Late-life Migraine Accompaniments Research Articles

Neuroimaging for Migraine: The American Headache Society Systematic Review and Evidence-Based Guideline.

To provide updated evidence-based recommendations about when to obtain neuroimaging in patients with migraine. Articles were included in the systematic review if they studied adults 18 and over who were seeking outpatient treatment for any type of migraine and who underwent neuroimaging (MRI or CT). Medline, Web of Science, and Cochrane Clinical Trials were searched from 1973 to August 31, 2018. Reviewers identified studies, extracted data, and assessed the quality of the evidence in duplicate. We assessed study quality using the Newcastle-Ottawa Scale. The initial search yielded 2269 publications. Twenty three articles met inclusion criteria and were included in the final review. The majority of studies were retrospective cohort or cross-sectional studies. There were 4 prospective observational studies. Ten studies evaluated the utility of CT only, 9 MRI only, and 4 evaluated both. Common abnormalities included chronic ischemia or atrophy with CT and MRI scanning, and non-specific white matter lesions with MRI. Clinically meaningful abnormalities requiring intervention were relatively rare. Clinically significant neuroimaging abnormalities in patients with headaches consistent with migraine without atypical features or red flags appeared no more common than in the general population. There is no necessity to do neuroimaging in patients with headaches consistent with migraine who have a normal neurologic examination, and there are no atypical features or red flags present. Grade A Neuroimaging may be considered for presumed migraine for the following reasons: unusual, prolonged, or persistent aura; increasing frequency, severity, or change in clinical features, first or worst migraine, migraine with brainstem aura, migraine with confusion, migraine with motor manifestations (hemiplegic migraine), late-life migraine accompaniments, aura without headache, side-locked headache, and posttraumatic headache. Most of these are consensus based with little or no literature support. Grade C.

Late-life migraine accompaniments: A narrative review.

Migraine is one of the most common chronic neurological disorders. In 1980, C. Miller Fisher described late-life migraine accompaniments as transient neurological episodes in older individuals that mimic transient ischemic attacks. There has not been an update on the underlying nature and etiology of late-life migraine accompanimentsd since the original description. The purpose of this article is to provide a comprehensive and extensive review of the late-life migraine accompaniments including the epidemiology, clinical characteristics, differential diagnosis, and treatment. Literature searches were performed in MEDLINE®, PubMed, Cochrane Library, and EMBASE databases for publications from 1941 to July 2014. The search terms "Migraine accompaniments," "Late life migraine," "Migraine with aura," "Typical aura without headache," "Migraine equivalents," "Acephalic migraine," "Elderly migraine," and "Transient neurological episodes" were used. Late-life onset of migraine with aura is not rare in clinical practice and can occur without headache, especially in elderly individuals. Visual symptoms are the most common presentation, followed respectively by sensory, aphasic, and motor symptoms. Gradual evolution, the march of transient neurological deficits over several minutes and serial progression from one symptom to another in succession are typical clinical features for late-life migraine accompaniments. Transient neurological disturbances in migraine aura can mimic other serious conditions and can be easily misdiagnosed. Careful clinical correlation and appropriate investigations are essential to exclude secondary causes. Treatments are limited and still inconsistent.

Migraine avec aura à début tardif résolutive après endartérectomie sur sténose carotide serrée

BackgroundVisual aura is the most common type of aura. Onset of visual aura occurring for the first time in an elderly person is atypical, even though late-life migraine accompaniments are well-recognized. ObservationWe report the case of a 72-year-old woman with a past history of migraine without aura since adolescence (one attack per month), who experienced for the first time of her life multiple visual aura over a period of more than one year. These auras were always left homonymous hemianopia which developed gradually over 5mins followed by severe migraine headache without strict lateralization. The patient was known to have a moderate right carotid artery stenosis. In October 2007, she suffered a minor ischemic stroke in the right carotid artery territory due to progression to severe stenosis of the right internal carotid artery. After carotid endarterectomy, she had no further migraine attacks with aura. DiscussionWe discuss the mechanism of aura in our case with probable microemboli due to the severe right internal carotid artery stenosis responsible for repeated cortical spreading depression. ConclusionClinicians should bear in mind to systematically explore all patients with late onset aura including patients who have previously suffered from migraine without aura and also to explore patients who have a dramatic increase of aura even if they are already migrainers with aura.

