Transient Ischemic Attacks (TIA)

If a patient in his/her fifties or sixties develops migraine-like headache symptoms for the first time, transient ischemic attacks are a possibility.

TIA may be a warning of an impending stroke. Migraine rarely starts after the age of 40; thus, one should consider organic causes for patients with late-onset headaches. Headache can be an important symptom and occurs in about 25-30 percent of patients with this condition. Usually the carotid artery is diseased, and the attacks are located on the same side as the affected carotid. The headache attacks occur episodically as in migraine, but the headache is usually not as severe as migraine. While the headache may have migraine characteristics, it usually does not have the typical collection of associated symptoms such as light, noise and smell sensitivity, nor nausea and vomiting. If the physician examines the neck with a stethoscope, he may be able to hear a murmur in the larger artery leading to the brain.

This is referred to as a bruit. Noninvasive tests have become available in recent years — that is, tests using ultrasound or other methods to determine the presence of a diseased or arteriosclerotic carotid, which could produce such attacks. Recurrences can be prevented with medication that retards clumping of platelets (anticoagulation) or by surgery.