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Evidence for a separate type of migraine with aura

Sporadic hemiplegic migraine

From The Danish Headache Center (Drs. Thomsen and Olesen), Department of Neurology, Glostrup Hospital, and Department of Neurology (Dr. Russell), Gentofte Hospital, University of Copenhagen; and Department of Medical Genetics (Dr. Ostergaard), The John F. Kennedy Institute, Denmark.

Address correspondence and reprint requests to Dr. Lise Lykke Thomsen, The Danish Headache Center, University of Copenhagen, Department of Neurology, Glostrup Hospital, Ndr. Ringvej 57, DK-2600 Glostrup, Denmark; e-mail: LLT{at}dadlnet.dk

Objective: To compare clinical characteristics of patients with sporadic hemiplegic migraine (SHM) with those of patients with migraine with typical aura (MA) and patients with familial hemiplegic migraine (FHM).

Methods: The authors used a computer search of Denmark’s National Patient Register to screen the population for patients with migraine with aura with motor weakness, and also examined case records from headache clinics and private practicing neurologists and placed advertisements. The authors screened patients and their relatives with a semi-structured validated telephone interview. All recruited patients were then interviewed by a physician and given a neurologic examination.

Results: A total of 105 patients with SHM were identified. Seventy-two percent had four typical aura symptoms: visual, sensory, aphasic, and motor. All had at least two symptoms present during SHM attacks. A gradual progression and sequential appearance of aura symptoms was typical; compared with MA, the duration of each aura symptom was usually prolonged and bilateral motor symptoms were more frequent. Of the patients with SHM, 72% fulfilled the criteria for basilar migraine during SHM attacks. The aura was usually followed by headache, as is common in FHM but not MA.

Conclusions: Patients with sporadic hemiplegic migraine had clinical symptoms identical to familial hemiplegic migraine and significantly different from migraine with typical aura. Sporadic hemiplegic migraine is a separate entity, and should be classified with familial hemiplegic migraine.

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