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Saturday, 23 November 2013

Migraine Aura Without Headache - The Causes and Risk Factors

Migraine Aura Without Headache
It is also known as migraine without headache or Silent Migraines. Migraine aura without headache should be considered as a diagnosis in anyone who has recurrent episodes of transient symptoms, especially those that are visual or neurological or involve vertigo. Visual and neurological symptoms due to migraine are not unusual and most commonly occur in older persons with a history of migraine headaches. Migraine aura without headache should be diagnosed only when transient. Migraine auras are reversible and recurrent episodes of neurological symptoms that resolve within 1 hour. They are associated with migraine but may not precede a headache, according to "Migraine aura without headache:
Benign, but a diagnosis of exclusion" by ROBERT S. KUNKEL, MD Consultant, Headache Center, Department of Neurology, The Cleveland Clinic Foundation (Page 529)(a)
Causes and risk factors
A. Causes
Migraine without headache is a result of a attack apparently starts in the brainstem and involves activation of the fifth cranial nerve (CNV), containing both sensory and motor fibers and areas of the cortex, that lead to release of various peptides and other vasoactive substances at the neurovascular junction, causing constriction followed by dilation of blood vessels, resulting of blood vessels inflammation.

Risk factors
Even though Migraine Without Headache can happen to anyone in any age with out history of migraine, but older people who have suffered with migraine with aura headache in Young age at higher risk to develop migraine without headaches
Reduction of cardiovascular risk factors, smoking cessation and use of non-estrogen-containing oral contraceptives in female patients are beneficial strategies to reduce the risk of ischaemic events in patients with migraine (especially those with aura). Attack frequency, acute medication overuse, obesity and coexisting depression and anxiety disorders are particularly strong but potentially modifiable independent risk factors for progression to chronic migraine(d)
1. Cigarette smoking
Researchers in Geisinger Wyoming Valley, Department of Neurology, Wilkes-Barre, PA, USA., may have found the link between cigarette smoking and the development of cranial autonomic symptoms with migraine, according to "A history of cigarette smoking is associated with the development of cranial autonomic symptoms with migraine headaches" by Rozen TD.(4)

2. Trigeminal nerve and autonomic reflex
Scientist at the Texas Tech University Health Sciences Center - Cell Physiology and Molecular Biophysics, Lubbock, TX 79430, USA. have found out that the Migraine Headaches were initiated by night guard-initiated irritation of the trigeminal nerve and a trigeminal autonomic reflex resulting in unilateral migrainous headache with autonomic signs, according to "Unilateral or "side-locked" migrainous headache with autonomic symptoms linked to night guard use" by Strahlendorf J, Schiffer R, Strahlendorf H.(5)

3. Depolarization
Some researchers suggested that migraine with aura may be result of the spreading depolarization which describes a wave in the gray matter of the central nervous system characterized by swelling of neurons, distortion of dendritic spines, a large change of the slow electrical potential and silencing of brain electrical activity (spreading depression) of that cause migraine headache and increase the risk of developing an ischemic stroke(6)

4. Hormonal contraceptives
Some reserachers suggested that women who use hormonal contraceptives and hormone replacement treatment may increase the risk of migraine occurrence.(7)

5. IgE levels
There are no direct evidence to associate migraine headache to cow's milk or egg-white allergy. However, the elevation of egg-white-specific IgE levels in migraine-type headache may signify the possible presence of shared pathogenetic pathways in the development of migraine and food allergies(8)

6. Stress
Stress can have an impact on one’s mental and physical well-being, including migraine headache. Stress describes a negative concept, life events, and concomitant psychosomatic illnesses should be considered important when evaluating individuals with migraine, and gender aspects need to be taken into account(9)

7. Serotonin
Serotonin, a type of neurotransmitter, passes messages between nerve cells, low serotonin levels in the brain may increase the risk of the process of constriction of the blood vessels as it alters levels of dopamine and stress hormones, and may be part of a complex cellular membrane trafficking dysfunction involving not only the serotonin transporter but also other transporters and ion channels of which trigger a migraine (10)

8. Reduced Magnesium Levels
Magnesium, plays an essential in many intracellular processes and in migraine pathogenesis, low levels of magnesium may promote cortical spreading depression, hyperaggregation of platelets, affect serotonin receptor function, and influence synthesis and release of a variety of neurotransmitters of which can trigger migraine headache(11)

9. Maxillary alveolar mucosal inflammation
Migraine, tension-type headache and facial pain patients are found to be associated with a maxillary alveolar mucosal inflammation and can be treated by chilling, application of anti-inflammatory gel and low-level (non-cutting) laser. Local treatment also mediates cervical muscle spasm, adding to its overall effectiveness(12)

10. Other causes
Beside the factors above, out of 126/179 replies, other factors triggering migraine attack include too much work (under the stress category 54/64), reflected sunlight (under the light category 35/44), too little sleep (under the sleep category 19/24), red wine (under the alcohol category 20/22), passive smoking (under the smoke category 11/11), menstruation (under the menstruation or break from the pill category 12/14) and perfume (under the fumes/heavy scents category 12/15). Hormones, light and stress were reported to cause at least 50 % of MA attacks in 62%, 47% and 42% of participants, respectively. No participants reported alcohol to be the trigger of 50% or more of their attacks. In the groups of participants with "light", "fumes/heavy scents", "smoke" or "physical effort" as triggers, nearly all patients reported that an exposure time to the trigger of less than 3 hours (90-100% of patients) was necessary to trigger an attack and a latency to onset of attack of less than 3 hours (90-100% of patients) in the study conducted by University of Copenhagen and Glostrup Hospital, Denmark J. (13)

11. Abnormal Calcium Channels
Abnormal Calcium Channels can interference with cells in the transportation of necessary minerals of which increase the risk of Migraine Headaches. some researchers found that mutated Ca(V)2.1 channels activate at more hyperpolarizing potentials and lead to a gain-of-function in synaptic transmission. This gain-of-function might underlie alterations in the excitatory/ inhibitory balance of synaptic transmission, favoring a persistent state of hyperexcitability in cortical neurons that would increase the susceptibility for cortical spreading depression (CSD), a mechanism believed to initiate the attacks of migraine with aura.(14)

12. Etc.

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Sources
a) http://ccjm.org/content/72/6/529.full.pdf 
(d) http://www.ncbi.nlm.nih.gov/pubmed/20017749
(4) http://www.ncbi.nlm.nih.gov/pubmed/20553330
(5) http://www.ncbi.nlm.nih.gov/pubmed/18783445
(5) http://www.ncbi.nlm.nih.gov/pubmed/20425031
(6) http://www.ncbi.nlm.nih.gov/pubmed/22367631
(7) http://www.ncbi.nlm.nih.gov/pubmed/22290682
(8) http://www.ncbi.nlm.nih.gov/pubmed/21668386
(9) http://www.ncbi.nlm.nih.gov/pubmed/22013141
(10) http://www.ncbi.nlm.nih.gov/pubmed/22426836
(11) http://www.ncbi.nlm.nih.gov/pubmed/12149787
(12) http://www.ncbi.nlm.nih.gov/pubmed?term=soy%20and%20menstrual%20migraine
(13) http://www.ncbi.nlm.nih.gov/pubmed/20847084
(14) http://www.ncbi.nlm.nih.gov/pubmed/22074995