Clinical Characteristics of Migraine with Aura in Korean: a Clinic Based Study

BACKGROUND: Several population- and clinic-based studies have investigated the clinical characteristics of migraine with aura in Western countries. However, migraine with aura has not been investigated in Korea or other Asian countries. The aim of this study was to determine the frequency and characteristics of migraine with aura in Korea. METHODS: We consecutively recruited patients with migraine from 2010 to 2014 in the Eulji Headache Clinic. Migraines with and without aura were diagnosed according to the International Classification of Headache Disorders-II criteria based on a clinical interview and structured questionnaire. RESULTS: In total, 97 (35% males and 65% females) and 649 (12% males and 88% females) patients were diagnosed as migraines with and without aura, respectively. Visual aura was the most common type of aura (94%) among patients with migraine with aura, followed by sensory aura (6%) and then speech aura, retinal aura, and brainstem aura (each 3%). The most frequently accompanying headache type was migraine (77%), followed by nonmigraine headache (17%), with no headache presenting in 6% of patients. Migraine without aura was the most common headache (61%) outside of migraine with aura, followed by nonmigraine headache (14%). CONCLUSIONS: Only 13% of migraineurs have aura symptoms. Nonvisual aura symptoms are rare in Korean patients with migraine with aura.

Clinical Features of Patients Complaining of Visual Symptoms and Diagnosed with Migraine

PURPOSE: To describe the characteristics of patients who visited Korean ophthalmology clinics complaining of visual symptoms and were diagnosed with migraine. METHODS: A retrospective study was performed by evaluating the patterns of visual symptoms, timing of headaches, and results of ophthalmologic examinations in 31 migraine patients who were recruited from a neuro-ophthalmology clinic. RESULTS: The patients consisted of 9 men and 22 women, with a mean age of 38.1 years (range, 12-71). The average age of symptom onset was 35.7 years (range, 12-64 years). The most common three visual symptoms were blurred vision (35.5%), blind spots (22.6%), and flashes of bright lights (22.6%). Visual symptoms disappeared within 5 minutes in 16 patients (51.6%) and 13 patients (41.9%) experienced visual symptoms before the onset of a headache. Brain magnetic resonance imaging findings in 14 cases revealed normal results and the remaining three patients showed minimal small vessel disease. Except for one patient who had exotropia, there was no other specific abnormality observed upon ophthalmologic examinations. CONCLUSIONS: Most of the migraine patients who first visited an ophthalmology clinic with visual symptoms had no definite ocular abnormalities. Thus, ophthalmologists must be aware that migraines could first present with various visual symptoms in order to make an early diagnosis of migraine.

Aura-like features and photophobia in sightless migraine patients / Características de fenômenos aura-relacionados e da fotofobia em enxaquecosos deficientes visuais

Migraine is a central nervous system disorder frequently expressed with paroxysmal visual dysfunctions. Objective To test the hypothesis that normal visual input is vital for the migrainous aura and photophobia. Method We studied the migraine-related visual disturbances in 8 sightless migraineurs identified among 200 visually impaired subjects. Results The main findings were the visual aura and photophobia disappearance along with blindness development, the oddness of aura – too short, colourful (e.g. blue or fire-like), auditory in nature or different in shape (round forms) – and the lack of photophobia. Conclusion We propose that the aura duration should be accepted as shorter in visually impaired subjects. The changes in aura phenotype observed in our patients may be the result of both cerebral plasticity induced by the visual impairment and/or the lack of visual input per se. Integrity of visual pathways plays a key role in migraine visual aura and photophobia. .

A enxaqueca é doença neurológica frequentemente associada a anormalidades visuais transitórias. Objetivo Testar a hipótese de que a visão normal é importante para o fenótipo da aura e da fonofobia. Método Estudamos 8 enxaquecosos deficientes visuais identificados em uma população de 200 indivíduos com visão subnormal. Resultados Os principais achados foram: o desaparecimento da aura visual e da fotofobia com o início da cegueira; a ocorrência de aura atípica – muito curta, colorida (p. ex. azul ou cor de fogo) auditiva ou diferente na forma (arredondadas); e a ausência de fotofobia. Conclusão Propomos que a duração da aura possa ser admitida como mais curta em pessoas com deficiência visual. As mudanças no fenótipo da aura observadas nos nossos pacientes pode ser o resultado da plasticidade cerebral induzida pela deficiência visual e/ou a deficiência visual em si. A integridade da via visual desempenha um papel crucial na aura enxaquecosa e na fotofobia. .

