1.2.1.2 Typical aura without headache

A 34-year-old secondary school teacher reports two episodes of transient neurological disturbance in her lifetime, the most recent six weeks ago. She describes a shimmering, zigzag pattern that began in the periphery of her right visual field and slowly enlarged, taking around five minutes to spread across that side of vision. Within a few minutes she also noticed pins-and-needles creeping up her right arm and into the corner of her mouth, and for a short stretch she struggled to get her words out, substituting the wrong word for what she meant. Altogether the disturbance lasted about 32 to 33 minutes before resolving completely on both occasions. She is adamant that no head pain developed either during the spell or in the hour that followed it. She reports no double vision, no unsteadiness, no slurred speech, and no limb weakness, and says vision in each eye separately remained normal throughout. She does carry a longstanding diagnosis of episodic tension headaches, occurring independently of these spells.