These authors contributed equally to this work.
Transient CNS Deficits and Migrainous Auras in Individuals Without a History of Headache
Article first published online: 11 FEB 2014
© 2014 American Headache Society
Headache: The Journal of Head and Face Pain
Volume 54, Issue 3, pages 493–499, March 2014
How to Cite
Naeije, G., Gaspard, N., Legros, B., Mavroudakis, N. and Pandolfo, M. (2014), Transient CNS Deficits and Migrainous Auras in Individuals Without a History of Headache. Headache: The Journal of Head and Face Pain, 54: 493–499. doi: 10.1111/head.12307
Conflict of Interest: None.
- Issue published online: 4 MAR 2014
- Article first published online: 11 FEB 2014
- Manuscript Accepted: 13 NOV 2013
- focal central nervous system deficit;
- migraine aura without headache;
- cortical excitability;
- transcranial magnetic stimulation;
- transient ischemic attack
To demonstrate that benign transient focal neurological symptoms represent equivalents of migraine auras without headache.
Benign focal neurological symptoms suggesting cerebral dysfunction are common and usually prompt an extensive diagnostic workup, but their etiology is often not elucidated. We hypothesized that benign transient focal neurological symptoms represent equivalents of migraine auras without headache, even in subjects who have never experienced migraine headaches.
We led a cross-sectional study and identified individuals who presented at least 1 episode of unexplained transient focal neurological symptoms suggestive of cerebral dysfunction, but no history of migraine headache, among physicians and inpatients of an academic hospital. Cortical hyperexcitability, assessed by occipital transcranial magnetic stimulation (oTMS), was used as a marker of possible migraine auras without headache.
Frequency of transient focal neurological symptoms suggestive of cerebral dysfunction among the physicians who responded was 9% (21/233), vs 0.09% (6/690) of inpatients. Most episodes resembled typical visual migrainous auras. Motor, sensory, and language dysfunction were more common among inpatients than among physicians. oTMS induced phosphenes in 12/16 (75%) subjects and in none of 10 controls.
Benign focal neurological symptoms were common in our population and likely represent migraine aura without headache. Non-visual symptoms are less common and lead to medical consultation. oTMS is abnormal in most cases, supporting the diagnosis of migraine aura without headache and helping separate this benign condition from transient ischemic attacks.