Migraine aura symptoms: Duration, succession and temporal relationship to headache

Background As there are no biological markers, a detailed description of symptoms, particularly temporal characteristics, is crucial when diagnosing migraine aura. Hitherto these temporal aspects have not been studied in detail. Methods We conducted a prospective diary-aided study of the duration and the succession of aura symptoms and their temporal relationship with headache. Results Fifty-four patients completed the study recording in a diary the characteristics of three consecutive auras ( n = 162 auras). The median duration of visual, sensory and dysphasic symptoms were 30, 20 and 20 minutes, respectively. Visual symptoms lasted for more than one hour in 14% of auras ( n = 158), sensory symptoms in 21% of auras ( n = 52), and dysphasic symptoms in 17% of auras ( n = 18). Twenty-six percent of patients had at least one aura out of three with one symptom lasting for more than one hour. In aura with multiple symptoms the subsequent symptom, second versus first one or third versus second, might either start simultaneously (34 and 18%), during (37 and 55%), with the end (5 and 9%), or after (24 and 18%) the previous aura symptom. The headache phase started before the aura (9%), simultaneously with the onset of aura (14%), during the aura (26%), simultaneously with the end of aura (15%) or after the end of aura (36%). Conclusion We provide data to suggest that symptoms may last longer than one hour in a relevant proportion of auras or migraine with aura patients, and that there is a high variability of scenarios in terms of time relationship among aura symptoms and between aura and headache.

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

Cephalalgia ◽

10.1177/0333102416657147 ◽

2016 ◽

Vol 37 (10) ◽

pp. 979-989 ◽

Cited By ~ 43

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.

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Aura status: A not so frequent aura

Cephalalgia ◽

10.1177/0333102414530525 ◽

2014 ◽

Vol 34 (14) ◽

pp. 1150-1162 ◽

Cited By ~ 6

Author(s):

Ana Alagoa João ◽

Tomas B Goucha ◽

Isabel P Martins

Keyword(s):

Systematic Review ◽

Retrospective Analysis ◽

Clinical Features ◽

Migraine With Aura ◽

Migraine Aura ◽

Visual Symptoms ◽

Research Criteria ◽

Detailed Diagnosis

Background Migraine aura status is a variety of migraine aura with unvalidated research criteria. Aim and methods We conducted a systematic review of published cases and a retrospective analysis of 500 cases of migraine with aura to evaluate the applicability and clinical features of ICHD-III beta criteria, compared to a more liberal definition for its diagnosis: ≥3 aura episodes for up to three consecutive days. Results Many publications under this title correspond to persistent or formerly designated prolonged auras. Nine cases fulfilled ICHD-III beta status criteria. In our series, either 1.7% or 4.2% cases fulfilled ICDH-III beta or our definition, respectively. Regardless of the criteria, aura status patients were older at onset of status than those with typical aura, had a predominance of visual symptoms, normal neuroimaging and no sequelae. Status recurred in a few. Conclusion Both criteria identify a similar population in terms of age, gender, main symptoms, imaging and outcome. Since patients with closely recurring auras might raise the same approach independently of the criteria, the use of more liberal criteria will allow more cases for detailed diagnosis and therapeutic analysis, eventually leading to the identification of subtypes.

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Migraine

Oxford Textbook of Neurologic and Neuropsychiatric Epidemiology ◽

10.1093/med/9780198749493.003.0022 ◽

2020 ◽

pp. 213-224

Author(s):

Julio R Vieira ◽

Richard B Lipton

Keyword(s):

Chronic Migraine ◽

Migraine With Aura ◽

Cortical Spreading Depression ◽

Migraine Without Aura ◽

Spreading Depression ◽

Headache Frequency ◽

Motor Symptoms ◽

Migraine Aura ◽

Younger Age ◽

Psychiatric Conditions

This chapter examines migraine. The incidence of migraine varies depending on multiple aspects, including age, sex, and the presence of aura. At an earlier age (younger than age ten), migraine initially affects more boys than girls, with migraine with aura (MA) occurring at a younger age than migraine without aura (MO). Later in life, when puberty starts, this relationship changes and it becomes more common in women than men. Migraine aura are focal neurological symptoms that typically occur prior to the onset of a headache due to a phenomenon called cortical spreading depression. The prevalence of migraine with aura vary between visual, sensory, or motor symptoms. It can also present as diplopia, slurred speech, aphasia, dizziness, vertigo, and hemiparesis. Moreover, the prevalence of migraine varies according to headache frequency. The chapter then looks at chronic migraine and menstrual migraine. It also explores several comorbidities associated with migraine, including many neurologic, medical, and psychiatric conditions.

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Prevalence of typical migraine aura without headache in Japanese ophthalmology clinics

Cephalalgia ◽

10.1177/0333102409361213 ◽

2010 ◽

Vol 30 (8) ◽

pp. 962-967 ◽

Cited By ~ 23

Author(s):

Saiko Aiba ◽

Muneto Tatsumoto ◽

Akihiro Saisu ◽

Hisatake Iwanami ◽

Keizou Chiba ◽

...

Keyword(s):

Migraine With Aura ◽

Age Distribution ◽

Japanese Version ◽

Self Report ◽

Migraine Aura ◽

Number Of Patients ◽

Headache Type ◽

Id Migraine

The aim of this study was to investigate the prevalence and characteristics of typical aura without headache (TAWH) in Japan. We distributed a self-report questionnaire comprising seven items. Of 1914 cases, the number of patients who provided valid answers was 1063. They included 1063 out-patients with 81 of these patients positive in the ID migraine screener Japanese version. TAWH was diagnosed in 35 patients (3.2%), aged 23–87 years, and included 12 males and 23 females. The age of patients with TAWH showed a biphasic distribution (20–39 years and 60–69 years), similar to the age distribution of all patients. Migraine with aura was diagnosed in 67 patients (6.3%) and showed a monophasic age distribution (40–49 years). These data suggest that TAWH is not a rare headache type in clinics especially in a setting of general ophthalmology clinics, and some patients of migraine with aura may transform to TAWH with ageing.

