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6 out of 10

A 20 yr old adolescent girl complains of recurrent occipital headache with associated vertigo, tinnitus, difficulty in hearing and diplopia. There are symptom free intervals in between the episodes. There is history of similar complaints in her mother too. Which of the following is most likely diagnosis? (AIPG 2011)

A Cervical spondylosis

B Basilar migraine

C Temporal arteritis

D Vestibular neuronitis

Ans. B

Basilar migraine

Migraine (Ref. Hari-18th ed., Pg- 114)

a. It is an episodic headache that is associated with certain features such as sensitivity to light, sound, or movement (formication); nausea and vomiting often accompany the headache.

b. Patient may have aura (classical migraine) or may not have aura (common migraine)

Associated symptoms include:

a. Paraesthesia with tingling and numbness

b. Other focal neurological symptoms such as clumsiness and weakness.

Variants of Migraine

Focal migraine

Is characterized by transient dysphagia, hemisensory symptoms or even focal weakness in addition to other symptoms of migraine

Migraine sine migraine

Is characterized by episodic visual disturbances without headache. Elderly patients with a history of classical migraine are typically affected

Retinal migraine

Is characterized by acute transient unilateral loss of vision. This may occur in middle aged persons without past history of migraine.

Ophthalmoplegic migraine

It is characterized by a recurrent transient third nerve palsy which begins after the headache. (AIPG 2011)

Familial hemiplegic migraine

Is characterized by a failure of full recovery of focal neurological features after an attack of migraine subsides

Basilar migraine

(AIPG 2011)

Occurs in children

It is characterized by a typical migrainous aura associated with numbness and tingling of lips and extremities which is often bilateral

Ataxia of gait and speech also occurs, with occasional impairment of consciousness

Basilar migraine

1. Basilar migraine is the diagnosis in patients in whom brain stem symptoms predominate.

2. In many patients, basilar attacks are intermingled with more typical migraine attacks.

3. Dizziness is frequently reported as a feature of an otherwise typical attack of migraine without an aura.

4. Bilateral paresthesias can also occur with anxiety and hyperventilation.

Table : Simplified Diagnostic Criteria for Migraine

Repeated attacks of headache lasting 4–72 h in patients with a normal physical examination, no other reasonable cause for the headache, and:

At least 2 of the following features:

Plus at least 1 of the following features:

i. Unilateral pain

i. Nausea/vomiting

ii. Throbbing pain

ii. Photophobia and phonophobia

iii. Aggravation by movement

iv. Moderate or severe intensity

MIDAS Migraine Disability Assessment Score.

Extra Edge:
Migraine has its activators, referred to as triggers.

Triggers are: bright lights, sounds, hunger; excess stress; physical exertion; barometric pressure changes; hormonal fluctuations during menses; lack of or excess sleep; and alcohol.

Neurology Flashcard List

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