In 1980, C. Miller Fisher described late-life migraine accompaniments as transient neurological episodes in individuals over 40 years old. This disorder is not rare in clinical practice and can occur without headache. Visual symptoms are the most common presentation, followed respectively by sensory, speech, and motor symptoms. In the study group of 120, the patients were categorized as follows: Visual, 25; visual and paresthesias, 18; visual and speech disturbance, 7; visual, and brain stem symptoms, 14; visual, paresthesias, and speech disturbance, 7; visual, paresthesias, speech disturbance and paresis, 25; recurrence of old stroke deficit, 9; miscellaneous, 8. Headache occurred in only 50% of cases. 

Transient neurological disturbances in migraine can mimic other serious conditions such as ischemic attacks and can be easily misdiagnosed. Appropriate investigations are essential to exclude secondary causes. 

–Alice Wong, NP