05/14/07 #1 - Almost continuous aura, Migraine without headache?

Health Professional

Full Question:

I am a 42-year-old man living in the Southern US. I have suffered from depression, pronounced skin flushing and burning, and abdominal cramping for about 15 years. The depression responded to Wellbutrin and the rashes to antihistamines and allergen shots. High fiber diet helped with the cramping. The strange thing about the symptoms was that they could be kicked off all together by food, mold, or MSG and that they were far worse in cold, wet weather. My general practitioner referred me to a neurologist when I developed a new symptom of tingling hands and feet. The neurologist diagnosed me with migraine-without-headache, which I had never heard of, but which apparently explains all my symptoms under a unified heading of migraine aura. Here is my question. According to everything I have been reading a migraine aura is supposed to last only a couple of hours. My symptoms are fairly continuous, although they did respond to the atenolol and Topamax the doctor put me on. The severe abdominal cramping, which sometimes progressed to vomiting, the tingling, and rare fairly mild headaches, respond to Relpax. Does the diagnosis of migraine-without-headache sound reasonable to you? If so, how can I be living with an almost continuous aura? Is there such a thing as "status aura", like "status migraine"? If so, how do you get rid of it! Thanks so much for your help. Gregory.


Dear Gregory;

The clinical condition you describe is quite interesting. It is quite rare but well-documented in a very small number of observations and studies. The category (1.5.3 of the international classification) describes migraine aura status. Valproate and acetazolamide have been used to treat this successfully although many cases had failed multiple types of treatments. I might consider lamotrigine, as it has been used successfully for treating migraine aura almost in the absence of headache. Perhaps consultation with a local headache expert might be useful to you.

Good luck,
John Claude Krusz and Teri Robert

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