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Most people who see, treat or experience migraine will be aware that its clinical manifestations exceed the symptom of head pain. However, available acute treatments so far have targeted migraine symptoms only in the context of the pain phase of an attack. The associated disability clearly involves more than just these symptoms, and the phenotype can include additional painless features, including alterations in mood, cognition and homeostasis and sensory sensitivities. Recognising these symptoms, understanding their neurobiological basis and systematically recording them prospectively in clinical therapeutic trials are likely to offer valuable pathophysiological and therapeutic insights into this complex brain disorder, ultimately helping to improve the quality of lives of sufferers. We aim to explore the multifaceted disorder that is migraine, with a particular focus on the non- painful non- aura symptoms. [ABSTRACT FROM AUTHOR]

Migraine and stroke are two common and heterogeneous neurovascular disorders responsible for a significant burden for those affected and a great economic cost for the society. There is growing evidence that migraine increases the overall risk of cerebrovascular diseases. In this review, based on available literature through a PubMed search, we found that ischaemic stroke in people with migraine is strongly associated with migraine with aura, young age, female sex, use of oral contraceptives and smoking habits. The risk of transient ischaemic attack also seems to be increased in people with migraine, although this issue has not been extensively investigated. Although migraine appears to be associated with haemorrhagic stroke, the migraine aura status has a small influence on this relationship. Neuroimaging studies have revealed a higher prevalence of asymptomatic structural brain lesions in people with migraine. They are also more likely to have unfavourable vascular risk factors; however, the increased risk of stroke seems to be more apparent among people with migraine without traditional risk factors. The mechanism behind the migraine-stroke association is unknown. In light of the higher risk of stroke in people with migraine with aura, it is important to identify and modify any vascular risk factor. There is currently no direct evidence to support that a migraine prophylactic treatment can reduce future stroke in people with migraine. [ABSTRACT FROM AUTHOR]

Chronic migraine is the relatively new term that the International Headache Society has adopted to describe patients with frequent headache thought to be biologically migrainous. The strict definition is for the patient to have 15 days or more of headache over each of the previous 3 months and to have 8 or more of these days as typical migraine or treated with a migraine specific agent, such as a triptan. Chronic migraine represents the most disabling spectrum of patients with migraine and such patients could be expected to present to primary care and often be referred for management to secondary care, especially to see neurologists. Many such patients present with concomitant medication overuse, defined as using a compound analgesic, opioid, triptan or ergot derivative on 10 days or more per month. While medicines used typically in the preventive management of migraine will help many patients, some remain refractory to current treatments either due to lack of efficacy or poor tolerability. New treatment strategies for this highly disabled patient cohort are welcome in clinical practice. [ABSTRACT FROM AUTHOR]

Objective: Raynaud's phenomenon (RP) is comprised of repeated episodes of colour changes of the skin of digits on cold exposure or emotional stress. The prevalence of RP in the general population is variable fluctuating between 4%-15%, among surveys. The aim of this study was to estimate the prevalence of RP in a healthy working Greek population and to investigate the possible association of RP with various demographic, social and other factors.Methods: A total of 756 employees of the University Hospital of Ioannina was included in the study. They belong to the administrative (120 subjects), nursing and technical (a representative sample of 418 and 218 subjects, respectively) personnel. Five hundred subjects (111 men and 389 women) responded in a face to face interview based on a specially conformed questionnaire. The study began in November 1997 and was completed in March 1998.Results: Twenty six subjects with RP (1 man and 25 women) were found. Their mean (SD) age was 32.73 (5.77) years. The prevalence of RP was 5.2% (0.9% in men and 6.4% in women). The sex ratio, male/female, was 1/7.1. An association between RP and migraine was found. However, there were no significant correlations of RP with smoking, alcohol and coffee consumption, dietary habits, occupational history and drug exposure. No social or other demographic parameters associated to RP frequency were found.Conclusions: The prevalence of RP (5.2%) in the population studied is relatively low compared with previous studies. RP focuses on the fourth decade of life and affects mainly women. There was no evidence of any correlation of RP with social, environmental or personal parameters while an association of RP with migraine was found. Geographical or genetic factors, or both, may be responsible for these results. [ABSTRACT FROM AUTHOR]

A comparison of the elementary visual hallucinations of 50 patients with migraine and 20 patients with occipital epileptic seizures showed that epileptic seizures are predominantly multi-coloured with circular or spherical patterns as opposed to the predominantly black and white linear patterns of migraine. This simple clinical symptom of the elementary visual hallucinations may be helpful in distinguishing between classic or basilar migraine and visual partial epileptic seizures, particularly in children. Claims that epileptic seizures are triggered or caused by migraine may be artificial, reflecting problems in the differential diagnosis between the two diseases. [ABSTRACT FROM AUTHOR]

