less commonly, headache and aura occurred simultaneously or aura followed the headache (4 and 3 percent, respectively). [hmsphysiology.pbworks.com]
[…] they are equal to a migraine attack, just without the headaches. [migravent.com]
Headaches are the most common and most incapacitating symptom of the disorder, he said. Generally, migraine headaches can be treated by medication and by a restricted diet. [articles.baltimoresun.com]
Although headache type (migraine or tension-type headache) did not correlate with migraine equivalents presence (χ2 = 33.2; P = 0.27), high frequency of headache episodes correlated with the occurrence of migraine equivalents. [pedneur.com]
- Dizziness
Migraine headaches are one of the most common causes of dizziness. Dizziness in migraine may occur with the HA, prior to or after the HA or completely independent of the HA. It is common to have dizziness as the only symptom of a migraine HA. [earassociates.com]
Among the brain stem symptoms, vestibular manifestations are quite common and include nonspecific dizziness, disequilibrium, vertigo, and motion intolerance. Auditory symptoms are less common. [pubmed.ncbi.nlm.nih.gov]
Dizziness, drowsiness, or nausea may occur. If any of these effects persist or worsen, tell your doctor or pharmacist promptly. [rxlist.com]
Some include: dimenhydrinate (Gravol) metoclopramide (Reglan) prochlorperazine (Compazine) promethazine (Phenergan) trimethobenzamide (Tigan) These drugs may make you drowsy, less alert, or dizzy, and have other possible side effects. [healthline.com]
- Stroke
Stroke-like symptoms presenting for the first time require rapid stroke evaluation, preferably in the emergency department or stroke unit. [neurologyadvisor.com]
Needless to say, he was concerned that he was having a stroke. How common are these symptoms, and is there a connection between migraine and stroke? Can a migraine cause a stroke? Shari, Kiel, Wis. [consults.blogs.nytimes.com]
Even if you think you are having a severe migraine equivalent attack involving stroke-like symptoms, you should have somebody contact emergency services. [migravent.com]
Branson's incoherence fuelled internet speculation that she suffered an on-air stroke. But doctors at the University of California, where she went to get a brain scan and blood tests, ruled it out. [telegraph.co.uk]
Ruling out stroke and other more serious disorders is crucial since the typical migraine head pain is not present. [migraine.com]
- Vertigo
Based on such considerations, we proposed a classification of vertigo and other vestibular disorders related to migraine, and believe that a particular variant of migraine-related vertigo should be introduced, namely "epigone migraine vertigo" (EMV): [ncbi.nlm.nih.gov]
Five patients with migraine equivalent symptoms that include vertigo are presented. The vertigo was the dominant symptom in some cases and was accompanied by nausea and vomiting. [pubmed.ncbi.nlm.nih.gov]
Fifteen had abdominal migraine, 12 benign paroxysmal vertigo, 5 confusional migraine, 3 aura without migraine, 2 paroxysmal torticollis, and 1 cyclic vomiting. [journals.sagepub.com]
Benign Paroxysmal Vertigo is considered as an early manifestation of migraine related vertigo. [headache.imedpub.com]
- Sinus Headache
Thinking it’s just a sinus headache or a tension headache could be a life-or-death delusion. [migraineagain.com]
Sufferers notice increased medication use with a decreased results. back to top Sinus Headache True sinus headache will show up on an x-ray and the sufferer will experience a yellow-green discharge from their nasal area. [headache-help.org]
Most patients who think they have sinus headache in fact have migraines. [hopkinsmedicine.org]
Sinus Headaches Sinus headaches are described as mild to moderate pain in the places near your sinuses—your cheeks, eyes, and across your nose. These headaches require the patient to first have a sinus infection. [onhealth.com]
A sinus headache should go away with treatment of the sinus infection. When should I seek help for my headaches? Sometimes, headache can signal a more serious problem. [womenshealth.gov]
Workup
The chapters present detailed, methodical guidelines f or the workup of the patient with chronic pelvic pain and for the diag nosis and treatment of the many disorders that cause pelvic discomfort. [books.google.com]
“The first one may prompt a workup, while subsequent ones do not.” Stroke evaluation in these cases includes neuroimaging using noncontrast computed tomography in the emergency department. [neurologyadvisor.com]
Gastroenterologic evaluation and workup typically yield unremarkable results. [48] Abdominal migraine symptoms are usually relieved with sleep. Antiemetics may help in aborting an acute attack. [emedicine.medscape.com]
These patient’s often undergo extensive abdominal and intestinal workups for infection or other intrinsic diseases of the bowel which are negative. [entad.org]
Treatment
Beware, however, that tension headaches, as opposed to migraines, are not necessarily neurological in origin, and cannot merit this treatment. [donpilzer.com]
The chapters present detailed, methodical guidelines f or the workup of the patient with chronic pelvic pain and for the diag nosis and treatment of the many disorders that cause pelvic discomfort. [books.google.com]
Prophylactic treatment was introduced in 23 patients; 4 lost follow-up and 19 had significant improvement. We conclude that the correct diagnosis of migraine equivalents enables an effective treatment with an excellent outcome. 1. Barlow, CF. [journals.sagepub.com]
