Migraine Aura: Causes, Symptoms & Treatment
Migraine aura refers to transient neurological symptoms that occur before or during a migraine attack, lasting between 5 and 60 minutes.
Things worth knowing about "Migraine aura"
Migraine aura refers to transient neurological symptoms that occur before or during a migraine attack, lasting between 5 and 60 minutes.
What Is Migraine Aura?
Migraine aura describes a series of transient neurological symptoms that typically occur shortly before or during a migraine headache attack. These symptoms are fully reversible and generally last between 5 and 60 minutes. Approximately 20 to 30 percent of all migraine sufferers experience aura. The term itself originates from the Greek word meaning “breeze” or “breath,” reflecting its fleeting nature.
Causes and Pathophysiology
The exact cause of migraine aura is not yet fully understood. The most widely accepted explanation involves a phenomenon known as cortical spreading depression (CSD) – a slowly propagating wave of altered electrical activity across the cerebral cortex. This wave causes a temporary suppression of neuronal activity and affects local blood flow, producing the characteristic aura symptoms.
Common triggers of migraine with aura include:
- Stress and emotional strain
- Sleep disturbances or irregular sleep patterns
- Hormonal fluctuations (e.g., during the menstrual cycle)
- Certain foods and beverages (e.g., alcohol, caffeine)
- Bright or flickering light
- Changes in weather or atmospheric pressure
Symptoms
Aura symptoms vary depending on which area of the brain is affected. The most common types include:
Visual Aura
The visual aura is the most prevalent form. It typically manifests as:
- Shimmering or zigzag lines in the visual field (known as a scintillating scotoma or fortification spectrum)
- Blind spots (scotomas)
- Flashes of light
- Blurred or distorted vision
Sensory Aura
Sensory aura involves tingling, numbness, or a pins-and-needles sensation, typically starting in the hand and spreading up the arm to the face.
Speech Aura
Less commonly, temporary speech disturbances may occur, such as difficulty finding words or impaired articulation.
Motor Aura
A rare subtype is hemiplegic migraine, characterized by temporary one-sided muscle weakness or paralysis.
Diagnosis
The diagnosis of migraine with aura is primarily clinical, based on the patient's medical history and a detailed description of symptoms. The diagnostic criteria set by the International Headache Society (IHS) provide standardized guidelines. Additional investigations such as MRI (Magnetic Resonance Imaging) or EEG (Electroencephalography) may be performed to rule out other conditions such as stroke or epilepsy.
Treatment
Management of migraine with aura includes both acute treatment during an attack and preventive strategies.
Acute Treatment
- Pain relievers: Ibuprofen, aspirin, or paracetamol may be effective for mild to moderate attacks.
- Triptans: These migraine-specific medications (e.g., sumatriptan) act on serotonin receptors in the brain and are highly effective. They are generally recommended after the aura phase has ended, as their use during aura remains a subject of debate.
- Rest in a quiet, darkened room
Preventive Therapy
For frequent or severe attacks, prophylactic treatment may be recommended. Options include:
- Beta-blockers (e.g., metoprolol, propranolol)
- Antiepileptics (e.g., topiramate, valproate)
- Antidepressants (e.g., amitriptyline)
- CGRP antibodies (e.g., erenumab) – a newer and highly effective class of preventive therapy
Non-Pharmacological Approaches
- Regular physical exercise
- Stress management and relaxation techniques (e.g., progressive muscle relaxation)
- Maintaining a consistent sleep schedule
- Keeping a migraine diary to identify personal triggers
References
- Headache Classification Committee of the International Headache Society (IHS): The International Classification of Headache Disorders, 3rd edition. In: Cephalalgia. 2018.
- Charles A.: The pathophysiology of migraine: implications for clinical management. In: The Lancet Neurology. 2018; 17(2):174-182.
- Goadsby P.J., Holland P.R., Martins-Oliveira M. et al.: Pathophysiology of Migraine: A Disorder of Sensory Processing. In: Physiological Reviews. 2017; 97(2):553-622.
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