Headache Edoardo Ferlazzo,* MD, PhD; Domenico Italiano,* MD, PhD; Vincenzo Belcastro, MD, PhD; Sara Gasparini, MD; Edoardo Spina, MD, PhD; Umberto Aguglia, MD From the Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy (E. Ferlazzo, S. Gasparini, and U. Aguglia); Regional Epilepsy Centre, Bianchi-Melacrino-Morelli Hospital, Reggio Calabria, Italy (E. Ferlazzo, S. Gasparini, and U. Aguglia); Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy (D. Italiano and E. Spina); Neurology Unit, S. Anna Hospital, Como, Italy (V. Belcastro)
REFERENCES 1. Dalla Volta G, Zavarise P, Ngonga G, et al. Transient global amnesia as a presenting aura. Headache. 2014;54:551-552. 2. Santoro G, Casadei B, Venco A. The transient global amnesia-migraine connection. Case report. Funct Neurol. 1988;3:353-360. 3. Schmidtke K, Ehmsen L. Transient global amnesia and migraine. A case control study. Eur Neurol. 1998;40:9-14. 4. Quinette P, Guillery-Girard B, Dayan J, et al. What does transient global amnesia really mean? Review of the literature and thorough study of 142 cases. Brain. 2006;129(Pt 7):1640-1658.
1235 5. Schipper S, Riederer F, Sándor PS, Gantenbein AR. Acute confusional migraine: Our knowledge to date. Expert Rev Neurother. 2012;12:307-314. 6. Sathe S, DePeralta E, Pastores G, Kolodny EH. Acute confusional migraine may be a presenting feature of CADASIL. Headache. 2009;49:590-596. 7. Headache Classification Committee of the International Headache Society (IHS). The International Classification of Headache Disorders, 3rd edition (beta version). Cephalalgia. 2013;33:629-808. 8. Bernasconi A, Andermann F, Bernasconi N, Reutens DC, Dubeau F. Lateralizing value of periictal headache: A study of 100 patients with partial epilepsy. Neurology. 2001;56:130-132. 9. Parisi P, Striano P, Negro A, Martelletti P, Belcastro V. Ictal epileptic headache: An old story with courses and appeals. J Headache Pain. 2012;13:607613. 10. Italiano D, Grugno R, Calabrò RS, Bramanti P, Di Maria F, Ferlazzo E. Recurrent occipital seizures misdiagnosed as status migrainosus. Epileptic Disord. 2011;13:197-201. 11. Butler CR, Graham KS, Hodges JR, et al. The syndrome of transient epileptic amnesia. Ann Neurol. 2007;61:587-598. 12. Labate A, Gambardella A, Andermann E, et al. Benign mesial temporal lobe epilepsy. Nat Rev Neurol. 2011;7:237-240.
Response to “Transient Global Amnesia as a Presenting Aura or Epilepsy?” We appreciate the opportunity to reply to the letter of Ferlazzo and colleagues about our recent publication: “Transient Global Amnesia as a Presenting Aura.”1 We consider of significant interest the aforementioned report by Ferlazzo and collaborators, to support the concept of acute confusional migraine (ACM) as a distinct clinical entity, requiring careful anamnesis and clinical evaluation, as well as diagnostic studies (radiological and neurophysiological), to rule out other alternative conditions. However,
several significant differences were present in our patient, supporting our idea that Transient Global Amnesia (TGA) could represent an atypical aura of migraine attack. First of all, the amnesic episodes experienced by our patient were not a simple epiphenomenon of a state of confusion and/or disorientation, but the main aspect of the episode, with all the other peculiar aspects of TGA amnesic crisis, in particular: (1) repetitive questioning; (2) an amnesic state for the entirety of the event itself (as a key symptom
1236 of hippocampal functional impairment). Furthermore, an intense headache (resembling the patient’s usual migraine episodes) started after the resolution of the amnestic episode. Accordingly, the 2 key aspects (TGA and migraine attack) were strictly interconnected in the clinical presentation, for all the 7 episodes presented by our patient. After this, considering also the differential diagnosis with transient epileptic amnesia, we performed not only standard EEG but also several EEG recordings after sleep deprivation, all normal for focal epileptic abnormalities. Furthermore, pharmacological prophylaxis with valproic acid was stopped after 1 year and no recurrence of migraine and/or TGA episodes was reported. Currently, after 5 years of clinical follow up from the last episode, the patient is still fully asymptomatic. In conclusion, we think that TGA presentation could be an atypical presentation of migraine with aura,
July/August 2014 representing an interesting functional connection between these 2 clinical conditions. In this sense, we hope that our proposal might be included in the International Classification of Headache Disorders. Giorgio Dalla Volta, MD; P. Zavarise, MD; G. Ngonga, MD; C. Agosti, MD; E. Premi, MD; A. Padovani, MD, PhD From the U.O. Neurologia, Istituto Clinico Citta’ di Brescia, Brescia, Italy (G. Dalla Volta, P. Zavarise, G. Ngonga, and C. Agosti); Clinica Neurologica, Universita’ di Brescia, Brescia, Italy (E. Premi and A. Padovani)
REFERENCE 1. Dalla Volta G, Zavarise P, Ngonga G, Agosti C, Premi E, Padovani A. Transient global amnesia as a presenting aura. Headache. 2014;54:551-552.
