Transient CNS Deficits and Migrainous Auras in Individuals Without a History of Headache

Authors

  • Gilles Naeije MD,

    Corresponding author
    1. Department of Neurology, Hôpital Erasme Université Libre de Bruxelles, Brussels, Belgium
    • Address all correspondence to G. Naeije, Department of Neurology, Hôpital Erasme, 808, route de Lennik, Brussels, 1070, Bruxelles, Belgium, email: gillesnaeije@yahoo.com

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    • These authors contributed equally to this work.
  • Nicolas Gaspard MD, PhD,

    1. Department of Neurology, Reference Center for the Treatment of Refractory Epilepsy, Hôpital Erasme Université Libre de Bruxelles, Brussels, Belgium
    2. Neurology Department, Comprehensive Epilepsy Center and Computational Neurophysiology Laboratory, Yale University School of Medicine, New Haven, CT, USA
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    • These authors contributed equally to this work.
  • Benjamin Legros MD,

    1. Department of Neurology, Reference Center for the Treatment of Refractory Epilepsy, Hôpital Erasme Université Libre de Bruxelles, Brussels, Belgium
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  • Nicolas Mavroudakis MD, PhD,

    1. Department of Neurology, Hôpital Erasme Université Libre de Bruxelles, Brussels, Belgium
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  • Massimo Pandolfo MD, PhD

    1. Department of Neurology, Hôpital Erasme Université Libre de Bruxelles, Brussels, Belgium
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  • Conflict of Interest: None.

Abstract

Objective

To demonstrate that benign transient focal neurological symptoms represent equivalents of migraine auras without headache.

Background

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.

Methods

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.

Results

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.

Conclusion

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.

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