Characteristics of migraine visual aura in Southern Brazil and Northern USA

Cephalalgia ◽  
2011 ◽  
Vol 31 (16) ◽  
pp. 1652-1658 ◽  
Author(s):  
Luiz Paulo Queiroz ◽  
Deborah Isa Friedman ◽  
Alan Mark Rapoport ◽  
R Allan Purdy
Keyword(s):  
Visual Field ◽  
Migraine With Aura ◽  
Descriptive Study ◽  
Migraine Aura ◽  
Southern Brazil ◽  
Visual Symptom ◽  
Blurred Vision ◽  
Visual Aura ◽  
Common Features ◽  
Gradual Onset

Background: Migraine aura, made up of one or more neurological symptoms arising from the cortex or brainstem, is a complex neurological phenomenon. Visual aura is the most frequent aura manifestation. Studying the subjective components of visual aura makes it possible to identify common characteristics. Objective: To thoroughly describe the characteristics of migraine visual aura in patients with migraine with aura. Methods: We performed a retrospective, descriptive study of the visual aura of 122 migraine patients collected at two headache clinics in the Americas. This study was designed to determine the characteristics of a typical visual aura. Results: The most common features of the visual aura in our study are that it occurs before the headache with a gap of less than 30 minutes, lasts 5 to 30 minutes, has a gradual onset, usually begins peripherally, is unilateral, and shimmers. Furthermore, the location of typical visual aura in the visual field has no fixed relationship to headache laterality, is slightly more often without color, and is often described as small bright dots and zigzag lines. Blurred vision, not typically considered to be an aura phenomenon of cortical origin, is in fact the most frequently reported visual symptom. Conclusions: Migraine visual aura is heterogeneous and pleomorphic, and some of our findings run contrary to common beliefs.

The depiction of migraine visual aura on the internet

Cephalalgia ◽  
2020 ◽  
Vol 40 (10) ◽  
pp. 1113-1118 ◽  
Author(s):  
Michele Viana ◽  
Anders Hougaard ◽  
Thien Phu Do
Keyword(s):  
Health Information ◽  
The Internet ◽  
Migraine Aura ◽  
Visual Symptom ◽  
Blurred Vision ◽  
Visual Aura ◽  
Visual Symptoms ◽  
Quality And Reliability ◽  
Visual Disturbances

Introduction The most common and multifaceted migraine aura symptoms are visual disturbances. Health information is one of the most popular topics on the internet but the quality and reliability of publicized information is unknown. The aim of this study was to analyze images of migraine aura on Google to determine the frequency of correct presentations of visual aura and distribution of visual aura phenotypes. Methods Two authors screened the 100 highest indexed migraine aura related images on Google. The content of the images was categorized into elementary visual symptoms. Results Forty out of 100 images were accurate representations of visual migraine aura. Such images included 31 different visual aura phenotypes. The majority had more than one elementary visual symptom (median 2, IQR 1–3), most commonly “bean-like” forms (45%), zigzag lines (40%), and foggy/blurred vision (33%). Discussion Forty percent of images were accurate portrayals of visual migraine aura symptoms, but these presented limited phenotypes. The information derived from the internet photos may hinder the effective recognition of aura symptoms. Thus, there is a need to provide a more comprehensive representation of visual migraine aura symptoms on the internet.

Clinical features of migraine aura: Results from a prospective diary-aided study

Cephalalgia ◽  
2016 ◽  
Vol 37 (10) ◽  
pp. 979-989 ◽  
Author(s):  
Michele Viana ◽  
Grazia Sances ◽  
Mattias Linde ◽  
Natascia Ghiotto ◽  
Elena Guaschino ◽  
...  
Keyword(s):  
Clinical Features ◽  
Migraine With Aura ◽  
Reliable Data ◽  
Visual Features ◽  
Clinical Aspects ◽  
Migraine Aura ◽  
Visual Symptom ◽  
Visual Symptoms ◽  
Detailed Evaluation ◽  
Temporal Succession

