Headache Medicine 2021, 12(1) p-ISSN 2178-7468, e-ISSN 2763-6178

ASAA

DOI: 10.48208/HeadacheMed.2021.10

Headache Medicine

Case Report

"Sound attacks": a case report of migraine with hearing aura

Antonio Marcos da Silva Catharino

1,2

Marco Antonio Orsini Neves¹ Nicolle dos Santos Moraes Nunes

Jacqueline Stephanie Fernandes do Nascimento

Janie Kelly Fernandes do Nascimento¹

Gilberto Canedo Martins Jr

1,2

Medical Semiology\Neurology, Universidade Iguaçu, Nova Iguaçu, Rio de Janeiro, Brazil

Neurology, General Hospital of Nova Iguaçu, Nova Iguaçu, Rio de Janeiro, Brazil

Abstract

Introduction

Migraine with aura is less frequent than the subtype form without aura. Normally, auras are typ-

ically manifested visual symptoms, but it is possible to have an auditory and olfactory complains

as aura symptomatology.

Case report

An 8-year-old boy with family cases of migraine, complained of auditory hallucination episodes,

since he was 5 years-old, with a duration of 10 to 20 minutes, followed by cure with intense

photophobia and nausea. He called these episodes as "sound attacks". The frequency of the

crises ranges from 4 to 5 episodes per month, with the maximum of 11 episodes in one month.

Neurological examination was normal. He performed angio-MRI of skull and EEG, without any

changes. Treatment was initiated with 250 mg sodium divalproate at night with reduction of

events, already in the rst month, for 2 to 3 episodes per month. The medication was adjusted

for 500 mg of sodium divalproate with a good result, not presenting new episodes in the last 2

months.

Conclusion

We report a case of migraine crises preceded by auditory aura, in a boy of 8 years. This is a rare

and extremely interesting presentation of migraine, with great improvement after the prophylactic

treatment.

Antonio Marcos da Silva Catharino

neurocurso@globo.com

Edited by

Mario Fernando Prieto Peres

Marcelo Moraes Valença

Keywords:

Headache

Migraine with Aura

Migraine Disorders

Pain

Divalproate

Auditory aura

Received: September 28, 2020

Accepted: December 22, 2020

ASAA

Catharino AMS, Neves MAO, Nunes NSM, Nascimento JSF, Nascimento JKF, Martins Jr GC

"Sound attacks": a case report of migraine with hearing aura

Introduction

igraine is a complex neurological disorder that affects

various cortical, subcortical, and brainstem areas.

This

disorder manifests as a painful headache event characterized

by acute, recurrent, disabling attacks associated with systemic

repercussions, such as gastrointestinal and neurological.

Migraine with aura is less frequent than the forms without

aura. Typically, auras are visual in nature, but an auditory

and olfactory nature is possible. However, since they are

less prevalent than visual auras, the current guidelines on the

Classication of Headache Disorders do not recognize them

as part of the typical symptomatology of migraine with auras,

despite their relevance, since they may offer new insights into

the pathophysiology of primary headaches.

3,4

Although little is known about the pathophysiology of auras

of a sensory nature, cortical spreading depression (CSD) is

believed to be responsible for such dysfunctions, as CSD pro-

vides changes in cortical excitabilities triggering disturbances

in the entire length of the neocortex during multisensory au-

ras.

5,6

As far as the auditory manifestations of the auras are

concerned, it is assumed that these arise from neurophysio-

logical alterations originating in the temporal lobe, expressed

by phantosmia, auditory hallucinations and tinnitus.

Since auditory aura associated with migraine is an uncom-

mon event, the aim of the present study is to report a case of

auditory events preceding headache in a male schoolchild,

highly suggestive of auditory aura.

Case study

An 8-year-old boy with a family history of migraine reports

that since he was 5 years old, he has had episodes of hearing

alteration, which he calls "sound attacks", lasting 10 to 20

minutes, followed by headache with intense photophobia and

nausea. The frequency of attacks ranged from 4 to 5 episodes

per month, with a maximum of 11 episodes in 1 month.

