Migrainous Visual Accompaniments Are Not Rare in Late Life

Abstract

Background and Purpose-Questionnaires to elicit symptoms of transient ischemic attacks (TIAs) may detect late-life transient visual symptoms similar to the visual aura of migraine, often without headache. We determined the frequency, characteristics, and stroke outcome of these symptoms in the Framingham Study. Methods- During 1971During -1989, at biennial examinations, 2110 subjects of the Framingham cohort were systematically queried about the occurrence of sudden visual symptoms. Results-Visual migrainous symptoms were reported by 1.23% (26/2110) of subjects (1.33% of women and 1.08% of men). In 65% of subjects the episodes were stereotyped, and they began after age 50 years in 77%. MeanϮSD age at onset of the episodes was 56.2Ϯ18.7 years. In 58% of subjects the episodes were never accompanied by headaches, and 42% had no headache history. The number of episodes ranged from 1 to 500 and was 10 or more in 69% of subjects. The episodes lasted 15 to 60 minutes in 50% of subjects. Sixty-five percent of the subjects were examined by a study neurologist, and only 19% of them met the criteria of the International Headache Society. Twelve percent of subjects sustained a stroke after the onset of migrainous visual symptoms: a subarachnoid hemorrhage 1 year later, an atherothrombotic brain stem infarct 3 years later, and a cardioembolic stroke 27 years later. In contrast, of 87 subjects with TIAs in the same cohort, 33% developed a stroke (Pϭ0.030), two thirds within 6 months of TIA onset. Conclusions-Late-life-onset transient visual phenomena similar to the visual aura of migraine are not rare and often occur in the absence of headache. These symptoms appear not to be associated with an increased risk of stroke, and invasive diagnostic procedures or therapeutic measures are generally not indicated. (Stroke. 1998;29:1539-1543.)

The optometric correlates of migraine

“…The Framingham Study (Wijman et al, 1998) demonstrated that these migrainous visual accompaniments occur in just over 1% of the population aged between 30 and 62 years. This study showed that the mean age of onset of these symptoms was 56 years and in 58% of subjects no headache was reported.…”

2013 Canadian Stroke Congress Abstracts

“…Pilot testing involved 76 participants (34 male; mean age 60 years, range 23-92; 51 with postsecondary education) and resulted in revisions to three items. 3. Repeat testing of the three revised items involved 36 participants (15 male; mean age 56 years, range 32-84; 30 with postsecondary education) and resulted in no further modification.…”

“…Boesen, ME 1,3 Background: Early detection and treatment of atrial fibrillation (AF) could prevent many strokes. New technology devices enable simple, rapid, inexpensive AF screening without requiring standard 12-lead ECG or medical personnel.…”

“…Fisher described patients in the stroke age bracket with transient neurological symptoms, late-life migraine accompaniments (LMA) that could be benign and potentially related to migraine aura-like phenomena (2). The Framingham study (3) found that most of these patients did not need to undergo extensive investigations. The decision as to what investigations are necessary, in these individuals, remains a common clinical problem.…”

Migraine and Stroke

“…This is particularly true for patients aged ≥60 years among whom transient ischemic attack occurrence increases, whereas attacks of MA are more likely to become more atypical because they are not always followed by a migraine headache. 52 The sudden onset of transient ischemic attack symptoms paired with the presence of vascular risk factors is the strongest difference from MA, which has a more gradual-progressing occurrence of symptoms. The presence of a headache after transient neurological symptoms does not necessarily mean that these symptoms are consistent with a diagnosis of MA, because a migraine-like attack can be triggered by ischemic vascular events.…”