Reader Response: The Index Vein Pointing to the Origin of the Migraine Aura Symptom: A Case Series

ObjectiveThis case series describes and discusses the potential clinical utility of a prominent vein (index vein) found on susceptibility-weighted MRI during migraine aura that drains the cortical area responsible for patients' symptoms.MethodsSix patients with acute migraine aura had a prominent draining sulcal vein on emergency MRI done initially for suspected stroke. The location of the prominent vein was correlated to patients' symptoms, and the diameter was compared to the corresponding contralateral vein.ResultsIn our patients with typical migraine aura, an accentuated sulcal vein pointed towards the cortical area correlating with the clinical presentation. Such an index vein outstands the ipsilateral area of hypoperfusion and exceeds the corresponding contralateral vessel in diameter by a factor 2.0 ± 1.6 (mean ± SD).ConclusionThis case series provides a definition of an index vein in MRI pointing to the area where the patients' symptoms originate. Although confirmation in a larger systematic study is necessary, the presence of such an index vein might support that, in patients with an acute neurologic deficit, migraine aura is the underlying etiology.

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The Impact of Extended-Cycle Vaginal Ring Contraception on Migraine Aura: A Retrospective Case Series

Headache The Journal of Head and Face Pain ◽

10.1111/j.1526-4610.2012.02211.x ◽

2012 ◽

Vol 52 (8) ◽

pp. 1246-1253 ◽

Cited By ~ 33

Author(s):

Anne Calhoun ◽

Sutapa Ford ◽

Amy Pruitt

Keyword(s):

Case Series ◽

Vaginal Ring ◽

Migraine Aura ◽

Retrospective Case ◽

Retrospective Case Series ◽

The Impact ◽

Extended Cycle

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Auditory hallucinations associated with migraine: Case series and literature review

Cephalalgia ◽

10.1177/0333102414563088 ◽

2014 ◽

Vol 35 (10) ◽

pp. 923-930 ◽

Cited By ~ 9

Author(s):

Eli E Miller ◽

Brian M Grosberg ◽

Sara C Crystal ◽

Matthew S Robbins

Keyword(s):

International Headache Society ◽

Case Series ◽

Primary Auditory Cortex ◽

Auditory Hallucinations ◽

Migraine Aura ◽

Noisy Environment ◽

Visual Aura ◽

High Prevalence ◽

Acute Headache ◽

Perceptual Changes

Objective The objective of this review is to describe auditory hallucinations (paracusias) associated with migraine attacks to yield insights into their clinical significance and pathogenesis. Background Isolated observations have documented rare associations of migraine with auditory hallucinations. Unlike visual, somatosensory, language, motor, and brainstem symptoms, paracusias with acute headache attacks are not a recognized aura symptom by the International Headache Society, and no systematic review has addressed this association. Methods We retrospectively studied patients experiencing paracusias associated with migraine at our center and in the literature. Results We encountered 12 patients (our center = 5, literature = 7), 58% were female, and 75% had typical migraine aura. Hallucinations most commonly featured voices (58%), 75% experienced them during headache, and the duration was most often <1 hour (67%). No patients described visual aura evolving to paracusias. Most patients (50%) had either a current or previous psychiatric disorder, most commonly depression (67%). The course of headache and paracusias were universally congruent, including improvement with headache prophylaxis (58%). Conclusion Paracusias uncommonly co-occur with migraine and usually feature human voices. Their timing and high prevalence in patients with depression may suggest that paracusias are not necessarily a form of migraine aura, though could be a migraine trait symptom. Alternative mechanisms include perfusion changes in primary auditory cortex, serotonin-related ictal perceptual changes, or a release phenomenon in the setting of phonophobia with avoidance of a noisy environment.

