Acephalgic Migraine: Fifteen Years Experience

Sixty-one patients with acephalgic migraine have been seen and thoroughly evaluated at the USAF School of Aerospace Medicine over the past 15 years. Patient age ranged in years from 21 to 61, with the number of spells varying between 1 and 100 and lasting from 15 seconds to 3 hours. These phenomena were present for 2 weeks to 25 years. Ocular involvement was represented by scintillation, transient hemianopia, bilateral central scotomata, classic amaurosis fugax, diplopia, altitudinal field loss, tunnel vision; temporal crescent involvement, and several patients who developed a transient central scotoma in one eye with alterations in color perception. Other neurologic involvement occurred in 29%. Permanent neurologic deficit occurred in only one patient. Positive family history for migraine was present in only 24%. Headache is not a necessary feature of migraine attacks. One should consider migraine in any acute episodic neurologic disorder.