"Positive" versus "negative" neurologic phenomena with headache*

Finding	Positive finding	Negative finding
Visual	Scintillating scotomata Fortification pattern	Blindness (absence of vision)
Motor	Involuntary movement of muscles	Weakness (absence of strength)
Sensory	"Pins and needles" or tingling ("like when your leg falls asleep")	Numbness ("like local anesthetic given at the dentist's office")
Speech	Saying nonsensical words	Decreased speech output

* As a simple rule of thumb, the positive findings above suggest a migrainous or seizure etiology, whereas negative findings are associated with destructive lesions, especially ischemia or infarction. To emphasize, this is a general guide, and exceptions occur. In migraine patients, for example, initial symptoms are typically positive but then may switch to negative. Thus, a careful history remains essential.

Graphic 132622 Version 1.0

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"Positive" versus "negative" neurologic phenomena with headache*