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Hemiplegic Migraine Aura Begins With Cerebral Hypoperfusion: Imaging in the Acute Phase
Article first published online: 28 JUL 2011
© 2011 American Headache Society
Headache: The Journal of Head and Face Pain
Volume 51, Issue 8, pages 1289–1296, September 2011
How to Cite
Hansen, J. M., Schytz, H. W., Larsen, V. A., Iversen, H. K. and Ashina, M. (2011), Hemiplegic Migraine Aura Begins With Cerebral Hypoperfusion: Imaging in the Acute Phase. Headache: The Journal of Head and Face Pain, 51: 1289–1296. doi: 10.1111/j.1526-4610.2011.01963.x
Conflict of Interest: None
- Issue published online: 1 SEP 2011
- Article first published online: 28 JUL 2011
- Accepted for publication April 3, 2011.
- familial hemiplegic migraine;
- migraine aura;
- cortical spreading depression;
- magnetic resonance imaging;
- computed tomography
Imaging studies of spontaneous migraine aura have proved challenging because of the episodic and unpredictable nature of migraine attacks. Two patients with signs of acute ischemic stroke were evaluated for thrombolysis and turned out to suffer from familial hemiplegic migraine. It was possible to record the early phase of the hemiplegic aura with computed tomography with perfusion sequences and magnetic resonance imaging. We found cerebral hypoperfusion in the relevant cortical areas within the first hour after onset of aura symptoms. This report supports the concept that migraine aura across the migraine spectrum is caused by similar mechanisms. In a setting with efficient cooperation between headache and stroke neurologists, thrombolysis centers provide the set-up and opportunity to record aura symptoms at an early phase. Furthermore, in the time of ready access to acute systemic thrombolysis treatment, these cases underscore the importance of an accurate headache history, especially in younger patients.