Neurological examination was normal. He underwent skull

MRI and EEG without alterations. Treatment with divalproate

sodium was started at 250 mg at night, with a reduction of

episodes in the rst month to 2 to 3 episodes per month.

The medication was adjusted to 500 mg of divalproate with

good results, with no new episodes in the last two months

of treatment.

Discussion

The focal neurological phenomena that precede or accompa-

ny a migraine attack are called aura. This may involve visual,

somatosensory, olfactory, or auditory changes. Auditory

symptoms rarely occur as part of an aura.

The auditory

symptom most often associated with migraine is phonopho-

bia, which is present in more than two-thirds of patients.

Besides this, oscillography, tinnitus, sudden deafness, and

uctuating hearing loss are also reported.

7-9

Different studies

also show the presence of auditory hallucinations such as

aura in migraine patients who do not have psychotic illness-

es. These hallucinations involve voices that last throughout

the migraine attacks, as well as oscillucusia and tinnitus.

It is believed that migraine attacks may increase the poten-

tiation of the auditory cortex and, sporadically, stimulate

acoustic auras with auditory hallucinations, since studies with

auditory evoked potentials have demonstrated an absence

of habituation in the auditory cortex of migraine patients.

Auditory hallucinations, such as the knowledge of sounds in

the absence of identiable external stimuli, have been speci-

ed in children without psychopathy associated with migraine

attacks. It seems reasonable to consider that hallucinations

are related to migraine pictures, because they start close to

the headache phase and reduce when attacks are treated

by prophylactic methods,

10,12

as in this case report.

In a study carried out by Dash et al.

, audio vestibular func-

tionality was observed in migraine patients with or without

associated vertigo. It was concluded that all patients in the

study had some alteration in auditory responses stimulated

by brainstem auditory evoked potential (BAEP); and that

such alterations may congure the rst sign of an auditory

involvement in migraine.

Migraine with aura is described as recurrent attacks, lasting

minutes, of unilateral reversible visual, sensory, or other CNS

symptoms, which usually develop gradually and are usually

followed by headache and other associated symptoms.

dene the diagnosis of migraine with aura it is fundamental

that the patient fullls some criteria, such as: at least two crises

in which the patient has at least one of the auras: visual, sen-

sory, language, motor, brainstem or retinal.

In addition, at

least three characteristics among: aura spreading gradually

over more than ve minutes, two or more aura symptoms in

succession, individual aura symptoms last between 5 and

60 minutes, at least one aura symptom is unilateral, at least

one aura symptom is positive, the aura is accompanied or

followed by headache within 60 minutes.

Furthermore, it

is valid to point out that for this diagnosis to be dened it is

fundamental that there is no other disease that can better

explain the patient's condition.

Authors contributions: AMSC, Data Collection, Writing and

Supervision; MAON, Supervision; NSMN, JSFN e JKFN,

Writing; GCMJr – approved the nal version.

Funding: No

Conflict of interests: No

ASAA

Catharino AMS, Neves MAO, Nunes NSM, Nascimento JSF, Nascimento JKF, Martins Jr GC

"Sound attacks": a case report of migraine with hearing aura

Antônio Marcos da Silva Catharino

https://orcid.org/0000-0002-5736-1486

Marco Antônio Orsini Neves

https://orcid.org/0000-0002-8526-6937

Nicolle dos Santos Moraes Nunes Medical

https://orcid.org/0000-0003-0336-2261.

Jacqueline Stephanie Fernandes do Nascimento

https://orcid.org/ 0000-0003-1847-3829

Janie Kelly Fernandes do Nascimento

https://orcid.org/ 0000-0002-6335-2914

Gilberto Canedo Martins Jr

https://orcid.org/0000-0002-8181-7930

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