Proposal for a Migraine Aura Complexity Score

Abstract

Objectives Currently, there is no scoring system for assessing the complexity of migraine aura. Our goal was to develop a Migraine Aura Complexity Score that synthesizes the quantity and quality of aura symptoms and to test its applicability in neuroimaging studies. Methods Patients with migraine aura were interviewed in order to obtain characteristics of migraine aura. Explorative and confirmatory analyses were used to develop the Migraine Aura Complexity Score. Median values were derived from 10 consecutive migraine auras in each patient. The Migraine Aura Complexity Score was correlated with an average cortical thickness of different brain areas in studied patients. The Surface-based Morphometric Analysis approach was used to estimate cortical thickness. Results This study included 23 (16 females and seven males) migraineurs with aura. Confirmatory factor analysis suggested the second-order model with three-factor measurement for grading migraine aura. The first factor is linked to higher cortical dysfunction during migraine aura, while the second is associated with the degree of involvement of primary visual and somatosensory cortices; the third linked symptoms of somatosensory aura and hand and head involvement. Positive correlation of Migraine Aura Complexity Score and averaged cortical thickness were found in the left and right hemispheres overall (r = 0.568, p = 0.007; r = 0.617, p = 0.003) and in some of their regions. Conclusions This study demonstrates that the Migraine Aura Complexity Score could be a valuable tool for assessing migraine aura. The score could be used in neuroradiological studies in order to achieve a stratification of patients with migraine aura.

Application of the Migraine Aura Complexity Score (MACS): Clinical and Neuroimaging Study

“…Our opinion is supported by the fact that patients who once experienced complex MA have the potential to experience it again, regardless of whether they have had more frequently reported migraine with a simple aura. Therefore, they should not be labeled as patients whose overall aura is presumed as simple aura, as we implied in our previous study (14). Indeed, in comparison with MwA-C, MwA-MC group reported the similar duration of the aura, the occurrence of the tunnel vision and characteristics of somatosensory aura.…”

“…These results suggest that patients who have HCDs during the aura are not a small part and such symptoms deserve the attention of physicians who investigates MwA. Recently proposed migraine aura scoring system (14), could help in better categorizing those groups of patients, leading to a phenotype stratification of patients in MwA studies. According to the MACS, patients can be denoted as ones who experience mostly simple auras and those who have mostly complex auras.…”

“…Migraine patients included in the study were from the cohort of patients that were enrolled in previous migraine neuroimaging studies (13, 15), including patients that participated in developing the MACS (14).…”

“…Higher cortical dysfunctions of occipital cortex (V-HCDs): micropsia, macropsia, dysmorphia, fractured vision, and prosopagnosia; higher cortical dysfunctions of parietal cortex (S-HCDs): astereognosis, dyspraxia, and unawareness of one's own body parts; dysphasic and memory disturbances symptoms (D-HCDs): (Broca's dysphasia, Wernicke's dysphasia, dysnomia, dyslexia, difficulties in remembering or recalling events, recalling names, and calculating and/or memorizing numbers). Adapted from our previous research paper (14).…”

“…Recently, we developed a scoring system for evaluating the complexity of MA (Migraine Aura Complexity Score—MACS) with an aim to provide better stratification of MA patients who participate in neuroimaging studies or clinical trials (14). The range of MACS is 0–9.…”