Clinical Characteristics of Children Diagnosed with Migraine

PURPOSE: To analyze the clinical characteristics of visual symptoms, aspects of headache, and ophthalmologic features in children diagnosed with migraine. METHODS: The medical records of 31 Korean children who had been diagnosed with migraine by pediatric neurologists were retrospectively reviewed and visual symptoms and ophthalmologic examinations were evaluated. RESULTS: The mean age of the 31 patients was 10.8 years (range, 5-17 years). The mean age of onset of headache was 9 years (range, 4-15 years). Nineteen patients (61.3%) had the associated visual aura. Visual symptoms of the 19 patients included blurred vision, unilateral vision loss, flickering lights, scotoma, and visual hallucination in descending order. However, there was no specific abnormality observed on thorough ophthalmologic examinations. CONCLUSIONS: Most of the children diagnosed with migraine did not show any ophthalmologic problems. Careful ophthalmologic examination with an understanding of migraine should be performed and reassurance to patients may be beneficial.

Late-onset childhood occipital epilepsy. An unusual case in adolescence and differential diagnosis with migraine / Epilepsia occipital da infância de início tardio

INTRODUCTION: The new proposed classification of ILAE Task Force (2001) proposes that the occipital epilepsies should be split into two subtypes: an early-onset benign childhood occipital epilepsy (or Panayiotopoulos type) and late-onset childhood occipital epilepsy (or Gastaut type). Migraine with visual aura must be considered as a differential diagnosis in childhood and adolescents with occipital epilepsy without motor phenomena. OBJECTIVE: The goal of our paper is to report the case a 16-year-old female, with normal psychomotor development, that during the lunch time presented an event characterized by the vision of multiple colored spots which were moving horizontally and vertically and also in circles through the visual field. Minutes after the visual event, the patient referred to a severe diffuse throbbing headache with frontal predominance. During the clinical investigation was submitted to a video-electroencephalogram exam for 12 hours with, reveling occipital sharp-waves discharges in occipital right region as well as in occipital left region. CONCLUSION: We reported of such classic type of epileptic syndrome in a patient in the unusual age of onset, the end of adolescence, considering the differential diagnosis with migraine with visual aura.

INTRODUÇÃO: A nova proposta de classificação da ILAE (2001) propõe que as epilepsias occipitais sejam classificadas em dois subtipos: epilepsia occipital benigna da infância de início precoce (ou tipo Panayiotopoulos) e epilepsia occipital benigna da infância de início tardio (ou tipo Gastaut). A migrânia com aura visual deve ser considerada como um diagnóstico diferencial nas crianças e nos adolescentes com epilepsia occiptal sem fenômenos motores associados. OBJETIVO: relatar o caso de uma paciente do sexo feminino de 16 anos, com desenvolvimento neuropsicomotor normal, que durante o almoço apresentou um evento caracterizado pela visão de múltiplas manchas coloridas que se movimentavam no sentido horizontal e vertical e também em círculos no seu campo visual. Minutos após este evento visual, a paciente passou a referir cefaléia difusa com predomínio frontal. Durante a investigação clínica foi submetida à realização de vídeo-eletrencefalograma com 12 horas de duração revelando descargas de ondas agudas ora na região occipital direita ora na região occipital esquerda. CONCLUSÃO: apresentamos um tipo clássico de síndrome epiléptica iniciando em uma idade pouco usual, o final da adolescência, considerando o diagnóstico diferencial com a migrânia com aura visual.

Estudio oftalmológico de la migraña con aura visual / Ophthalmological study of migraine with visual aura

En la migraña con aura visual, la cefalea va precedida por la aparición de escotomas centelleantes y pérdida de la visión en la mitad del campo visual entre otros síntomas. Se estudió un grupo de pacientes migrañosos con aura visual con el objetivo de determinar las alteraciones oftalmológicas y los defectos de refracción que aparecen en estos casos y cuales de éstas pueden agravar sus crisis. Se realizó un estudio oftalmológico completo, a 30 pacientes con este diagnóstico, que incluyó la refracción, la medida del punto próximo de convergencia, y la amplitud de fusión. Se considera que la disminución de la amplitu de fusión pudiera ser un factor desencadenante en la aparición de las crisis de migraña.

In the migraine with visual aura, headache is preceded by the appearance of sparkling scotomas and the loss of vision in half of the visual field, among other symptoms. A group of patients suffering from migraine with visual aura was studied aimed at determining the ophthalmological alterations and the refraction defects appearing in these cases and which of them may worsen their crises. A complete ophthalmological study was conducted in 30 patients with this diagnosis that included refraction, the measurement of the proximal point of convergence and the amplitude of fusion. It is considered that the reduction of the amplitude of fusion may be a precipitating factor in the emergence of migraine crises.