Patients with Typical Aura without Headache with Cortical Hyperperfusion on Arterial Spin-Labeling MRI Have Clinical Features Similar to Those of Patients with Migraine with Aura.

BACKGROUND AND PURPOSE: We previously reported that arterial spin-labeling (ASL)-MRI revealed a high incidence of cortical hyperperfusion (CHP) in patients with interictal migraine, particularly among patients without insomnia. In this study, we hypothesized that patients with typical aura without headache (TAWH), whose pathophysiology has yet to be elucidated and who had CHP, had similar clinical characteristics to those with migraine with aura (MWA). MATERIALS AND METHODS: We retrospectively investigated the frequency of CHP findings by using ASL along with characteristic clinical features of migraine in patients with TAWH (65 cases) and MWA (98 cases) who had aura symptoms of scintillating scotoma. RESULTS: Patients were divided into 4 clinical groups based on CHP findings:: Group MWA without CHP (62 patients), Group MWA with CHP (36 patients), Group TAWH with CHP (27 patients), and Group TAWH without CHP (38 patients). Clinical feature comparisons among the 4 groups showed that the TAWH without CHP group exhibited a significantly higher number of men, higher average age, fewer patients under 40 years old, and more patients with a history of hypertension, hypercholesterolemia, or cerebral infarction. Family migraine history frequencies and characteristic symptoms of migraines, such as photophobia, phonophobia, and osmophobia, did not significantly differ between the 3 groups (MWA without/with CHP and TAWH with CHP), and the frequencies of these symptoms were significantly lower in the TAWH without CHP group (P < .001). There was a significantly higher incidence of patients with reduced regional cerebral blood flow in the posterior cerebral artery (PCA) territory accompanied by PCA stenosis in the TAWH without CHP group (23 of 38, 61%). Although there was no significant difference between the cortical CBF of the MWA with CHP and TAWH with CHP groups, the cortical CBF of both groups was significantly higher compared with the MWA without CHP, TAWH without CHP, and normal groups (P < .001). CONCLUSIONS: Patients with TAWH who have CHP on ASL exhibit clinical features similar to those for MWA. Conversely, the absence of CHP is a warning sign when diagnosing TAWH and indicates the need to consider underlying diseases other than migraine in these cases.