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Migraine Aura Without Headache — SCE Neurology MCQ

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ModerateHeadache & Facial PainMigraine Aura Without HeadacheSCE Neurology

A 60-year-old man with no headache history presents with recurrent episodes of scintillating scotomata and zigzag lines in his left visual field, each lasting 20–30 minutes, followed by complete resolution. He has NO headache at any point. MRI brain is normal. Ophthalmological examination is unremarkable. What is the most likely diagnosis?

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Correct answer: A — Migraine aura without headache (acephalgic migraine)

Migraine aura without headache (acephalgic migraine, formerly 'migraine equivalent') is increasingly recognised, particularly in older adults who may have had migraine with aura in earlier life. It presents with typical visual aura (gradual onset, march, duration 5–60 minutes, full resolution) without subsequent headache. It is a diagnosis of exclusion — TIA, occipital seizures, and retinal pathology must be excluded. ICHD-3 classifies it as 'typical aura without headache'. A: Retinal detachment has flashing lights and floaters with visual field curtain. C: Occipital seizures are usually brief (<2 minutes) with different visual phenomena. D: TIA symptoms are maximal at onset without march. E: CBS occurs in the context of visual field loss.

Reference: ICHD-3 (2018)