Migraine With Aura

Migraine with aura is a disorder that presents with repeated episodes of reversible local neurological symptoms (aura), usually increasing over 5-20 minutes and lasting no more than 60 minutes.

“Aura“ is a term that doctors understand as follows:

1. Visual impairment. It can be lines, lights, spots, flickers. In severe cases, loss of vision. All manifestations are reversible.
2. Sensory disturbances. It seems that goosebumps are crawling through the body, the person feels tingling, there may be areas of numbness. All this is also reversible.
3. Speech disorders also go away with an attack.

Migraine headaches with and without aura proceeds in the same way. A person feels a throbbing pain, usually in one half of the head. It often concentrates on the eyeball. The pain increases with movement, sound, and light stimuli. It can last from 4 hours to 3 days. At this time, it is impossible to lead the usual way of life. A person wants to be left alone in a dark and cool room, freezing, hiding under a blanket. Typically, patients describe the pain as “bursting,” “splitting,” “about to burst,” “each sound is like a hammer on the head.” And even after an attack, the consequences persist. The person is apathetic, tired, and broken. You can recover for more than one day.

Migraine headaches

Differences from migraine without aura

Migraine without aura is called “classic migraine“. It affects about 80% of patients. Migraine without an aura manifests itself as a throbbing pain at one point. It is not preceded by any visual, auditory, or sensory impairment. Sometimes people do not even understand that this is a migraine but think that they just have a headache. For this reason, patients do not go to the doctor, which is fraught with consequences.

You have a classic migraine if the following symptoms are present:

• 5 episodes of pain;
• the attacks last 4 to 72 hours if the medication is not taken;
• the pain is pulsating, focused on one side of the head. The forehead, the neck may hurt, and then – the face or the back of the head;
• with any physical activity, the pain gets worse;
• fearful of light, sounds and voices.

What are the characteristics of migraine with aura?

Aura is about 20% of patients. But only a few say that it occurs with every attack. The most common symptom of the aura is visual disturbances. Less commonly, sensory disorders (tingling, numbness, goosebumps). Aura symptoms are classified as positive and negative. In the first case, something is felt, and in the second, the field of vision falls out or the hands go numb. Another property of the aura is dynamism, a gradual increase in symptoms, and then their gradual decline. Usually, the aura is replaced by a headache, but sometimes the aura appears on its own.

Migraine headaches with aura are characterized by the following features:

1. Two episodes of migraine without aura.
2. The presence of an aura for 1 hour or more before the onset of pain. In this case, the following neurological symptoms appear:

• visual disturbances – photophobia, blinking, black spots in the field of view, flickering arches, lines, zigzags, misperception of objects in the field of view;
• sound disturbances, mainly intolerance to any sounds;
• speech problems;
• sensory disturbances – tingling, burning, numbness, etc.;
• violation of motor abilities, for example, a sharp weakening of the muscles on one side of the body.

Causes of migraine headaches

The mechanisms of development of migraine are not fully understood. Hereditarily determining dysfunction of vasomotor regulation serves as a predisposing factor for the development of the disease. Approximately 70% of migraine patients have close relatives with a history of migraine-like headaches.

There are two groups of factors influencing the course of migraine: worsening the course of migraine in general and provoking an attack.

1. Factors that worsen the course of migraine

In a patient with migraine headaches, factors such as emotional stress, frequent consumption of alcoholic beverages, and other environmental influences can cause a prolonged (over several months or years) deterioration in the course of the disease in the form of an increase in the frequency and/or intensity of attacks.

In patients with migraines, provoking factors increase the likelihood of attacks; usually, their effects are manifested in less than 48 hours. Despite migraine triggers have been well studied in several epidemiological (for example, the effect of menstruation) and clinical (the effect of aspartame, chocolate, etc.) studies, in each case, it is not always easy to establish a direct causal relationship between a provocateur and a migraine attack.

2. Factors provoking migraine aura:

• dietary: hunger, food irregularities, certain foods (chocolate, cheese, nuts, alcohol (red wine), creams, yogurt, chicken liver, avocados, citrus fruits, bananas, soups from concentrates, fried pork, sausages, pizza, coffee, cola, tea);
• hormonal: menstruation, ovulation, estrogen replacement therapy, taking oral contraceptives;
• psychological: emotional stress, anxiety;
• depression, tiredness;
• weather changes;
• exercise stress;
• lack or excess of sleep at night;
• stuffiness, odors (smell of perfumery);
• visual stimuli (flickering or bright light);
• cold;
• noise;
• stay on top.

Types and symptoms of migraine aura

Let’s consider the main types of auras and how they appear.

1. Visual or ophthalmic

This aura is called “classic migraine“. With it, visual images appear – flashes of light, curved or straight lines, flickering objects, white or golden figures, spherical images, etc.

Symptoms develop over 5-30 minutes. The positive ones can be replaced by the negative ones. The duration of the aura can be up to 1 hour. The image usually appears in the center of the field of view. It gradually increases and goes to the periphery. Behind it remains a scotoma – a dark, “blind” area. Pain comes during the aura or within an hour after its appearance. When the attack ends, any violations go away without consequences.

