Definition and Diagnosis of Migraine With Aura

The Features and Diagnosis of Migraine With Aura

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About one-third of migraineurs experience an aura with their migraine — a somewhat alarming experience, especially the first time it happens.

Let's take a closer look at what a migraine with aura is and how it's diagnosed.

What is a Migraine Aura?

An aura lasts anywhere from five minutes to one hour and involves vision changes in the majority of cases. A common example of a visual aura is when a person will begin to notice a tiny bright spot or a small loss of vision.

This is then slowly followed by an expansion of that vision loss or bright light with movement into their peripheral vision, followed by flickering or shimmering lights.

Sensory symptoms are the next common type of aura and can occur on their own or follow the vision changes. The sensory part of the aura often begins with tingling of one limb or one side of the face that gradually moves to different parts of the body — like from the right shoulder down the to the right forearm. The tingling is mostly replaced by numbness as it travels.

Speech or language difficulties may also occur during a migraine aura — and can occur on their own or in addition to vision and/or sensory changes.

There are other rarer types of migraine auras — for instance, motor weakness is seen in hemiplegic migraine, a migraine subtype. Migraines with typical auras though consist of visual, sensory, and/or speech disturbances.

Features of a Migraine With Aura

  • According to the third edition of the International Classification of Headache Disorders, here are some features of a migraine with aura:
  • Aura symptoms are reversible
  • At least one aura symptom (visual, sensory or speech) develops gradually over ≥5 minutes (i.e aura symptoms are not sudden) and/or two or more symptoms occur in succession
  • Each individual aura symptom lasts 5 to 60 minutes
  • At least one aura symptom is unilateral — occurring on only one side of the body
  • Aura is accompanied or followed within 60 minutes by a headache

Diagnosing a Migraine With Aura

Using criteria from the International Headache Society, doctors can usually make the diagnosis of migraine with aura from a person's history. In this case, a headache diary can be particularly useful, especially if a person is able to detail their precise aura symptoms.

Other tests, like the POUND mnemonic and ID questionnaire , can be helpful in confirming a migraine diagnosis — although these tests do not ask questions related to a person's aura.

Sometimes the tricky part is distinguishing auras from other serious neurological conditions, like stroke or seizure. A headache specialist or neurologist who understands the subtle patterns of migraine auras can tell the difference or use tests like, an MRI of the brain, to make the diagnosis.

Final Thought

If you suffer from migraines with aura, do not be afraid to talk about your symptoms with your doctor and ask lots of questions.

Be an advocate for your migraine health.

Sources

Buchholz, David & Reich, Stephen G (foreword). Heal Your Headache: The 1-2-3 Program For Taking Charge of Your Pain. New York: Workman, 2002.

Ebell MH. Diagnosis of migraine headache. Am Fam Physician. 2006;74(12):2087–2088

Headache Classification Committee of the International Headache Society. "The International Classification of Headache Disorders: 3rd Edition (beta version)". Cephalalgia 2013;33(9):629-808.

Wilson JF. In the clinic. Migraine [published correction appears in Ann Intern Med 2008;148(5):408]. Ann Intern Med. 2007;147(9):ITC11-1–ITC11-16

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