Our Evolving Understanding of Migraine with Aura

Abstract

Migraine aura consists of fully reversible focal neurologic symptoms that may precede or coexist with headache in a significant minority of migraine patients. Typical aura symptoms include visual, sensory, and language disturbances. The most recent International Classification of Headache Disorders, 3rd edition (beta version) has added other aura types such as brainstem localizing symptoms, lateralizing weakness, and monocular visual loss. Currently available data from animal models and functional neuroimaging in humans implicate cortical spreading depression (CSD) as the phenomenon underlying migraine aura. Ongoing study suggests that susceptibility to migraine aura and CSD may be genetically mediated. CSD appears to be a potential target for future development of migraine-specific preventive therapies.

Aura and Other Neurologic Dysfunction in or with Migraine

“…When multiple aura symptoms are seen, they occur in a successive fashion. The duration of the motor aura tends to be longer (typically up to 72 hours) than the typical migraine aura symptoms, but should be fully reversible . Similar to sensory aura, the weakness of hemiplegic migraine tends to start in the hand and progress up the arm in a gradual fashion .…”

“…Similar to sensory aura, the weakness of hemiplegic migraine tends to start in the hand and progress up the arm in a gradual fashion . The weakness has been described as ranging from mild clumsiness to complete hemiplegia . Aside from hemiplegic migraine, in rare instances complex motor dysfunction such as the alien limb phenomenon or apraxia have been reported to occur in conjunction with migraine headache …”

Recent Insights in Migraine With Aura: A Narrative Review of Advanced Neuroimaging

“…Since the first research using surface‐evoked potentials and transcranial magnetic stimulation, occipital cortex hyperresponsiveness to light stimulation seemed to be a peculiar feature of patients with MwA. However, the poor spatial resolution of these techniques prevented a thorough identification of the neuroanatomic localization of the observed increased response within the visual cortex …”

Tryptophan Catabolites and Migraine

“…About one-third of the patient suffering from migraine can be classified to the MA group [59], where aura indicates the presence of preceding or accompanying transient focal neurological symptoms related to the headache. The aura symptoms are in the most cases visual, however sensory, language and motor symptoms can also manifest [60]. A typical aura develops within 5 minutes and lasts for 5-60 minutes [58].…”