2. Retinal

With this aura, scotomas or blindness in one eye occur. Symptoms persist for up to 1 hour.  This is a rare type of aura. There is an assumption that the symptoms appear in connection with a spasm of the central retinal artery of the eye. In most patients, retinal migraine attacks alternate with migraine attacks with or without a classic aura migraine.

3. Auditory

Auditory auras are hallucinations with sound. Tinnitus may occur and patients sometimes hear music or voices. Doctors associate this aura with epileptic activity in the cerebral cortex, in its temporal region.

4. Speech

It manifests itself as a speech disorder because it affects the speech centers of the brain. Before the onset of pain for several minutes, it is difficult or impossible for the person to speak. It can cause rearrangement syllables in words, letters, and repeat the same thing. At the same time, the consciousness is pure.

5. Vestibular

This is an aura in the form of movement disorders – dizziness. Quite a common occurrence that can be hidden and explicit. In the second case, the person is “rocked” even with small loads. In the first, violations can be detected only within the framework of the survey. 

According to the ICD, there are 2 forms of vestibular migraine:

1. Basilar – is rare, mainly in adolescent girls. The attack begins with visual disturbances, followed by dizziness, tinnitus, impaired sensitivity, etc. Then, in 25% of cases, confusion occurs. Neurological symptoms persist for 20-30 minutes, then pain in the back of the head comes. Without treatments for migraine, throbbing pain may persist for 2–3 days.
2. Paroxysmal vertigo of young children (benign). It occurs in children 1-4 years old. It manifests itself in short – from several seconds to several minutes – attacks of dizziness. The child loses stability, becomes anxious, vomiting appears. He may turn pale and sweat profusely. There is no headache. Attacks can recur over months or years.
3. Vegetative
4. Often such auras are manifested by a sensation of heat, chills, coldness, trembling, the face and neck may turn red or pale. Goosebumps can run, and even hairs will rise on the skin. During an attack, pupil size may change asymmetrically. This attack is usually part of a complex attack, rather than an independent occurrence.

Diagnostics, treatment, and prophylaxis of migraine aura

Diagnostics

It is necessary to address such a problem with a neurologist. The doctor should rule out cysts, swelling, encephalitis, and vascular pathologies that cause similar symptoms. Therefore, a neurological examination, CT, or MRI of the brain is carried out, the patient is sent for a consultation with an ophthalmologist to examine and determine the visual fields.

An EEG (electroencephalography) is mandatory, which provides information about the functional activity and characteristics of the biorhythm of the brain of a particular patient. Based on the EEG results, the doctor chooses medications for therapy.

Treatments for migraine

Treatments for migraine are based on eliminating pain and making it happen as rarely as possible or go away altogether. NSAIDs or specific medications, most commonly triptans, may be used. Intravenous fluid therapy is also used to treat migraines. The effectiveness of pain relief is directly proportional to the time of taking the drugs. You can stop an attack when it has just begun. At the peak of the attack, the pills almost do not help, because, with migraine gastric stasis in the intestine, the absorption of any substances is very difficult.

Alternative treatments for migraine are physical activity, exercise therapy, physiotherapy, psychotherapy. Massaging the neck area is especially helpful because muscle spasms in this area can trigger an attack. Recently, migraines have been successfully treated with injections of botulinum toxin type A. Injections make remission longer, and in some cases relieve pain for a long time.

Prophylaxis of migraine aura

 Prevention consists in taking medication prescribed by a neurologist every day for a certain time. This medicine will not act on the symptoms, but on the cause of the disease, preventing attacks from developing. However, drug prophylaxis is not indicated for everyone. It is prescribed if:

• the number of attacks – up to 8 per month or 2 per week;
• specific anti-migraine drugs – Zomig, Relpax, and other triptans don’t help;
• it is impossible to take triptans and analgesics due to contraindications;
• the patient has hemiplegic migraine, a rare hereditary disorder that leads to stroke.

FAQs

• Why are migraines dangerous?

According to the expert, migraine adversely affects the work in the trigeminal nerve system, which leads to vasodilation of the dura mater of nerves, the occurrence of non-infectious inflammation, and its edema. As a result, the person has an intense and throbbing headache.

• How does a migraine headache start?

If you have stereotypical symptoms before a migraine attack, such as transient visual disturbances (flickering lines before the eyes, loss of visual fields), numbness of a part of the body, a feeling of “tingling”, a change in consciousness, then you may be suffering from a migraine with aura.

• How does migraine and migraine aura arise?

The human brain consists of nerve cells – neurons. At the onset of a migraine attack, a wave of electrical excitation arises that travels along the brain from the back of the head towards the forehead. Scientists call it Leo’s Pervasive Depression. This wave travels at a speed of 2-3 mm per minute.

• What are the prescriptions for migraine relief?

Regardless of their type, two types of drugs are used for migraines- specific and non-specific. Specific ones are designed specifically for this disease, affect the mechanism of development of an attack, and are aimed at stopping it. Nonspecific drugs are used to relieve pain. These are analgesics and non-steroidal anti-inflammatory drugs.