Patients with "migraine aura without headache" can be separated from those with transient ischaemic attacks (TIA) on the basis of the onset of symptoms, which is generally gradual and which spread or intensify over minutes or hours, and from the typical migrainous nature of their visual symptoms. Fifty cases were prospectively identified and these were compared with 50 age matched patients with a TIA. Surprisingly, there were no significant differences in the prevalence of vascular risk factors and diseases in the two groups although those with TIAs tended to have more. Only one patient with "migraine aura without headache" suffered a subsequent vascular event (a myocardial infarction). Three patients with TIAs had strokes and two others died from vascular disease. Although the results are not conclusive, they do suggest that patients with the clinical characteristics of "migraine aura without headache" have a low risk of subsequent vascular events, lower than those with TIAs, despite perhaps having similar prevalence of vascular risk factors. Although their risk factors should be treated, patients with "migraine aura without headache" should be reassured and not subjected to inappropriate and potentially hazardous investigations and treatment. [ABSTRACT FROM AUTHOR]

Forty six patients aged 18-39 years with transient ischaemic attacks (TIA) were studied; two thirds were women. Twenty five patients had attacks accompanied by headache, and seven gave a history of common migraine. Only four of 27 angiograms were abnormal; no operable carotid lesion was demonstrated. Over a mean follow up period of 10 years stroke or myocardial infarction (AMI) occurred in all four patients who presented major cerebrovascular risk factors, but in only two of the remaining 42 patients. Thus irrespective of age thromboembolic TIA is a harbinger of stroke or AMI. However, most TIAs under the age of 40 years are caused by a non-embolic benign vascular disorder. The clinical characteristics, long-term prognosis, and possible pathogenesis, for such attacks are often indistinguishable from those of classical migraine. In the absence of cardiovascular risk factors, arteriography does not provide much diagnostic and prognostic information. [ABSTRACT FROM AUTHOR]

The clinical and visual evoked potential (VEP) findings were analysed in 18 patients with anterior ischaemic optic neuropathy. The VEP studies showed a variety of abnormalities which could be interpreted as being the result of subcomponent interaction consequent upon loss or attenuation of the normal macular-derived P100 component. Delay of normal VEP subcomponents was not seen. The VEP findings were non-specific but pointed to a severe disturbance of transmission in optic nerve fibres subserving central vision. No significant changes were observed with time in most cases indicating a static monophasic process with no significant recovery. [ABSTRACT FROM AUTHOR]

Typical causes of internuclear ophthalmoplegia (INO) include arterial infarcts, demyelinating conditions, inflammation and trauma. We here report the unique case of a 33-year-old man with INO of the right eye caused by infarction of the right midbrain, confirmed by diffusion-weighted MRI. At presentation he displayed impaired adduction of the right eye with normal movement of the left. CT angiogram revealed an underlying developmental venous anomaly (DVA), raising the concern of venous infarction. His symptoms improved with aggressive management of blood pressure and risk factors. The patient had vascular risk factors -- smoking, hypertension and dyslipidaemia -- and we theorise that the hyalinised and inelastic walls of our patient's DVA were more vulnerable to the thrombogenic effects of his risk factors, predisposing him to this event. Venous infarcts owing to DVA are rare. To our knowledge INO secondary to venous infarct has not been reported, and should be considered in the differential of such cases. [ABSTRACT FROM AUTHOR]

The article presents a study which examined the link between migraine and the risk of cardiovascular disease in women. The primary outcome of the study include major cardiovascular disease, stroke and fatal cardiovascular disease. Based on the results, migraine is linked to around 50% increased relative risk of major cardiovascular disease and about 37% increased relative risk of cardiovascular disease mortality.

The author ponders on the link between migraine aura and cardiovascular disease. She discusses a study by Schürks and colleagues, which examined the association between migraine and stroke, myocardial infarction and death. She claims that the findings of the study noted the need for doctors to closely monitor and aggressively treat cardiovascular risk factors in patients with migraine. The author argues that since women with aura are at high risk of having ischaemic stroke, doctors should address the factors that might trigger an attack.

The article comments on the study "Migraine and hemorrhagic stroke: a meta-analysis," by S. Sacco, R. Ornello, P. Ripa and colleagues. Topics discussed include the strong association of migraine to the vascular system, the associaton of haemorrhagic stroke with migraine, and the study results of the conducted observational studies regarding the adjusted relative risk of stroke among participants with migraine.

Presents a letter to the editor about the red ear syndromes.