Background A detailed evaluation of migraine aura symptoms is crucial for classification issues and pathophysiological discussion. Few studies have focused on the detailed clinical aspects of migraine aura. Methods We conducted a prospective diary-based study of migraine aura features including presence, quality, laterality, duration of each aura symptom, their temporal succession; presence of headache and its temporal succession with aura. Results Seventy-two patients completed the study recording the characteristics of three consecutive auras ( n = 216 auras). Visual symptoms occurred in 212 (98%), sensory symptoms in 77 (36%) and dysphasic symptoms in 22 (10%). Most auras had more than one visual symptom (median 2, IQR 1–3, range 1–4). The majority of patients (56%) did not report a stereotyped aura on the three attacks with respect to visual features, the combination and/or temporal succession of the three aura symptoms. Fifty-seven percent of patients also reported a different scenario of temporal succession between aura and headache in the three attacks. Five per cent of aura symptoms were longer than four hours. Conclusion These findings show a high inter- and intravariability of migraine with aura attacks. Furthermore, they provide reliable data to enrich and clarify the spectrum of the aura phenotype.

scholarly journals Migraine aura: results from an art contest

2020 ◽  
pp. 10-13
Author(s):  
Bruna de Freitas Dias ◽  
Arao Belitardo de Oliveira ◽  
Juliane Prieto Peres Mercante ◽  
Michele Viana ◽  
Luiz Paulo de Queiroz ◽  
...  
Keyword(s):  
Migraine With Aura ◽  
Primary Headache ◽  
Digital Art ◽  
Migraine Aura ◽  
Visual Aura ◽  
Disease Awareness ◽  
Raising Awareness ◽  
Prevention And Treatment ◽  
The Mean ◽  
Cluster Headaches

Introduction: Migraine is a common primary headache and a major cause of disability. In at least a third of migraine attacks, the headache is preceded and/or accompanied by aura and the visual manifestation is the most frequent phenotype. Migraine with aura, a subtype of migraine disorder, are underdiagnosed and undertreated. So, a detailed aura iconography is important for better recognition, prevention and treatment of migraine with aura. Objective: A visual aura art contest was performed by ABRACES (Brazilian Association of Cluster Headaches and Migraines), in order to provide new images for raising awareness among population and professionals and decreasing the gap between diagnosis and treatment. Methods: The contest involved free subscription of drawings, paintings and digital art that expressed realistic results of a visual aura of migraine and answering of a questionnaire. The awards were separated in two categories (painting/drawing and digital art/photography) and amounted up to R$ 5,000. Results: There were 139 participants, 24% men and 76% women. The most common visual aura’s characteristic was the presence of colorful points, and the less frequently was golden. The mean duration of visual aura was 110.6 minutes (450.5 of standard deviation), median of 20 minutes, minimum of 1 minute and maximum of 3600 minutes. 36.7% of the subscribers have only one kind of visual aura and 33.8% answered that have more than one kind. 46,5% said that their visual aura almost never occurs without pain after or while aura and 19% reported that their visual aura always occurs without a headache. Conclusion: Art contests are useful tools for disease awareness. Further actions in disseminating aura images may help migraine aura underdiagnosis and undertreatment. 

Characteristics and Prevalence of Transient Visual Disturbances Indicative of Migraine Visual Aura

Cephalalgia ◽  
1999 ◽  
Vol 19 (5) ◽  
pp. 479-484 ◽  
Author(s):  
P Mattsson ◽  
PO Lundberg
Keyword(s):  
General Population ◽  
Migraine With Aura ◽  
Population Data ◽  
Visual Aura ◽  
Gradual Onset ◽  
Ihs Criteria ◽  
Visual Disturbances

The objective of this study was to estimate the prevalence of and to compare the characteristics of transient visual disturbances (TVDs) of possible migraine origin in a clinical and a general population. Data were obtained in interviews from 100 consecutive female migraine patients (17-69 years) and 245 women (40-75 years) from the general population. The lifetime prevalences were 37% and 13%, respectively. We did not detect any differences in characteristics of TVDs between patients and women in the general population. A gradual onset of five or more minutes was stated by as few as 45% and 46%, respectively. The typical headache phase in conjunction with a TVD had more migrainous features in patients. We conclude from our data that the TVDs in this study, which do not fulfill the IHS criteria for migraine with aura, more likely represent poorly described or abortive migraine phenomena, rather than phenomena of other origin.

