Recibido: 26/07/2018; Aceptado: 02/11/2018 //http://doi.org/10.22546/52/1732 withoutheadache–achallengecase ofclitorisparestesia. Galicia Clin2019;80(2): 30-31 Cómo citareste artículo: Poças A, RamalhoJ Correspondencia: [email protected] out associatedheadacheinthis patient, thelastonescan The episodes of clitoral paresthesia occurred with and with- an aurabefore. hexagons. Exceptforthesecases, her migrainesneverhad a visualaurawhereshesaw theimagesasiftheywere sodes ofmigrainewithaura, butonthoseoccasions, itwas About fiveyearsago, thispatienthadalreadytwoepi- raphy andelectroencephalogramwerealsonormal. and controlanalysiswerenormal. Cranialcomputedtomog- She deniedothersymptoms/signs. Neurologicalexamination to herpreviousmigrainousheadaches. 5 minutes of that clitoris aura and the was similar in twooftheseepisodesshehadassociatedmigraineafter the ability to achieve orgasm. When asked, she confirmed that morning whenshewasdrivingafterwork. Maintainslibidoand She mentionsthatthefirsttimeitoccurredtoher, wasona associate theonsetofsymptomswithanyparticularsituation. to 45minutes. Shedeniesatraumaticevent anddoesnot a day, onnon-consequentialdays, andhaveadurationof10 evolution. Sheexplainsthateventsoccuronetothreetimes plaints ofclitoralparesthesiaepisodeswithtwoweeks She presented worried, at a medical brain oranytypeofsurgicalintervention. photophobia. offallswithtraumatothe Shedeniesahistory as a pulsating, severe pain, associated with phonophobia and fact ofsleepinglessasatriggeranddescribehermigraines rangedfrom2to3timesamonth. Sheidentifiesthe as needed as chronic medication the contraceptive pill and analgesics ofrelevanceexceptmigraineandasthma,history havingonly boyfriend for5yearandsheissexuallyactive. Nomedical Our clinical report is about a 25-year-old woman. She has a common aspeoplegetolder. migraine” or “acephalgic migraine” andcanbecomemore tacks thereisaurawithoutheadache, previouslycalled “silent is generally followed by a headache but in some migraine at- generally lastsome minutesandarefullyreversible. The aura symptoms.other centralnervous The neurologicsymptoms symptoms thatcanincludevisual, sensory, speech, motoror The term “aura” denotes recurrent attacks of neurologic Keywords: Aura. Migraine. Clitoris Palabras clave: Aura. Migraña. Clítoris 1 Ana Poças un casodedesafíoparestesiasdelclítoris Aura demigrañasindolorcabeza: a challengecaseofclitoris parestesia Migraine aurawithoutheadache– CASO CLÍNICO Centro HospitalardeLeiria(Portugal) for headache(ibuprofen600mg). The frequencyof 1 , JoãoRamalho 2

