Different Phenotypes at Possibly Shared Genotype of Migraine Family

Case Report

Austin J Clin Neurol 2015; 2(9): 1078.

Different Phenotypes at Possibly Shared Genotype of Migraine Family

Yalın OÖ¹*, Edgünlü TG² and Özge A³

¹Department of Neurology, Istanbul Education and Research Hospital, Turkey

²Department of Medical Biology and Genetics, Mugla School of Health Sciences, Turkey

³Department of Neurology, Mersin University School of Medicine, Turkey

*Corresponding author: Osman Özgür Yalın, Department of Neurology, Istanbul Education and Research Hospital, Istanbul, Kasapİlyas Caddesi Org, Abdurrahman, Nafiz Gürman Cd. No: 18 Fatih/Istanbul, Turkey

Received: June 12, 2015; Accepted: August 10, 2015; Published: August 12, 2015


In this paper we described clinical features of a family including mother and all three children with migraine. Migraine is regarded as a chronic disorder with episodic manifestations and also is progressive for at least some of the patients. Our nuclear family consist mother and her all-three children with migraine. We pointed clinical differences and comorbidity of migraine with aura (MwA) and migraine without aura (MwoA) and existence of cutaneous allodynia (CA) at this family. We believe in that family or twin studies could help us not only to reveal pathophysiology of migraine but also could contribute us to understand possible effects of clinical variables (such as aura, cutaneous allodynia).

Keywords: Migraine; Inheritance; Aura; Cutaneous allodynia


Migraine is a common neurovascular disorder characterized by disabling headache attacks and associated with accompanying symptoms. Migraine affects more than 10 % of the population and is one of the major causes of health costs for all over the world [1]. Genetic predisposition of migraine is obvious and family history is present more than half of the patients. However responsible genes or inheritance form are still uncovered excluding hemiplegic migraine. To this date, migraine investigations have advanced current knowledge about genetic contributions and the pathophysiology of disease. Generally migraine genetic basis depends on polygenic and multifactorial. Familial hemiplegic migraine (FHM) is a rare monogenic subtype of migraine with motor aura symptoms. On the other hand many candidate genes analyzed for common migraine types (including 5-HT related genes, dopamine-related genes, and glutamate receptors). Vascular (ACE, MTHFR, NOS2, NOS3, NOTCH3), hormonal (ESR-1, ESR2, CYP19A1) and inflammatory candidate genes (TNFA, TNFB, COX2) are also investigated for associations of migraine [2-8]. International Headache Genetics Consortium (IHGC) analyzed the first Genome wide association studies (GWAS) of migraine in 2010. Genetic markers could explain phenotypic variation in many common forms of migraine [9].

Migraine phenotype could have different presentations and about a third of patients with migraine have attacks with aura (Russell 1995) [10]. Aura is defined as clinical transient disturbances attributed to the brain dysfunction [11]. The most common form of the aura is visual aura, sensory and aphasic aura expresses less commonly. Russel & Olesen precisely described migraine aura spectrum in their paper. Visual symptoms were most frequent (99%), followed by sensory (31%), aphasic (18%) and motor (6%) symptoms [12].

Migraine is associated with an increased risk of cardio- and cerebrovascular disease, and this relationship is confirmed by large prospective studies [13]. Recently according to a systematic review elevated risk is reported particularly in the case of aura and female sex and denoting doubts of benignity of migraine [14]. Currently there is limited data reveals natural course of MwA and there is necessity of long-term follow-up studies to reveal enigma of this subjects [15].

In this report we aimed to discuss migraine phenotypic variability in the light of a nuclear family.

Patient Descriptions

Mother; GB, 53 years old: She remembers her first headache at 15 years old, before 38 years ago. Some of her headache attacks include aura, containing visual and sensorial perceptions. Her typical attack starts by scintillating scotoma, blurring at left visual field and 5-10 minutes later headache begins. After headache started almost every time spontaneous sensorial symptoms occurs at right hand and leg. Paresthesia starts distal parts of extremities and gradually spreads proximal and face region and lasts about 30 minutes. After aura phase completed and ended, headache gradually increases its severity and lasts about two days. She describes 4 attacks per month for one year and states attack numbers reduced since menopause without phenotypic evolution. She described prominent CA symptoms and her Allodynia Symptom Checklist (ASC-12) score was twelve. She has history of hypertension, diabetes mellitus, and coronary artery disease.

First male child; IBM, 25 years old male: He have headache for 5 years. He describes visual auras, with scintillating scotoma for 10 minutes at some of attacks. Headache attacks gradually increases its severity and lasts approximately 8 hours. He describes 5 attacks per month. He does not have CA, and ASC-12 score was zero. He has history of childhood epilepsy that resolved completely. He is not using any medication regularly.

Secondmale child; ASM, 21 years old male: He has headache for 10 years. We asked carefully but he did not notice any kind of aura. Headache attacks gradually increases its severity and lasts approximately 12 hours. He describes 10 headache days per month. He has prominent allodynia symptoms. He has history of hypertension, hyperlipidemia, and coronary artery disease. He doesn’t using any medication regularly and smokes cigarette 1 pack/day for 10 years.

Citation: Yalın OÖ, Edgünlü TG and Özge A. Different Phenotypes at Possibly Shared Genotype of Migraine Family. Austin J Clin Neurol 2015; 2(9): 1078. ISSN : 2381-9154