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.

Headache is one of the most common problems that bring patients to the neurology clinic. Several precipitants can trigger headaches such as laughing, coughing, straining, sneezing, stooping, or sexual activity. 1 Here we described an atypical presentation of headache onset after laughter in one patient. Case reportA 50-year-old man visited the Comprehensive Headache Clinic at Bangkok Hospital Medical Center with the chief complaint of headaches occurring when he was laughing.

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