Pattern Reversal Visual Evoked Potentials in Migraine with Aura and Migraine Aura Without Headache

Cephalalgia ◽  
1998 ◽  
Vol 18 (6) ◽  
pp. 319-323 ◽  
Author(s):  
K Shibata ◽  
M Osawa ◽  
M Iwata
Keyword(s):  
Evoked Potentials ◽  
Migraine With Aura ◽  
Visual Evoked Potentials ◽  
Spreading Depression ◽  
Normal Subjects ◽  
Pattern Reversal ◽  
Migraine Aura ◽  
Visual Aura ◽  
Duration Of Illness ◽  
Visual Evoked

Pattern reversal visual evoked potentials (PVEPs) were recorded in 20 patients with migraine with aura (MA), 19 patients with migraine without headache (migraine equivalent; ME) during interictal periods, and 34 normal subjects. All migraine patients had hemianopsia or fortification spectra during attacks. In both MA and ME patients of less than 49 years of age, there were significant ( p<0.01) differences in amplitude of PVEPs at the mid-occipital and contralateral to visual aura electrode sites compared to normal subjects. Amplitude of PVEPs in MA and ME showed significant ( p<0.001) increases when recorded soon after attacks, especially within 10 days. There was a significant ( p<0.01) correlation between percentage asymmetries and the duration of illness in both MA and ME. We conclude from our PVEP findings that cortical spreading depression remains the most likely explanation for the migraine visual aura.

An Analysis of the Factors Associated with Visual Field Deficits Measured with Flickering Stimuli in-between Migraine

Cephalalgia ◽  
2004 ◽  
Vol 24 (5) ◽  
pp. 389-397 ◽  
Author(s):  
AM McKendrick ◽  
DR Badcock
Keyword(s):  
Visual Field ◽  
Migraine With Aura ◽  
Migraine Without Aura ◽  
Visual Stimuli ◽  
Visual Aura ◽  
Factors Associated ◽  
Broad Group ◽  
Control Subjects ◽  
The Past ◽  
Visual Field Deficits

We have previously demonstrated that perimetric performance measured with flickering stimuli is not normal in some individuals who experience migraine with aura in the period between their attacks. In this study, flicker perimetric performance is measured in a broad group of migraineurs to determine whether the existence of such visual field deficits is dependent on the presence of visual aura, is correlated with the duration of migraine history, or frequency of attacks. Twenty-eight migraine with aura, 25 migraine without aura, and 24 non-headache control subjects participated. The performance of the migraine groups was not significantly different from each other. The migraine groups showed significantly lower general sensitivity across the visual field and higher incidence of localized visual field deficits relative to controls. Both length of migraine history and frequency of migraine occurrence over the past 12 months were significantly correlated with lower general sensitivity to flickering visual stimuli.

scholarly journals Have You Seen A Kaleidoscope? A Case of Visual Migraine Aura

2022 ◽  
Vol 5 (1) ◽  
pp. 01-03
Author(s):  
Fatimah Lateef
Keyword(s):  
Visual Field ◽  
Differential Diagnoses ◽  
Migraine Aura ◽  
Visual Aura ◽  
Detailed History ◽  
The Common ◽  
Work Up

This is a case of migraine, presenting with the interesting visual aura of a ‘kaleidoscope’: waves with flickering movements made up of a variety of colors (red, blue, green, yellow), commencing laterally and spreading superiorly in the visual field of the left eye. This description is quite similar to a fortification spectrum, which usually expands and spreads in a C-shape fashion over one side of the visual field. Several different possible pathophysiological explanation are shared as well as the common differential diagnoses. In the work up of a patient with visual aura migraine, a comprehensive and detailed history is important, together with the appropriate investigations, in order not to miss any serious syndromes, including stroke syndromes and epilepsy.

The Visual Aura Rating Scale (VARS) for Migraine Aura Diagnosis

Cephalalgia ◽  
2005 ◽  
Vol 25 (10) ◽  
pp. 801-810 ◽  
Author(s):  
MK Eriksen ◽  
LL Thomsen ◽  
J Olesen
Keyword(s):  
Rating Scale ◽  
Evidence Based ◽  
Validation Sample ◽  
Semistructured Interview ◽  
Migraine Aura ◽  
Visual Symptom ◽  
Visual Aura ◽  
Maximum Score ◽  
Cardinal Characteristics ◽  
Visual Disturbances

