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Migraine Equivalent

Page history last edited by Jessica Hu 12 years, 7 months ago

Note: Below I have shared the information I found regarding migraine equivalents. But there does not seem to be such a thing as migraine-equivalent headaches.




National Headache Foundation:


Migraine Equivalents or Migraine Variants


This term applies to migraine that exhibits itself in a form other than head pain. A diagnosis of migraine equivalent is determined by a previous history of migraine attacks, no evidence of organic or physical lesions, and the replacement of normal headaches by an equivalent group of symptoms. It is important that these patients be evaluated thoroughly, with attention to past and family migraine histories. Characteristically, drugs used to treat migraine often help the equivalent symptoms.


Although not common, the most prevalent migraine equivalent is abdominal migraine, which is characterized by recurrent episodes of vomiting and abdominal pain without headache. The bouts of pain can last for hours and occur more frequently in female children. Patients characteristically show other symptoms of migraine such as yawning, listlessness, and drowsiness during their attacks.


A migraine equivalent may also be characterized by visual symptoms such as blind spots, partial vision, neurologic deficits, or psychic disturbances without headache.



Up to Date:


Migraine aura without headache (also known as migraine equivalent and acephalgic migraine) manifests as isolated aura unaccompanied by headache. Auras without headache may be confused with transient ischemic attacks, especially in older patients. In the Danish study, 38 percent of patients reported having both attacks of migraine aura without headache as well as migraine aura with headache, and four percent had exclusively migraine aura without headache.


Migraine aura is the complex of neurologic symptoms that accompanies migraine headache [47]. An aura presents as a progressive neurologic deficit or disturbance with subsequent complete recovery. Auras are thought to be caused by cortical spreading depression occurring in regions of the cortex that correspond to the clinical manifestations of the aura. This is associated with a decrease in cortical blood flow. (See 'Cortical spreading depression' above.)

  • Auras typically occur before the onset of migraine headache, and the headache usually begins simultaneously with or just after the end of the aura phase. However, headache onset can rarely occur an hour or more after the end of the aura phase.
  • Although atypical, an aura can develop during or after the onset of headache.
  • Some patients have migraine aura with only a minimal or no subsequent headache.
  • Most auras resolve in less than one hour, although motor auras may persist longer.

Typical auras may involve any of the following manifestations [47]:

  • Visual disturbances
  • Sensory symptoms
  • Motor weakness
  • Speech disturbances

Visual disturbances are the most common type of aura, accounting for the majority of the neurologic symptoms associated with migraine. (See "Approach to the patient with visual hallucinations", section on 'Migraine'.) Numbness and tingling of the lips, lower face, and fingers of one hand (cheio-oral) is the second most common type of aura. Some patients have several types of aura symptoms that vary with attacks.

In a population study of 4000 people from Denmark, 163 had migraine with aura [48]. Visual symptoms were present in 99 percent of patients, followed by sensory, aphasic, and motor symptoms (31, 18, and 6 percent, respectively). The following observations were made regarding auras:

  • The typical visual aura started with a flickering uncolored zig-zag line in the center of the visual field and gradually progressed toward the periphery of one hemifield, often leaving a scotoma.
  • The typical sensory aura was unilateral, started in the hand and progressed towards the arm, later affecting the face and tongue.
  • The typical motor aura involved the hand and arm on one side.
  • The visual, sensory, and aphasic auras rarely lasted longer than one hour, while the motor aura did in 67 percent.
  • Headache followed the aura in 93 percent.
  • Less commonly, headache and aura occurred simultaneously or aura followed the headache (4 and 3 percent, respectively).

As noted above, most auras resolve in less than one hour, although motor auras may persist longer. Auras that last longer than one hour are indicative of complicated migraine in the IHS classification scheme [47]. (See 'Complications of migraine' below.) Rarely, auras persist for longer than one week or are associated with infarcts on brain imaging; these are indicative of migrainous infarction.

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