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

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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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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Scent of aura? Clinical features of olfactory hallucinations during a migraine attack (OHM)

Cephalalgia ◽

10.1177/0333102416630580 ◽

2016 ◽

Vol 37 (2) ◽

pp. 154-160 ◽

Cited By ~ 4

Author(s):

Federico Mainardi ◽

Alan Rapoport ◽

Giorgio Zanchin ◽

Ferdinando Maggioni

Keyword(s):

Migraine Attack ◽

Clinical Features ◽

Migraine With Aura ◽

Temporal Pattern ◽

Migraine Without Aura ◽

Age At Onset ◽

Average Frequency ◽

Migraine Aura ◽

Phase 2 ◽

Olfactory Hallucination

Introduction Olfactory hallucination during a migraine attack (OHM) is a rare phenomenon. At present, it is not considered a manifestation of migraine aura. Material and methods The clinical features of OHM were collected in 11 patients. Results Of the 11 patients, 10 had migraine without aura and one migraine with aura associated with OHM. Mean age at onset of headache and at appearance of OHM were respectively 17.8 and 32.3 years. Migraine average frequency was 3.9 attacks/month, 19% of them being associated with OHM. The temporal pattern of OHM maintained the same characteristics in the different attacks. OHM onset was described as sudden ( n = 5), gradual ( n = 3), initially sudden and then gradual ( n = 2), or developing in a few seconds ( n = 1). In most of the cases ( n = 8) OHM lasted from 3 to 10 minutes; it persisted during the pain phase (2–24 hours) in only three patients. The type of the perceived smell was invariably constant in nine patients. Conclusion OHM features fulfilled the ICHD-III beta criteria for typical aura.

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The depiction of migraine visual aura on the internet

Cephalalgia ◽

10.1177/0333102420927027 ◽

2020 ◽

Vol 40 (10) ◽

pp. 1113-1118 ◽

Cited By ~ 1

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.

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

Cephalalgia ◽

10.1177/0333102415593089 ◽

2015 ◽

Vol 36 (5) ◽

pp. 413-421 ◽

Cited By ~ 28

Author(s):

Michele Viana ◽

Mattias Linde ◽

Grazia Sances ◽

Natascia Ghiotto ◽

Elena Guaschino ◽

...

Keyword(s):

Migraine With Aura ◽

Median Duration ◽

Biological Markers ◽

Temporal Relationship ◽

High Variability ◽

Migraine Aura ◽

Temporal Characteristics ◽

Visual Symptoms ◽

Temporal Aspects ◽

Multiple Symptoms

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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Effect of corneal refractive surgery on accommodative and binocular dysfunctions among civilian pilots in Southwest China

BMC Ophthalmology ◽

10.1186/s12886-021-01855-0 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Ye Wu ◽

Zhen Zhang ◽

Meng Liao ◽

Qi Li ◽

Xue Lin Tang ◽

...

Keyword(s):

Binocular Vision ◽

Refractive Surgery ◽

Visual Symptom ◽

Chi Square ◽

Visual Symptoms ◽

Significant Difference ◽

Symptom Scores ◽

Chi Square Test ◽

Corneal Refractive Surgery ◽

Normal Binocular Vision

Abstract Background To analyze whether corneal refractive surgery (CRS) is associated with the distribution of different accommodative dysfunctions (ADs) and binocular dysfunctions (BDs) in civilian pilots. A further aim was to analyze the percentages and visual symptoms associated with ADs and/or BDs in this population. Methods One hundred and eight civilian pilots who underwent CRS from January 2001 to July 2012 (age: 30.33 ± 4.60 years) were enrolled, the mean preoperative SE was − 1.51 ± 1.15 D (range: − 1.00- − 5.00 D). Ninety-nine emmetropic civilian pilots (age: 29.64 ± 3.77 years) who were age- and sex-matched to the CRS group were also enrolled. Refractive status, accommodative and binocular tests of each subject were performed. Visually related symptoms were quantified using the 19-item College of Optometrists in Vision Development Quality of Life (COVD-QOL) questionnaire. The 19 items were summed to obtain visual symptom scores that might indicate visual dysfunctions. The chi-square test was used to analyze differences in percentages of ADs and/or BDs between the CRS and emmetropic groups. The Mann-Whitney U test was used to compare visual symptom scores between pilots with ADs and/or BDs and pilots with normal binocular vision. Results No significant difference was observed between the CRS and emmetropic groups in the overall prevalence of ADs and BDs (15.7% and 15.2% in the CRS and emmetropic groups, respectively; P = 0.185). ADs were present in 4.63% and 3.03% of the CRS and emmetropic group, respectively. BDs were observed in 11.1% and 12.1% of the CRS and emmetropic group, respectively, yielding no significant differences between the groups in the prevalence of ADs or BDs (AD: P = 0.094; BD: P = 0.105). Pilots with ADs and/or BDs had significantly more visual symptoms than pilots with normal binocular vision (p < 0.001). Conclusions CRS for civilian pilots with low-moderate myopia might not impact binocular functions. ADs and/or BDs commonly occur in both emmetropia pilots and pilots who undergo CRS, and pilots with ADs and/or BDs are associated with increased symptoms. This study confirms the importance of a full assessment of binocular visual functions in detecting and remedying these dysfunctions in this specific population.

