Migraine Variants and Beyond

Migraine is amongst the oldest of diseases known to mankind. Migraine is a heterogenous

entity, usually characterised by periodic attacks of headache on one or both sides of the

head. These may be accompanied by nausea, vomiting, increased sensitivity of the eyes to

light (photophobia), increased sensitivity to sound (phonophobia), dizziness, blurred vision,

cognitive disturbances, and other symptoms. Migraines are not always preceded by an aura

and some migraines may not include headache. If migraine does not manifest itself in the

form of headache but in some other form such as paroxysmal episodes of prolonged visual

auras, atypical sensory, motor, or visual aura, confusion, dysarthria, focal neurologic deficits

with or without a headache, it is labelled a Migraine Variant (MV). MV is therefore diagnosed

by the history of paroxysmal symptoms with or without cephalgia and a prior history of

migraine with aura, in the absence of other medical disorders that may contribute to the

symptoms. Many of the MVs have been included and redefined in the revised edition of The

International Classification of Headache Disorders (ICHD-II) 2004 classification. These include

hemiplegic migraine, basilar migraine, childhood periodic syndromes, retinal migraine,

complicated migraine and ophthalmoplegic migraine. Even though conditions such as

vertiginous migraine, acute confusional migraine of childhood and nocturnal migraine are

well recognized entities, they have not yet been included in IHCD-II, but will be discussed

here in brief because they are relatively common conditions.

What is Hemiplegic Migraine?

Hemiplegic migraine is a very rare but well described form of MV. It was initially described as

a type of migraine consisting of recurrent headaches associated with transient unilateral

hemiparesis or hemiplegia, at times accompanied by ipsilateral numbness or tingling, with or

without a speech disturbance.

Abdominal Migraine

Abdominal migraine most typically occurs in children, although it has been reported in adults

also. Patients usually complain of paroxysmal mid-abdominal pain associated with nausea

and vomiting, flushing, or pallor. Like cyclic vomiting, attacks may be associated with other

migraine prodromes such as fatigue and drowsiness.

Migraine Infarctions

The relationship between migraine, mostly migraine with aura, and ischemic stroke has been

well recognized. Migraine, generally a benign condition, has been recognized as an

independent risk factor for ischemic stroke. 

The treatment

The first step in treatment is to establish the diagnosis. Once the syndromes are recognized,

MVs respond to typical migraine preventive medications

practice, I never limit the problem of anorexia nervosa to the physical situation and pubertal

phase of an affected person in cause research and therapy.

*Senior Professor and Head, Department of Neurology, M S Ramaiah Medical College and

Hospitals, Bangalore