Can migraine aura be provoked experimentally? A systematic review of potential methods for the provocation of migraine aura

Abstract

Background The nature of the migraine aura and its role in migraine pathophysiology is incompletely understood. In particular, the mechanisms underlying aura initiation and the causal relation between aura and headache are unknown. The scientific investigation of aura in patients is only possible if aura can be triggered. This paper reviews potential methods for the experimental provocation of migraine aura. Methods We systematically searched PubMed for studies of experimental migraine provocation, including case reports of patients with aura and reports of the occurrence of aura following exposure to any kind of suspected trigger. Results We identified 21 provocation studies, using 13 different prospective provocation methods, and 34 case reports. In the prospective studies, aura were reported following the administration of intravenous and sublingual glyceryl trinitrate, visual stimulation, physical activity, calcitonin gene-related peptide infusion, chocolate ingestion, and the intravenous injection of insulin. In addition, carotid artery puncture has consistently been reported as a trigger of aura. Conclusions No safe and efficient method for aura provocation exists at present, but several approaches could prove useful for this purpose.

Heterogenous migraine aura symptoms correlate with visual cortex functional magnetic resonance imaging responses

“…13,16 This may explain why we were not able to show temporal changes of the BOLD response. First, ideally the patients should be scanned continuously from immediately prior to the initiation of aura symptoms.…”

“…10,11 One study using BOLD fMRI reported signal changes with several characteristics of CSD during a typical scintillating scotoma in a migraine patient provoked by physical activity. 13 In the present study, we used state of the art high-field BOLD fMRI during visual stimulation combined with retinotopic mapping to investigate migraine patients during various forms of aura symptoms induced by hypoxia, sham hypoxia, or physical exercise with concurrent photostimulation. 13 In the present study, we used state of the art high-field BOLD fMRI during visual stimulation combined with retinotopic mapping to investigate migraine patients during various forms of aura symptoms induced by hypoxia, sham hypoxia, or physical exercise with concurrent photostimulation.…”

Intravenous Endothelin‐1 Infusion Does Not Induce Aura or Headache in Migraine Patients With Aura

“…Procedures involving damage to the wall of arteries supplying blood to the brain have been reported to induce migraine attacks with aura . Cerebral angiography by direct carotid puncture is a relatively consistent trigger, which induces the patients’ usual aura symptoms in at least 30% of cases .…”

“…Studies involving the provocation of migraine attacks without aura in migraine patients using vasoactive substances have provided tremendous insights into the pathophysiology of migraine . A robust method for experimental provocation of migraine aura, however, has not yet been established . Migraine provocation using vasodilating drugs (glyceryl trinitrate, calcitonin‐gene related peptide, and cilostazol) has been attempted in patients suffering from migraine with aura specifically .…”

Iatrogenic visual aura: a case report and a brief review of the literature

“…A systematic review of potential methods for the provocation of migraine has been conducted by Lindblad et al in 2016 12. The systematic review has identified studies of experimental migraine aura provocation by administration of sublingual glyceryl trinitrate,13 calcitonin gene-related peptide infusion,14 intravenous injection of insulin,15 visual stimulation,16 chocolate,17 or physical activity 18…”