Three young men (Case A 19 year-old, Case B 21 year-old, Case C 25 year-old) came to our observation for recurrent attacks of migraine-like headache of a pulsating quality and severe intensity, with nausea, photo- and phonophobia, that resolved spontaneously within 12 h if untreated. The attacks were preceded by reversible visual symptoms presenting as fortification spectrum and ipsilateral cheiro-oral paresthesia (Cases B and C only), that lasted for 15-40 min.
Onset of the symptoms occurred a few years earlier: 4 years for Cases A and C, 2 years for Case B.
In all cases the symptoms occurred when they were in the locker room: in Cases B and C shortly after a football match, but never after training; whilst in Case A the symptoms occurred occasionally after swimming pool and gym training or after participating in physical education activities at school.
No other subtypes of headache, or head trauma were reported by the patients.
The father of Case A and the mothers of Cases B and C suffered from episodic attacks of migraine without aura.
The patients' medical history, physical and neurological examination did not suggest any other secondary disorder (Cases A and B are smokers). Case A also suffers from episodic migraine without aura according to the current International Classification of Headache Disorders (ICHD-II) Criteria.
The patients, however, underwent extensive diagnostic investigation: brain magnetic resonance with angiographic sequences, electroencephalography, vertebral and carotid echo-doppler, complete ocular examination, electrocardiography, transthoracic echocardiography and complete blood cell count, general chemistry profile, coagulation studies, protein C, protein S, antithrombin III, anticardiolipin antibody, erythrocyte sedimentation rate, C-reactive protein, antinuclear antibody and thyroid function test. The results of the laboratory tests and determinations were normal.