To supplement the traditional ICHD-2 diagnosis for migraine with aura (MA) we developed a diagnostic scale for migraine aura that quantifies the importance of the cardinal characteristics of MA. Since more than 99% of MA patients have visual aura, we developed for simplicity a Visual Aura Rating Scale (VARS). In total 427 patients with MA (ICHD-2) or nonaura visual disturbances were diagnosed in a validated semistructured interview by a trained physician. The patients were separated into a derivation sample and a validation sample. By regression analysis we identified the visual aura characteristics associated with MA in the derivation sample. Based on the identified characteristics we developed VARS and derived a predictive VARS score which was tested in the validation sample. The VARS score is the weighted sum of the presence of five visual symptom characteristics: duration 5-60 min (3 points), develops gradually ≤5 min (2 points), scotoma (2 points), zig-zag lines (2 points), and unilateral (1 point). The maximum score is 10 points. A VARS score of 5 or more diagnosed MA with a sensitivity of 96% (95% CI 92-99%) and a specificity of 98%(95% CI 95-100%) in the derivation sample, and a sensitivity of 91% (95% CI 86-95%) and a specificity of 96% (95% CI 91-100%) in the validation sample. VARS adds evidence based weights to a number of clearly specified characteristics; it is easy to learn, apply and teach and may therefore be a valuable addition to traditional ICHD-2 diagnosis.

Improved Description of the Migraine Aura by a Diagnostic Aura Diary

Cephalalgia ◽  
1994 ◽  
Vol 14 (2) ◽  
pp. 107-117 ◽  
Author(s):  
MB Russell ◽  
HK Iversen ◽  
J Olesen
Keyword(s):  
Migraine With Aura ◽  
Migraine Headache ◽  
Migraine Without Aura ◽  
Total Duration ◽  
Acute Onset ◽  
Migraine Aura ◽  
Visual Aura ◽  
Head Pain ◽  
Maximum Development

We present a diagnostic aura diary for prospective recordings of migraine with aura. Three questionnaires are supplemented with sheets for drawings and plottings of visual and sensory auras. Twenty patients recorded 54 attacks of migraine with aura and 2 attacks of migraine aura without headache. The visual and sensory aura were usually gradually progressive, reaching maximum development in 15 and 25 min (median) respectively and had a total duration of 20 and 55 min (median) respectively. Approximately 13% of the attacks had acute onset of visual aura associated with other features more typical of migraine. The visual and sensory auras always preceded typical migraine headache, and headache occurring before aura symptoms was always of the tension type, The migraine headache was milder than in attacks of migraine without aura and often did not have migraine characteristics. In attacks with unilateral head pain, headache and aura symptoms were contralateral in 90% and ipsilateral in 10%.

scholarly journals Migraine Visual Aura and Cortical Spreading Depression—Linking Mathematical Models to Empirical Evidence

Vision ◽  
2021 ◽  
Vol 5 (2) ◽  
pp. 30
Author(s):  
Louise O’Hare ◽  
Jordi M. Asher ◽  
Paul B. Hibbard
Keyword(s):  
Experimental Evidence ◽  
Migraine With Aura ◽  
Visual Processing ◽  
Subjective Experience ◽  
Reaction Diffusion ◽  
Diffusion Models ◽  
Oscillatory Activity ◽  
Migraine Aura ◽  
Visual Aura ◽  
Neural Noise

This review describes the subjective experience of visual aura in migraine, outlines theoretical models of this phenomenon, and explores how these may be linked to neurochemical, electrophysiological, and psychophysical differences in sensory processing that have been reported in migraine with aura. Reaction–diffusion models have been used to model the hallucinations thought to arise from cortical spreading depolarisation and depression in migraine aura. One aim of this review is to make the underlying principles of these models accessible to a general readership. Cortical spreading depolarisation and depression in these models depends on the balance of the diffusion rate between excitation and inhibition and the occurrence of a large spike in activity to initiate spontaneous pattern formation. We review experimental evidence, including recordings of brain activity made during the aura and attack phase, self-reported triggers of migraine, and psychophysical studies of visual processing in migraine with aura, and how these might relate to mechanisms of excitability that make some people susceptible to aura. Increased cortical excitability, increased neural noise, and fluctuations in oscillatory activity across the migraine cycle are all factors that are likely to contribute to the occurrence of migraine aura. There remain many outstanding questions relating to the current limitations of both models and experimental evidence. Nevertheless, reaction–diffusion models, by providing an integrative theoretical framework, support the generation of testable experimental hypotheses to guide future research.

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