An investigation of complicated migraine

Abstract

A series of 40 patients suffering from complicated migraine have been investigated in detail by methods including carotid and indirect vertebral angiography and cerebrospinal fluid examination. The purpose of the investigation was to try to correlate the clinical complications with the occurrence of structural vascular abnormalities. The investigation of hemiplegic migraine is liable to be fruitless. Persistent and nonprogressive sequelae of an attack, such as hemianopias or scotomata, are probably due to infarction and are not associated with vascular anomalies. Recurrent attacks of ophthalmoplegia following migraine but regressing after days or weeks are probably benign; a single attack with local persisting periorbital headache and no previous migraine history should be investigated by angiography. Strictly unilateral headache and the presence of carotid bruits in young people with migraine are not in our experience of sinister significance. Epileptic attacks occurring at the height of an attack of migraine or focal epilepsy and migraine with clinical features resulting from lesions in the same cerebral localization should be indications for angiography. Patients with a long history of migraine subsequently developing acute meningitic signs usually have not suffered a subarachnoid hemorrhage, but lumbar puncture is a justifiable investigation.