In 20-30% of cases , migraine is associated with an aura that manifests as recurrent attacks of visual , sensory , or other central nervous system symptoms that are unilateral and fully reversible (Dodick et al. 2018).
A patient may sometimes experience migraines with aura , and sometimes migraines without . This phase generally precedes the onset of headaches , but these stages often overlap and the aura blends with the onset of the first pains (Davoine et al. 2016). In some cases, the migraine attack is limited only to the aura, without the onset of headache.
The symptoms can be single or multiple and can follow one another or add up, there is great variability between patients (Géraud et al. 2015). Find out how to relieve migraine
Aura Symptoms
Symptoms are usually visual , with the scintillating scotoma representing the most common typical visual aura. It is a blind zone in the visual field, bordered by a fringe of brilliant phosphenes and drawing a hatched line. At the beginning, this one is small and central, then it develops gradually towards the periphery of the visual field, to invade in 10 to 30 minutes the totality of the hemifield.
Other symptoms may be sensory with the appearance of paresthesias; they can also present in the form of language disorders or more rarely, with the appearance of motor signs (ICHD-3 2018; Géraud et al. 2015).
Several clinical forms of migraine aura
The international ICHD-3β classification distinguishes four clinical forms of migraine with aura:
- Migraine with typical aura that may or may not be followed by a headache, and there is no distinction between migraine headaches or other headaches
- Migraine with aura of the brainstem with, among other things, vertigo, tinnitus, diplopia or hypoacusis
- Hemiplegic migraine with a motor deficit of a hemibody, ranging from a simple heaviness to a total deficit
- Retinal migraine with monocular visual disturbances that can go as far as blindness
Diagnosis of migraine aura
Diagnostic criteria for migraine with aura (ICHD-3β: 1.2):- At least two seizures fulfilling criteria B and C
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One or more of the following fully regressive aura symptoms:
- Visual
- Sensitive
- Affecting speech and/or language
- Engine
- From the brainstem
- Retinal
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At least two of the following four characteristics
- At least one aura symptom develops gradually over > 5 minutes and/or or more symptoms occur in succession;
- Each individual aura symptom lasts between 5 and 60 minutes
- At least one of the aura symptoms is unilateral
- Aura is accompanied or followed by headache within 60 minutes
- No better diagnostic criteria in ICHD-3β and transient ischemic attack ruled out
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