title: Late-life migraine accompaniments: A narrative review.
abstract: BACKGROUND
  Migraine is one of the most common chronic neurological disorders. In 1980, C. Miller Fisher described late-life migraine accompaniments as transient neurological episodes in older individuals that mimic transient ischemic attacks. There has not been an update on the underlying nature and etiology of late-life migraine accompanimentsd since the original description.
  
  
  OBJECTIVE
  The purpose of this article is to provide a comprehensive and extensive review of the late-life migraine accompaniments including the epidemiology, clinical characteristics, differential diagnosis, and treatment.
  
  
  METHODS
  Literature searches were performed in MEDLINE®, PubMed, Cochrane Library, and EMBASE databases for publications from 1941 to July 2014. The search terms "Migraine accompaniments," "Late life migraine," "Migraine with aura," "Typical aura without headache," "Migraine equivalents," "Acephalic migraine," "Elderly migraine," and "Transient neurological episodes" were used.
  
  
  CONCLUSIONS
  Late-life onset of migraine with aura is not rare in clinical practice and can occur without headache, especially in elderly individuals. Visual symptoms are the most common presentation, followed respectively by sensory, aphasic, and motor symptoms. Gradual evolution, the march of transient neurological deficits over several minutes and serial progression from one symptom to another in succession are typical clinical features for late-life migraine accompaniments. Transient neurological disturbances in migraine aura can mimic other serious conditions and can be easily misdiagnosed. Careful clinical correlation and appropriate investigations are essential to exclude secondary causes. Treatments are limited and still inconsistent.
authors.affiliation: Comprehensive Headache Clinic, Neuroscience Center, Bangkok Hospital, Bangkok Hospital Group, Thailand.
authors.forename: Kiratikorn
authors.initials: K
authors.lastname: Vongvaivanich
authors.affiliation: Bangkok Eye Center, Bangkok Hospital, Bangkok Hospital Group, Thailand.
authors.forename: Paweena
authors.initials: P
authors.lastname: Lertakyamanee
authors.affiliation: Jefferson Headache Center, Thomas Jefferson University, USA.
authors.forename: Stephen D
authors.initials: SD
authors.lastname: Silberstein
authors.affiliation: Department of Neurology, Mayo Clinic, USA Dodick.David@mayo.edu.
authors.forename: David W
authors.initials: DW
authors.lastname: Dodick
mesh_terms: D000375:Aging / Q000473:pathology* / Q000523:psychology; D003937:Diagnosis, Differential; D006801:Humans; D002546:Ischemic Attack, Transient / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology; D008881:Migraine Disorders / Q000175:diagnosis* / Q000453:epidemiology* / Q000523:psychology; D020325:Migraine with Aura / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology
keywords: Migraine; acephalic migraine; elderly migraine; late-life migraine; migraine accompaniments; migraine equivalents; migraine with aura; transient neurological episodes; typical aura without headache