1 2 UCSP Litoral(Portugal) appointment, with com- may playarole. of emotionalorphysiologicalstress, suchas lackofsleep, molecules as a result mechanisms that invoke inflammatory specific processesthatinitiateCSDinhumansarenotknown, perpolarization/inhibition incorticalneuronsandglia. While propagating waveofdepolarization/excitationfollowedbyhy- is caused by cortical spreading depression (CSD), a slowly Clinical and preclinical studies suggest that migraine aura so noprophylactictreatmentwasoffered. quency ofmigraineswasreducedtooneortwotimesamonth These aurasymptomscompletelydisappearedandthefre- migraine, one of the treatment options of NICE guidelines. with problem, whichledhertoseeadoctor. Shewasmedicated to becomeworriedandthinkthatshecouldhaveasexual any sort. The lackofknowledge ofthisdiseaseledthepatient aura isneitheraccompaniednorfollowedbyheadacheof be classifiedasmigraineaurawithoutheadacheinwhich 1 kind ofauraafterthevisual(31%versus99%). and theipsilateralvulva. by intense paresthesia inboththe righthalfof her mouth ceded byrighthemianopia, whichwasconsistently followed the leftand the female patient presented with headache pre- paresthesia clearlylocalizedin histesticles, more evidenton in thegenitalregionduringtheirmigraineauras. The malehad symptoms male patient)whoexperiencedprominentsensory We onlyfoundintheliteraturetwopatients(amaleandafe- been ruledout. when transientischemicattackandseizuredisordershave for exampletransientischemicevents, shouldbeexcluded. short,negative orwhenauraisprolonged/very othercauses, first timeaftertheageof40, whensymptomsareexclusively requires additionalinvestigation. When auraoccurs forthe that maysignalseriousdiseasebecomesmoredifficultand precise diagnosisofauraanditsdistinctionfromimitators of headachefulfillingcriteriaformigrainewithoutaura, the to thearmandreachperioralregion. Intheabsence symptomsclassicallybegininonehand,the sensory spread appear informofparesthesia, hypoesthesia, orbothand Migraine aura without headache should be diagnosed only sumatriptan 50mgandparacetamol100mgprnforthe 4 2

Sensory auraisthesecond most frequent Sensory 5 We havenotfoundintheavailable 3 Itmay

Galicia Clínica | Sociedade Galega de Medicina Interna Poças A, et al

literature any description of sensory aura involving the clitoris. Bibliography Genital disturbances as migraine aura have not been de- 1. The International Classification of Headache Disorders, 3rd edition (beta version). Headache Classification Committee of the International Headache Society (IHS). scribed in many patients, but other neurological disorders are Cephalalgia. 2013 Jul; 33(9):629-808. known to produce this kind of symptoms. have geni- 2. Hadjikhani N, Sanchez Del Rio M, Wu O, Schwartz D, Bakker D, Fischl B, et al. tal symptoms well characterized: orgasms may trigger reflex Mechanisms of migraine aura revealed by functional MRI in human visual cortex. epileptic seizures and genital symptoms may represent true Proc Natl Acad Sci U S A. 2001 Apr 10; 98(8):4687-92. 3. Russell MB, Olesen J. A nosographic analysis of the migraine aura in a general 6 epileptic manifestations , sexual auras presenting as erotic population. Brain 1996; 119: 355-61. pleasant feelings or thoughts with or without sexual arousal 4. Kunkel RS. Migraine aura without headache: benign, but a diagnosis of exclusion.. and orgasm are associated with temporal lobe .7 Cleve Clin J Med. 2005; 72(6):529-34. 5. Casas-Limón J, Cuadrado-Pérez ML, González-Menacho J, Olivé-Plana JM, Ordás- The reasons for a low incidence of sensory symptoms in the Bandera CM, Vives-Masdeu G, et al. Genital sensory aura in migraine. Rev Neurol. genital region during migraine aura are partially unknown. 2012 Oct 1;55(7):445. 6. Ozkara C, Ozdemir S, Yilmaz A, Uzan M, Yeni N, Ozmen M. Orgasm-induced sei- Some authors suggest that the cortical neurons representing zures: a study of six patients. Epilepsia 2006; 47:2193-7. the genital area can have a higher threshold to be activated 7. Currier RD, Little SC, Suess JF, Andy OJ. Sexual seizures. 21. Arch Neurol 1971; 25: during the CSD. 8 Feelings of embarrassment can also explain 260-4. Galicia Clínica | Sociedade Galega de Medicina Interna 8. Casas-Limón J, Cuadrado-Pérez ML, González-Menacho J, Olivé-Plana JM, Ordás- the fact that patients don’t always confess this sort of symp- Bandera CM, Vives-Masdeu G, Matías-Guiu JA, et al. Genital sensory aura in mi- toms, so they may have been under-recognized. graine. J. Rev Neurol. 2012 Oct 1;55(7):445-7.

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