Friday, May 13, 2011

The "aura" of migraine

Migraine can be with or without aura. What exactly comprises this aura. The prodromal  and associated  migraine symptoms may me mistaken as aura. Lets see what comprises the so called aura.  It is the migraine with aura that is related to an increased incidence of ischemic stroke, and is a contraindication for taking oral contracptives!(as risk of stroke increases 4 fold in this population)

The migraine aura is a complex of neurologic symptoms that may precede or accompany the headache phase or may occur in isolation. It usually develops over 5-20 minutes and lasts less than 60 minutes. The aura can be visual, sensory, motor, or any combination of these.
Auras most commonly consist of visual symptoms, which may be negative or positive. Negative symptoms include negative scotoma, homonymous hemianopic or quadrantic field defects, central scotomas, tunnel vision, altitudinal visual defects, or even complete blindness.The most common positive visual phenomenon is the scintillating scotoma. This consists of an arc or band of absent vision with a shimmering or glittering zigzag border. It is often combined with photopsias or visual hallucinations, which may take various shapes.Scintillating scotoma is a highly characteristic syndrome that always occurs prior to the headache phase of an attack and is pathognomonic of a classic migraine.Other positive visual phenomena include photopsia (uniform flashes of light) or simple forms of visual hallucinations. Heat waves, fractured vision, macropsia, micropsia, and achromatopsia may also occur.
Paresthesias, occurring in 40% of cases, constitute the next most common aura; they are often cheiro-oral with numbness starting in the hand, migrating to the arm, and then jumping to involve the face, lips, and tongue. As with visual auras, positive symptoms typically are followed by negative symptoms; paresthesias may be followed by numbness. Sensory aura rarely occurs in isolation and usually follows visual aura. 
Motor symptoms may occur in 18% of patients and usually are associated with sensory symptoms. Motor symptoms often are described as a sense of heaviness of the limbs before a headache but without any true weakness.Speech and language disturbances have been reported in 17-20% of patients. These disturbances are commonly associated with upper extremity heaviness or weakness.
The migrainous aura generally resolves within a few minutes and then is followed by a latent period before the onset of headache.When an aura is not followed by a headache, it is called a migraine equivalent or acephalic migraine. This is reported most commonly in patients older than 40 years who have a history of recurrent headache.
Again....all this means...that we need a more detailed history from these patients to elicit these findings!!


  1. Good article. I have migraine equivalent and was on short-term disability for it till I found a proper diagnosis back in end of 2011. I feel like a lot of people need guidance and are scared when they don't know what's wrong. A lot of doctors tell them they can't find anything, but thats because they don't know much about it. All I have to say is if you feel any of these symptoms and your getting MRIs w/negative results, go to a neurologist that knows about migraines and epilepsy. Your best bet is there. They can then rule out anything else. It took me months and several doctor opinions. I also read Dr.Sacks' book,"Migraines" because I have very strange symptoms with my migraines. Biofeedback is great for reducing symptoms in all types of migraines and write a diary of your symptoms when you have them! These things can feel very strong and only you can tell others what's going on even if an X-ray or blood test doesn't show it.

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