This article includes discussion of late-life migrainous accompaniments, late-life acephalgic migraine, late-life migrainous equivalents, transient migraine accompaniments, and transient migraine equivalents. The foregoing terms may include synonyms, similar disorders, variations in usage, and abbreviations.
Historical note and terminology
Late-life migrainous accompaniments, a topic of historical interest, is a clinical concept that is still important to modern-day neurologic diagnosticians and students of migraine. Miller Fisher published his 2 seminal articles on late-life migrainous accompaniments in 1980 and 1986. In his combined case series of 205 patients, Fisher was attempting to differentiate late-life migrainous accompaniments from the symptoms and signs of transient ischemic attacks (Fisher 1980; Fisher 1986).
In his first series, Fisher reported 120 patients with neurologic accompaniments of migraine classified according to the following symptoms: visual accompaniments (excluding patients who had only ordinary scintillating scotoma) (25); visual symptoms and paresthesias (18); visual symptoms and speech disturbances (7); visual and brainstem symptoms (14); visual symptoms, paresthesias, and speech disturbances (7); visual symptoms, paresthesias, speech disturbances, and paresis (25); recurrence of old stroke deficit (9); and miscellaneous symptoms (8). Diagnosis was facilitated when 2 or more similar episodes occurred or migraine-like scintillations were present (Fisher 1980). Headache occurred in 50% of the patients.
In the second series, Fisher reported 85 cases that were similarly categorized: visual symptoms (21); visual symptoms and paresthesias (6); visual symptoms and speech disturbances (2); visual symptoms, paresthesias, and speech disturbances (3); visual symptoms, paresthesias, speech disturbances, and weakness (20); visual and brainstem symptoms (3); and no visual symptoms (32) (Fisher 1986). These patients ranged in age from 40 to 73 years. Forty percent had some headache associated with the neurologic symptoms, with 65% having a history of recurrent headache. Fisher was particularly interested in patients who had migrainous accompaniments and normal cerebral angiograms. Headache was present in 40% of cases in this series.
In both of Fisher's studies, many patients had headache; thus, all were not totally acephalgic (only aura). The essence of his original communication was to explain why patients in the stroke-age bracket (older than 40 years) occasionally have unexplained transient ischemic attacks in association with normal cerebral angiograms. He believed that these patients probably had migraine aura; those with headache were more typical migraine. Fisher was not the only one to note the phenomenon of aura symptoms without headache. Whitty reported that in middle-age, migraine auras could occur alone, without a headache; this was more common in people who had had typical migraine in the past (Whitty 1967).
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