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The pathological spectrum behind migraine aura status: a case series

Neurological Sciences ◽

10.1007/s10072-018-3671-0 ◽

2018 ◽

Vol 40 (4) ◽

pp. 861-864 ◽

Cited By ~ 1

Author(s):

Alberto Terrin ◽

Federico Mainardi ◽

Ferdinando Maggioni

Keyword(s):

Case Series ◽

Migraine Aura

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Olfactory hallucinations in primary headache disorders: Case series and literature review

Cephalalgia ◽

10.1177/0333102411423315 ◽

2011 ◽

Vol 31 (14) ◽

pp. 1477-1489 ◽

Cited By ~ 31

Author(s):

Elisheva R Coleman ◽

Brian M Grosberg ◽

Matthew S Robbins

Keyword(s):

Case Series ◽

Primary Headache ◽

Prophylactic Therapy ◽

Motor Symptoms ◽

Migraine Aura ◽

Headache Disorders ◽

Primary Headache Disorders ◽

Unpleasant Odor ◽

Headache Center

Background: Olfactory hallucinations (phantosmias) have rarely been reported in migraine patients. Unlike visual, sensory, language, brainstem, and motor symptoms, they are not recognized as a form of aura by the International Classification of Headache Disorders. Methods: We examined the clinical features of 39 patients (14 new cases and 25 from the literature) with olfactory hallucinations in conjunction with their primary headache disorders. Results: In a 30-month period, the prevalence of phantosmias among all patients seen at our headache center was 0.66%. Phantosmias occurred most commonly in women with migraine, although they were also seen in several patients with other primary headache diagnoses. The typical hallucination lasted 5–60 minutes, occurred shortly before or simultaneous with the onset of head pain, and was of a highly specific and unpleasant odor, most commonly a burning smell. In the majority of patients, phantosmias diminished or disappeared with initiation of prophylactic therapy for headaches. Conclusions: We propose that olfactory hallucinations are probably an uncommon but distinctive form of migraine aura, based on their semiology, timing and response to headache prophylaxis.

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The typical duration of migraine aura: A systematic review

Cephalalgia ◽

10.1177/0333102413479834 ◽

2013 ◽

Vol 33 (7) ◽

pp. 483-490 ◽

Cited By ~ 37

Author(s):

Michele Viana ◽

Till Sprenger ◽

Michaela Andelova ◽

Peter J Goadsby

Keyword(s):

Literature Search ◽

Significant Proportion ◽

Case Series ◽

Population Based ◽

Scientific Data ◽

Migraine Aura ◽

Hemiplegic Migraine ◽

Visual Aura ◽

Prolonged Duration ◽

Probable Migraine

Background According to ICHD-II, and as proposed for ICHD-III, non-hemiplegic migraine aura (NHMA) symptoms last between five and 60 minutes whereas hemiplegic migraine aura can be longer. In ICHD-III it is proposed to label aura longer than an hour and less than a week as probable migraine with aura. We tested whether this was appropriate based on the available literature. Methods We performed a systematic literature search identifying articles pertaining to a typical or prolonged duration of NHMA. We also performed a comprehensive literature search in order to identify all population-based studies or case series in which clinical features of NHMA, including but not restricted to aura duration, were reported, in order to gain a complete coverage of the available scientific data on aura duration. Results We did not find any article exclusively focusing on the prevalence of a prolonged aura or more generally on typical NHMA duration. We found 10 articles that investigated NHMA features, including the aura duration. Five articles recorded the proportion of patients in whom whole NHMA lasted for more than one hour, which was the case in 12%–37% of patients. Six articles reported some information on the duration of single NHMA symptoms: visual aura disturbances lasting for more than one hour occurred in 6%–10% of patients, sensory aura in 14%–27% of patients and aphasic aura in 17%–60% of patients. Conclusions The data indicate the duration of NHMA may be longer than one hour in a significant proportion of migraineurs. This seems to be especially true for non-visual aura symptoms. The term probable seems inappropriate in ICHD-III so we propose reinstating the category of prolonged aura for patients with symptoms longer than an hour and less than one week.

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