Migraine with aura in the locker room: three case reports

Abstract

It is well known that physical activity can aggravate the intensity of the headache, but the pathophysiological relationship between exertion and aura is still unknown. Anecdotal reports describe episodes of migraine preceded by head trauma and visual symptoms, migraine prodrome symptoms after unusually strenuous running with no subsequent head pain or recurrent attacks of hemiplegic migraine induced only by exertion. We describe the cases of three young men with recurrent episodes of migraine with aura occurring in the locker room shortly after a football match. Since the symptoms could mimic important pathologies in approximately 10% of these of headaches, it was mandatory to exclude a secondary form of headache in these patients. Several theories exist regarding the cause of primary exertional headache, but the pathogenesis of migraine triggered by physical activity has still not been identified. The present International Classification of Headache Disorders does not mention sport/exercise-induced migraine with aura episodes as primary headache. Since there are many cases described in the literature of migraine with aura triggered only by exercise, it may be helpful to specify, in the typical aura with migraine headache comments, that in some cases it can be exclusively triggered by sport/exercise.

A Human Sensory Pathway Connecting the Foot to Ipsilateral Face That Partially Bypasses the Spinal Cord

“…Our demonstration that the sensory pathway by which a noxious stimulus applied to the foot can bypass an interrupted spinal cord explains Nathan's original observation (Villanueva et al, 2006) as well as more recent work (Wrigley et al, 2018). While the entity referred to as jogger's migraine (Corbelli et al, 2012) might be explained by this pathway (although not the preceding aura), its end-point—facial vasodilation mediated by beta-adrenergic receptors—supports recent work suggesting a far greater contribution of neurovascular dysfunction to migraine pathophysiology via antidromic vasodilation (Geppetti et al, 2012) and the mechanism by which beta-blockers prevent attacks (Jacobs and Dussor, 2016). This pathway also identifies one potential mechanism for some of the positive effects of acupuncture [often applied to the ipsilateral foot (Silberstein, 2009)] in treating episodic migraine, and may have additional implications for the mechanism by which acupuncture exerts its effect (Linde et al, 2016).…”

“…(D,E) Application of capsaicin to lower thigh of immersed limb did not result in an increase in facial blood flow in healthy controls undergoing warm water immersion only without nociceptive challenge. The small reduction in ipsilateral facial blood flow only identified immediately after capsaicin application may reflect a direct vasoconstrictive effect (Keeble and Brain, 2006; Corbelli et al, 2012). #Change from baseline statistically significant ( p < 0.05).…”

Triggers of migraine: where do we stand?

“…The authors also investigated strenuous physical exercise-induced migraine and found that attacks were triggered in four patients out of 12, whereas an additional three out of seven patients developed headache after the combined exposure to light stimulation and exercise. The possible triggering role of strenuous exercise in migraine with aura is supported by a few other case reports [47]. This could be explained by considering that exerciseinduced dehydration, and consequently hyperthermia, reduces cerebral oxygenation [48], possibly promoting the genesis of a wave of cortical spreading depression.…”

Can migraine aura be provoked experimentally? A systematic review of potential methods for the provocation of migraine aura

“…Two reported cases of aura were triggered following air microbubble injection during transcranial Doppler ultrasound examination (44,45). Three studies reported aura induced by physical activity (46–49) and one following orgasm (47). Two studies reported aura after the consumption of two different food sources (50,51).…”

“…Two of the reviewed studies used physical activity for the provocation of aura, with a total trigger rate of 18% (8,20). In addition, three case reports of aura triggered by physical activity were identified (46,48,49). These studies suggested that different types of strenuous physical activity may induce aura.…”