The sooner these treatments are administered, the more effective they are. × Treatment There is no absolute cure for migraine since its pathophysiology has yet to be fully understood. [ninds.nih.gov]
Sumatriptan-naproxen for acute treatment of migraine: a randomized trial. JAMA. April 4, 2007;297(13):1443-1454. 8. Cady R, Elkind A, Goldstein J, Keywood C. [consumerreports.org]
Prognosis
Prognosis Responsive prevention and treatment of migraine is incredibly important. [ninds.nih.gov]
First, genetics undoubtedly plays a very prominent role in determining the frequency, severity and long-term prognosis of migraine for an individual sufferer. [consults.blogs.nytimes.com]
The prognosis of childhood abdominal migraine.Arch Dis Child. 2001; 84: 415-418 Lanzi G. Balottin U. Fazzi E. Rosano F.B. The periodic syndrome in pediatric migraine sufferers.Cephalalgia. 1983; 3: 91-93 Lanzi G. Zambrino C.A. Balottin U. [pedneur.com]
Dignan F, Abu Arafeh, Russel G (2001) The prognosis of childhood abdominal migraine. Arch Dis Child 84: 415-418. Mcgrath PJ, Goodman JT, Firestone P (1983) Recurrent abdominal pain: a psychogenic disorder. Arch Dis Child 58: 888-890. [headache.imedpub.com]
What is the prognosis for a person with migraines? Is there a cure? Most people who have migraines find that their headaches may be controlled with the preventive medications and lifestyle changes. [medicinenet.com]
Etiology
Abstract: Migraine equivalents of infancy, childhood, and adolescence are recognized periodic, paroxysmal syndromes without associated headache that are thought to be migrainous in etiology. Five such equivalents are presently recognized. [scite.ai]
These recognized migraine equivalents of infancy, childhood, and adolescence are recognized periodic paroxysmal syndromes without associated headache that are thought to be migrainous in etiology. [medlink.com]
This strongly suggests dopaminergic hypersensitivity as a possible etiology of migraine. [ahcmedia.com]
Medscape: "Migraine Headache," "Migraine in Children," "What is the vascular theory of migraine etiology?" "Understanding migraine." National Headache Foundation: "Low Tyramine Diet for Migraine." NIH: "Migraine information page." [onhealth.com]
Despite such progress, in view of the complexity of the etiology of migraine, it still remains undiagnosed and available therapies are underused. [raysahelian.com]
Epidemiology
Clinical epidemiology of childhood abdominal migraine in an urban general practice. Dev Med Child Neurol. 1993 ;35: 243 – 248. Google Scholar | Crossref | Medline | ISI 12. Symon, DN, Russell, G. [journals.sagepub.com]
Epidemiology of vertigo, migraine and vestibular migraine. Lempert T, Neuhauser H. Lempert T, et al. J Neurol. 2009 Mar;256(3):333-8. doi: 10.1007/s00415-009-0149-2. Epub 2009 Feb 17. J Neurol. 2009. PMID: 19225823 Review. [pubmed.ncbi.nlm.nih.gov]
Epidemiology of migraine and tension type headache. Current Opinion in Neurology 1994; 7: 264-271. More than two-thirds of medication overuse headache occurs in people with migraine as the primary headache. [migraine.ie]
Medication-overuse headache: epidemiology, diagnosis and treatment. Ther Adv Drug Saf. 2014;5(2):87-99. [ PubMed ] 28. Leniger T, Pageler L, Stude P, Diener H, Limmroth V. [aliem.com]
The epidemiology, burden, and comorbidities of migraine. Bigal ME, Lipton RB. Neurol Clin. 2009 May;27(2):321-34. Review. 40. Neurologie, editions Masson, 2008, J. Cambier, H. Dehen, M. Masson. 41. [passeportsante.net]
Pathophysiology
Migraine: pathophysiology, pharmacology, treatment and future trends. Curr Vasc Pharmacol. 2003;1(1):71-84. 9. Reddy DS. The pathophysiological and pharmacological basis of current drug treatment of migraine headache. [uspharmacist.com]
The sooner these treatments are administered, the more effective they are. × Treatment There is no absolute cure for migraine since its pathophysiology has yet to be fully understood. [ninds.nih.gov]
Primary headache pathophysiology in children: the contribution of clinical neurophysiology.Clin Neurophysiol. 2014; 125: 6-12 Hashkes P.J. Gorenberg M. Oren V. Friedland O. Uziel Y. [pedneur.com]
After the ongoing evidence on the multifaceted pathophysiology of CSX, it became even more clear that there is a need for a pragmatic approach to education and training of medical practitioners in the management of patients, especially in refractory patients [onlinejacc.org]
Functional neuroimaging: enhanced understanding of migraine pathophysiology. Neurology. 2000. 55(9 Suppl 2):S36-45. [Medline]. Goadsby PJ. Migraine pathophysiology. Headache. 2005 Apr. 45 Suppl 1:S14-24. [Medline]. Lagman-Bartolome AM, Lay C. [emedicine.medscape.com]
Prevention
Prognosis Responsive prevention and treatment of migraine is incredibly important. [ninds.nih.gov]
Preventive (prophylactic) medications are taken on a regular basis to prevent headaches before they start and may lower the frequency and severity of migraines, or prevent them all together. [migrelief.com]
Antidepressants, anti-seizure drugs and antihistamines have also been used to prevent migraines. A doctor can help you choose the best medicinal route if you need preventive medication. [livestrong.com]
If your migraines are severe or you have tried avoiding possible triggers and are still experiencing symptoms, a GP may prescribe medicines to help prevent further attacks. [nhs.uk]
Effect of Fremanezumab compared with placebo for prevention of episodic migraine a randomized clinical trial. JAMA. 2018 May 15;319(19):1999-2008. [revistafarmaciahospitalaria.sefh.es]