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Clinical Features of Wheat Allergy Are Significantly Different between Tri a 14 Sensitized Patients and Tri a 19 Sensitized Ones

International Archives of Allergy and Immunology ◽

10.1159/000520936 ◽

2021 ◽

pp. 1-9

Author(s):

Elide Anna Pastorello ◽

Alessandro Toscano ◽

Giuseppe Scibilia ◽

Chrysi Stafylaraki ◽

Carlo Maria Rossi ◽

...

Keyword(s):

Physical Exercise ◽

Clinical Features ◽

Food Challenge ◽

Cross Reactivity ◽

Clinical Aspects ◽

Wheat Allergy ◽

Inverse Relation ◽

Food Avoidance ◽

High Consumption ◽

Clinical Pictures

Introduction: Wheat is the most important cereal for human nutrition but its high consumption is associated to an increasing complaint of wheat-related disorders, many of which are allergic in nature and different in respect to the involved allergens. In this study, we compared the clinical aspects of wheat allergy presented by patients sensitized to Tri a 19 in respect to those presented by patients sensitized to Tri a 14. Methods: With this aim, we selected patients sensitized to 1 or both of the 2 allergens, and among these we identified those who were really wheat allergic and reactive on the basis of a standardized methodology. We evaluated the clinical features such as the kind and severity of symptoms, the coexistence of triggering factors such as physical exercise and NSAIDs and alcohol consumption, and the association with other allergens and with various immunologic parameters. Wheat allergy in Tri a 19 sensitized patients was confirmed through a questionnaire while the patients sensitized to Tri a 14 underwent wheat challenge with 100 g of pasta followed by exercise on a treadmill. Results: Seventy-nine patients sensitized to Tri a 14 and 40 patients sensitized to Tri a 19 were recruited. The 2 sensitizations were independent with a significant inverse relation (p < 0.00001). The Tri a 19 sensitized patients presented, in respect to the Tri a 14 sensitized ones, an older age (p = 0.0017), a higher risk to be wheat allergic (p < 0.0001), a higher severity of the reactions (p < 0.00001) and a higher association with some cofactors, namely alcohol (p < 0.0005) and physical exercise (p = 0.003). On the contrary, Tri a 14 sensitization was associated with atopy (p < 0.0001), with a higher probability of patients being asymptomatic (p < 0.0001) and being sensitized to other foods, in particular to nuts and cereals (p < 0.00001). Conclusions: Sensitization to Tri a 19 or Tri a 14 determines different clinical pictures. In particular, sensitization to Tri a 19 implies a higher probability of severe reactions, even dependent on daily triggers, while that to Tri a 14 implies a higher cross-reactivity with other foods but it’s more frequently asymptomatic, making a food challenge necessary to prevent useless food avoidance.

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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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Migraine Aura

Neuro-Ophthalmology ◽

10.1093/med/9780195390841.003.0012 ◽

2011 ◽

pp. 63-67

Author(s):

Matthew J. Thurtell ◽

Robert L. Tomsak ◽

Robert B. Daroff

Keyword(s):

Clinical Features ◽

Specific Reference ◽

Migraine Aura ◽

Common Cause ◽

Visual Phenomena

Migraine aura is a common cause of transient positive and negative visual phenomena. Similar symptoms can occasionally occur with occipital lesions or as a manifestation of occipital seizures. In this chapter, we review the clinical features of migraine aura, with specific reference to those features that help distinguish it from occipital seizures.

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