This Article  • Full text  • PDF  • Reply to article  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on ISI (8)  • Contact me when this article is cited  Related Content  • Related article  • Similar articles in this journal  Topic Collections  • Headache  • Migraine  • Alert me on articles by topic

Mehrdad Razavi, MD; Behzad Razavi, MD; Deema Fattal, MD; Adel Afifi, MD; Harold P. Adams, Jr, MD

Arch Neurol. 2000;57:1363-1365.

Background  It is known that exertion can aggravate migraine headache. However, the relationship between exertion and migraine aura is unknown.

Objective  To study the relationship between exertion and migraine aura.

Design  Case report.

Setting  Tertiary care hospital.

Patient  A 67-year-old man presented with recurrent attacks of exertion-induced hemiplegic migraine. Since the hemiparetic attacks were exertion induced, they were initially ascribed to recurrent transient ischemic attacks. However, the clinical picture, normal findings on cerebral angiography and neuroimaging (during the period of hemiparesis), lack of response to treatment with antiplatelets and anticoagulants, and successful treatment with verapamil suggested that the hemiparesis was not due to ischemia, but was indeed a migraine aura. We suggest that exertion induced the aura of hemiparesis by lowering the threshold for the development of cortical spreading depression. Even though our patient had no family history of hemiplegic migraine, a mutation in an ion channel gene (eg, the CACNA1A gene on chromosome 19) might account for his episodic attacks.

Conclusion  Migraine aura should be included in the differential diagnosis of exertion-induced focal neurologic deficit.

From the Departments of Neurology (Drs M. Razavi, Fattal, Afifi, and Adams), Medicine (Dr B. Razavi), and Pediatrics and Anatomy (Dr Afifi), University of Iowa Hospitals and Clinics, Iowa City.

RELATED ARTICLE

Archives of Neurology Reader's Choice: Continuing Medical Education
Arch Neurol. 2000;57(9):1387-1388.
FULL TEXT  

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Evidence for a separate type of migraine with aura: Sporadic hemiplegic migraine
Thomsen et al.
Neurology 2003;60:595-601.
ABSTRACT | FULL TEXT  

Treatment of sporadic hemiplegic migraine with calcium-channel blocker verapamil
Yu and Horowitz
Neurology 2003;60:120-121.
ABSTRACT | FULL TEXT  

Familial hemiplegic migraine and its abortive therapy with intravenous verapamil
Yu and Horowitz
Neurology 2001;57:1732-1733.
FULL TEXT