Treatment of Headache in the Elderly

Opinion statementMost primary headaches in the elderly are similar to those in younger patients (tension, migraine, and cluster), but there are some differences, such as late-life migraine accompaniments and hypnic headaches. Although migraine in younger persons usually presents with headache, migraine in older persons may initially appear with visual or sensory phenomena, instead of headache (“migraine accompaniments”). Hypnic headaches awaken patients from sleep, are short-lived, and occur only in the elderly. The probability of secondary headache increases steadily with age. Secondary headaches include those associated with temporal arteritis, trigeminal neuralgia, sleep apnea, post- herpetic neuralgia, cervical spondylosis, subarachnoid hemorrhage, intracerebral hemorrhage, intracranial neoplasm, and post-concussive syndrome. Certain rescue treatments for migraine headache in younger individuals (triptans or dihydroergotamine, for example) should not be used in elderly patients because of the risk of coronary artery disease. Naproxen and hydroxyzine are commonly used oral rescue therapies for older adults who have migraine or tension headaches. Intravenous magnesium, valproic acid, and metoclopramide are all effective rescue therapies for severe headaches in the emergency room setting. Some effective prophylactic agents for migraine in younger patients (amitriptyline and doxepin) are not usually recommended for older individuals because of the risks of cognitive impairment, urinary retention, and cardiac arrhythmia. For these reasons, the recommended oral preventive agents for migraine in older adults include divalproex sodium, topiramate, metoprolol, and propranolol. Oral agents that can prevent hypnic headaches include caffeine and lithium. Cough headaches respond to indomethacin or acetazolamide.

Stroke: 30 years of progress: 1982-1987.

The invitation to reflect on the progress in stroke and the contributions of this journal to developments during the years 1982 to 1987 arouses many memories. In committee report format, it is to be noted that in 1982 the 6 bimonthly issues totaled 942 pages, including the index, the news from the AHA, the literature abstracts, and the program of the Stroke Council Conference. By 1987 there were 1406 pages. Permission was granted to go monthly. Behind the dull statistics, the expansion of Stroke reveals that a critical mass of professionals were dedicating their careers to the study of this common cause of death and dreadful disability. This increased enthusiasm occurred in countries on both sides of the Atlantic, in Japan, Taiwan, and “down under.” The internationalization of the journal is reflected in all successive issues and was a factor determining expansion. Descriptive stroke neurology was still ongoing during this half-decade. The further delineation of the lacunar stroke as a clinically identifiable entity was a feature of one issue. Classic descriptions of “pure sensory stroke” came from the pen of the master of this subject, C. Miller Fisher. He was allowed an unprecedented 13 pages for his report. His Discussion portion occupied only 1 page. There were 7 references, all referring, appropriately, to his past communications about lacunar disease, dating back to 1965. Motor strokes of presumed lacunar origin were the subject of a smaller series reported from Toulouse, France. What has become a classic review on the concept of lacunes came from the pen of Fisher’s pupil and the deputy editor of Stroke , J.P. Mohr. Stroke was privileged later in this era to publish another lengthy article describing the observations of Fisher on the subject of “Late-Life Migraine Accompaniments.” This persuasive case-series report was accompanied by a discussion …

Headaches in the elderly

Headache prevalence and etiology vary dramatically with age. The prevalence of primary headache disorders, such as migraine and cluster, declines with age, while the prevalence of secondary headache disorders, such as temporal arteritis and mass lesions, increases. In evaluating elderly patients with new onset of headache, a high index of suspicion for organic disease is required. Headache symptomatology also varies with age. For example, migraine may evolve into a pattern of chronic daily headache, or auras may occur in the absence of headache (late-life migraine accompaniments). A careful longitudinal headache history is therefore important. Headache management is also influenced by age. Elderly people are more susceptible to medication side effects and are often treated with several drugs. Medications may cause headaches and drug interactions may complicate therapy. For these reasons, age of onset and duration of illness are critical headache features that guide the subsequent approach to diagnosis and treatment.