A family with dominantly inherited migraine headaches, episodic vertigo, and essential tremor is reported from the UCLA School of Medicine, Los Angeles, CA. Episodes were triggered by stress, exercise, or lack of sleep. Tremor began in adolescence or early adulthood. Treatment with acetazolamide in 5 patients relieved visual auras, headaches, and vertigo, and diminished the tremor. Linkage analysis excluded linkage to markers on chromosome 19p, involved in families with hemiplegic migraine and ataxia syndrome. [1]

COMMENT. Several studies have shown a beneficial effect of acetazolamide in essential tremor. In the present report, both tremor and headache were relieved by acetazolamide. Of 15 family members with migraine, 8 also had essential tremor, whereas none of unaffected members had tremor. It seemed likely that the migraine and tremor were genetically connected. Migraine is expressed in various clinical forms and appears to be genetically heterogeneous.

An 11-year-old boy with basilar migraine aura without headache and ictal fast EEG activity is reported from the Pediatric Institute, Ferrara University, Italy [2]. Anisocoria, ataxia, dysarthria, and confusional state were predominant manifestations. Beta activity in the EEG has been described previously with attacks of basilar migraine.

Familial hemiplegic migraine and autosomal dominant arteriopathy with leukoencephalopathy (CADASIL) is described from St Vincent’s Hospital, Dublin, Ireland [3]. Four subjects with CADSIL (cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy) had a history of familial hemiplegic migraine dating back to childhood. The disorder typically presents in adulthood but the MRI may show evidence of leukoencephalopathy before symptoms develop. This family is the first with both hemiplegic migraine and migraine as presenting symptoms of CADSIL.