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Characteristics of migraine visual aura in Southern Brazil and Northern USA

Cephalalgia ◽

10.1177/0333102411430263 ◽

2011 ◽

Vol 31 (16) ◽

pp. 1652-1658 ◽

Cited By ~ 49

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.

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The presence of aura is not related to changes in the cervical performance and mobility of patients with migraine

10.21203/rs.3.rs-42272/v1 ◽

2020 ◽

Author(s):

Gabriela F Carvalho ◽

Samuel S Lodovichi ◽

Carina F Pinheiro ◽

Mariana T Benatto ◽

Lidiane L Florencio ◽

...

Keyword(s):

Neck Pain ◽

Migraine With Aura ◽

Neck Disability Index ◽

Self Report ◽

Clinical Aspects ◽

Migraine Aura ◽

Headache Clinic ◽

Neck Disability ◽

Disability Severity ◽

Flexion Test

Abstract Background: Migraine is related to musculoskeletal impairment of the neck and the chronicity of migraine is related to greater disability levels. However, it is not known if other forms of migraine, such as migraine with aura, is related to a different pattern of neck impairment.Objective: To assess the musculoskeletal and clinical aspects of the neck in patients with migraine with and without aura.Methods: Up to 125 consecutive patients diagnosed with migraine according to the ICHD-III were recruited from a tertiary headache clinic. Patients were classified by the presence of aura into two groups: migraine with aura (MA, n=37) and migraine without aura (MoA, n=88). The self-report of neck pain was assessed and patients completed the Neck Disability Index (NDI) questionnaire. Furthermore, patients performed the Flexion Rotation Test (FRT) and the Cranio-Cervical Flexion Test (CCFT). Results of all outcomes were contrasted between groups through Mann-Whitney and Qui-square tests.Results: There was no association between the presence of aura and self-report of neck pain (x²: 1.32, p=0.25). No differences were verified between groups regarding presence of neck disability (MA: 10.73, SD: 6.22; MoA: 9.63, SD:8.13, p=0.25) or disability severity (x²=6.17, p=0.10). Groups did not differ regarding the FRT (MA: 35.07°, SD: 7.90 and MoA: 34.60°, SD: 8.70, t=-0.22, p=0.83) and there was no association between positive FRT and presence of aura (x²=3.35, p=0.07). The CCFT did not demonstrate differences among the two groups either (x²=1.65, p=0.80).Conclusion: There is no association between migraine aura and presence or disability of neck pain, reduced superior cervical mobility or reduced neck performance. It is expected to find similar neck profile during the clinical assessment of patients with migraine with and without aura.

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Migraine aura: results from an art contest

Headache Medicine ◽

10.48208/headachemed.2020.4 ◽

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.

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No Evidence of Reduced Contrast Sensitivity in Migraine-with-Aura for Large, Narrowband, Centrally Presented Noise-Masked Stimuli

Vision ◽

10.3390/vision5020032 ◽

2021 ◽

Vol 5 (2) ◽

pp. 32

Author(s):

Jordi M. Asher ◽

Louise O’Hare ◽

Paul B. Hibbard

Keyword(s):

Contrast Sensitivity ◽

Migraine With Aura ◽

Gaussian White Noise ◽

Alternative Methods ◽

Migraine Aura ◽

Contributing Factors ◽

Control Groups ◽

Neural Noise ◽

Masking Noise ◽

And Control

Individuals with migraine aura show differences in visual perception compared to control groups. Measures of contrast sensitivity have suggested that people with migraine aura are less able to exclude external visual noise, and that this relates to higher variability in neural processing. The current study compared contrast sensitivity in migraine with aura and control groups for narrow-band grating stimuli at 2 and 8 cycles/degree, masked by Gaussian white noise. We predicted that contrast sensitivity would be lower in the migraine with aura group at high noise levels. Contrast sensitivity was higher for the low spatial frequency stimuli, and decreased with the strength of the masking noise. We did not, however, find any evidence of reduced contrast sensitivity associated with migraine with aura. We propose alternative methods as a more targeted assessment of the role of neural noise and excitability as contributing factors to migraine aura.

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Misfits: A Feminist Materialist Disability Concept

Hypatia ◽

10.1111/j.1527-2001.2011.01206.x ◽

2011 ◽

Vol 26 (3) ◽

pp. 591-609 ◽

Cited By ~ 188

Author(s):

Rosemarie Garland-Thomson

Keyword(s):

Temporal Relationship ◽

Temporal Aspects ◽

Critical Conversation ◽

Materialist Feminist

This article offers the critical concept misfit in an effort to further think through the lived identity and experience of disability as it is situated in place and time. The idea of a misfit and the situation of misfitting that I offer here elaborate a materialist feminist understanding of disability by extending a consideration of how the particularities of embodiment interact with the environment in its broadest sense, to include both its spatial and temporal aspects. The interrelated dynamics of fitting and misfitting constitute a particular aspect of world-making involved in material-discursive becoming. The essay makes three arguments: the concept of misfit emphasizes the particularity of varying lived embodiments and avoids a theoretical generic disabled body; the concept of misfit clarifies the current feminist critical conversation about universal vulnerability and dependence; the concept of misfitting as a shifting spatial and perpetually temporal relationship confers agency and value on disabled subjects.

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

Cephalalgia ◽

10.1046/j.1468-2982.1998.1806319.x ◽

1998 ◽

Vol 18 (6) ◽

pp. 319-323 ◽

Cited By ~ 41

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.

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