Hemiplegic migraine aura begins with cerebral hypoperfusion: imaging in the acute phase

Headache. 2011 Sep;51(8):1289-96. doi: 10.1111/j.1526-4610.2011.01963.x. Epub 2011 Jul 28.


Imaging studies of spontaneous migraine aura have proved challenging because of the episodic and unpredictable nature of migraine attacks. Two patients with signs of acute ischemic stroke were evaluated for thrombolysis and turned out to suffer from familial hemiplegic migraine. It was possible to record the early phase of the hemiplegic aura with computed tomography with perfusion sequences and magnetic resonance imaging. We found cerebral hypoperfusion in the relevant cortical areas within the first hour after onset of aura symptoms. This report supports the concept that migraine aura across the migraine spectrum is caused by similar mechanisms. In a setting with efficient cooperation between headache and stroke neurologists, thrombolysis centers provide the set-up and opportunity to record aura symptoms at an early phase. Furthermore, in the time of ready access to acute systemic thrombolysis treatment, these cases underscore the importance of an accurate headache history, especially in younger patients.

Publication types

  • Case Reports

MeSH terms

  • Acute Disease
  • Adult
  • Brain Ischemia / complications*
  • Cerebrovascular Circulation*
  • Diffusion Tensor Imaging
  • Disease Progression
  • Hemiplegia / complications
  • Hemiplegia / diagnosis
  • Hemiplegia / etiology*
  • Humans
  • Magnetic Resonance Imaging
  • Male
  • Migraine with Aura / complications
  • Migraine with Aura / diagnosis
  • Migraine with Aura / etiology*