Migraine with aura in patients over 50 years of age: the Marseille's registry

The goal of this study was to describe specifically the clinical characteristics of migraine with aura in patients over the age of 50. During 1 year, three neurologists working in a tertiary headache center included all patients aged 50 years and over presenting migraine with aura in a prospective registry. Fifty-seven patients with migraine with aura aged 50 years and over were interviewed using a standardized questionnaire during a consultation. Auras were visual for all the patients, paresthesic for 16 patients, and aphasic for 16. One patient had a sporadic hemiplegic migraine. The headache followed the aura in a large majority of patients and fulfilled the International Headache Society criteria for migraine headache for 38 patients. Typical aura without headache was described in 26 patients and was the only expression of the disease for five patients. Two groups can be defined: in the first one, migraine with aura began before 50 years (39 patients). Thirty-one patients had typical aura with migraine headache and 15 complained of typical aura without headache. The second group (18 patients) included patients who developed migraine with aura over 50 for the first time. Among them, patients may have typical aura with migraine headache (seven patients), typical aura with non-migraine headache (eight patients) and/or typical aura without headache (11 patients). Late-life onset transient visual phenomena are not rare. These symptoms may occur for the first time after 50, in the absence of headache. When migraine with aura began after 50 years, headache has more often the characteristics of typical aura with non-migraine headache, or migraine may have the presentation of typical migraine without headache.