NEW YORK (Reuters Health) – Severe migraine is commonly complicated by unilateral weakness, according to a report in the June issue of the Journal of Neurology, Neurosurgery, and Psychiatry.

"Persons with migraine with unilateral motor symptoms (MUMS) have a fairly common migraine variant," Dr. William B. Young from the Jefferson Headache Center, Thomas Jefferson University, Philadelphia, told Reuters Health. "The migraine requires aggressive treatment."

Dr. Young and colleagues characterized the clinical features of non-familial MUMS in 24 patients compared with 48 matched controls whose migraine was not accompanied by motor symptoms.

All 24 affected patients reported weakness of the arm or hand, while only 4 reported facial weakness and 2 reported leg weakness. On examination, all had weakness in both arm and leg and "a give-way character was always present."

Most patients (21, 88%) had unilateral headaches, the authors report, and the weakness was always ipsilateral to the headache in 13 patients (62%) and always contralateral in 7 (33%).

Nearly two-thirds of the patients experienced typical visual aura, and most patients reported non-specific language disturbance (92%) or confusion (83%).

Nine patients (38%) had been told by a doctor that their symptoms were due to stroke, the researchers note, and another 4 patients believed they had a stroke despite having normal brain imaging.

Compared with controls, MUMS patients had more allodynia symptoms, were more likely to have lost their jobs because of their headaches, and had more adjustment disorders and less depression.

"The first attack requires an MRI," Dr. Young said. "The amount of (stroke) workup depends on how clearly the neurological symptoms fit into the preexisting migraine. The key, in my opinion, is not to keep repeating the same workup, as so often happens, and to give a proper diagnosis and go on with migraine treatment."

"Making the diagnosis will save society a lot of money and spare physicians and patients a great deal of anxiety," Dr. Young concluded.

"It is easy to dismiss these patients as being either benignly or malignantly crazy, elaborating symptoms for the purpose of attention to a problem that is not medically serious," writes Dr. Peter J. Goadsby, from the Institute of Neurology in London, in a related editorial. "However, they seem to have no excess of psychopathology, and frankly their problem (migraine) is serious and it is high time it is considered as such."

"Sometimes it is better to err on the generous side when judging the worthiness of symptoms, so-to-speak, rather than to jump to the judgment that symptoms not easily explained are just modified madness," Dr. Goadsby concludes. "A fair wind of interest and a modicum of curiosity may be well rewarded in understanding of perhaps one of the many secrets of neurology’s most interesting opportunity and perhaps greatest current challenge-migraine."

J Neurol Neurosurg Psychiatry 2007;78:600-604,553.

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