REFERENCES 1. Dalla Volta G, Zavarise P, Ngonga G, et al. Transient global amnesia as a presenting aura. Headache. 2014;54:551-552. 2. Santoro G, Casadei B, Venco A. The transient global amnesia-migraine connection. Case report. Funct Neurol. 1988;3:353-360. 3. Schmidtke K, Ehmsen L. Transient global amnesia and migraine. A case control study. Eur Neurol. 1998;40:9-14. 4. Quinette P, Guillery-Girard B, Dayan J, et al. What does transient global amnesia really mean? Review of the literature and thorough study of 142 cases. Brain. 2006;129(Pt 7):1640-1658.
1235 5. Schipper S, Riederer F, Sándor PS, Gantenbein AR. Acute confusional migraine: Our knowledge to date. Expert Rev Neurother. 2012;12:307-314. 6. Sathe S, DePeralta E, Pastores G, Kolodny EH. Acute confusional migraine may be a presenting feature of CADASIL. Headache. 2009;49:590-596. 7. Headache Classification Committee of the International Headache Society (IHS). The International Classification of Headache Disorders, 3rd edition (beta version). Cephalalgia. 2013;33:629-808. 8. Bernasconi A, Andermann F, Bernasconi N, Reutens DC, Dubeau F. Lateralizing value of periictal headache: A study of 100 patients with partial epilepsy. Neurology. 2001;56:130-132. 9. Parisi P, Striano P, Negro A, Martelletti P, Belcastro V. Ictal epileptic headache: An old story with courses and appeals. J Headache Pain. 2012;13:607613. 10. Italiano D, Grugno R, Calabrò RS, Bramanti P, Di Maria F, Ferlazzo E. Recurrent occipital seizures misdiagnosed as status migrainosus. Epileptic Disord. 2011;13:197-201. 11. Butler CR, Graham KS, Hodges JR, et al. The syndrome of transient epileptic amnesia. Ann Neurol. 2007;61:587-598. 12. Labate A, Gambardella A, Andermann E, et al. Benign mesial temporal lobe epilepsy. Nat Rev Neurol. 2011;7:237-240.
Response to “Transient Global Amnesia as a Presenting Aura or Epilepsy?” We appreciate the opportunity to reply to the letter of Ferlazzo and colleagues about our recent publication: “Transient Global Amnesia as a Presenting Aura.”1 We consider of significant interest the aforementioned report by Ferlazzo and collaborators, to support the concept of acute confusional migraine (ACM) as a distinct clinical entity, requiring careful anamnesis and clinical evaluation, as well as diagnostic studies (radiological and neurophysiological), to rule out other alternative conditions. However,
several significant differences were present in our patient, supporting our idea that Transient Global Amnesia (TGA) could represent an atypical aura of migraine attack. First of all, the amnesic episodes experienced by our patient were not a simple epiphenomenon of a state of confusion and/or disorientation, but the main aspect of the episode, with all the other peculiar aspects of TGA amnesic crisis, in particular: (1) repetitive questioning; (2) an amnesic state for the entirety of the event itself (as a key symptom
1236 of hippocampal functional impairment). Furthermore, an intense headache (resembling the patient’s usual migraine episodes) started after the resolution of the amnestic episode. Accordingly, the 2 key aspects (TGA and migraine attack) were strictly interconnected in the clinical presentation, for all the 7 episodes presented by our patient. After this, considering also the differential diagnosis with transient epileptic amnesia, we performed not only standard EEG but also several EEG recordings after sleep deprivation, all normal for focal epileptic abnormalities. Furthermore, pharmacological prophylaxis with valproic acid was stopped after 1 year and no recurrence of migraine and/or TGA episodes was reported. Currently, after 5 years of clinical follow up from the last episode, the patient is still fully asymptomatic. In conclusion, we think that TGA presentation could be an atypical presentation of migraine with aura,
July/August 2014 representing an interesting functional connection between these 2 clinical conditions. In this sense, we hope that our proposal might be included in the International Classification of Headache Disorders. Giorgio Dalla Volta, MD; P. Zavarise, MD; G. Ngonga, MD; C. Agosti, MD; E. Premi, MD; A. Padovani, MD, PhD From the U.O. Neurologia, Istituto Clinico Citta’ di Brescia, Brescia, Italy (G. Dalla Volta, P. Zavarise, G. Ngonga, and C. Agosti); Clinica Neurologica, Universita’ di Brescia, Brescia, Italy (E. Premi and A. Padovani)
REFERENCE 1. Dalla Volta G, Zavarise P, Ngonga G, Agosti C, Premi E, Padovani A. Transient global amnesia as a presenting aura. Headache. 2014;54:551-552.
