What is Migraine With Aura?
Migraines are a common health issue that often cause a throbbing headache on one side of the head. These headaches typically build up slowly over a few hours to days. It’s interesting to note that about 25% of people with migraines also have what are called “auras” either before or during the headache. Auras are neurological symptoms that can affect vision, hearing, movement, or sensation.
Migraines typically go through four stages: the prodrome (early symptoms), aura, headache, and postdrome (after-effects). In the past, it was believed the pain from migraines was due to the blood vessels in the head expanding and auras were caused by these vessels narrowing again. However, current research suggests that migraines are primarily caused by our genes and a process known as ‘cortical spreading depression of Leão’. This is a wave of brain activity followed by a period of decreased activity.
Understanding the ins and outs of how migraines with auras develop, their signs and symptoms, as well as evaluation and treatment, is crucial for healthcare professionals. By working together as a team, they can offer thorough care to those dealing with this condition.
What Causes Migraine With Aura?
Current research indicates that migraines are caused by disruptions in the brain’s normal functioning. The brain experiences a wave of disruption that spreads across its outer layer, causing the headache and aura (visual symptoms) found in migraines. This disruption also activates certain nerve endings, causing an inflammatory reaction in the brain’s protective coverings, which results in the pain of a migraine.
Genetics also play a significant role in migraines. People who have relatives with migraines are three times more likely to have migraines. But exactly how this works is complex and still not fully understood. Changes in key elements of the cell’s machinery, like membrane channels, receptor families, and enzyme systems, have been found among affected families. It’s likely that several genes and environmental factors work together to decide someone’s susceptibility to migraines. The balance between stimulation and relaxation in different parts of the nervous system determines if those predisposed to migraines will actually develop them.
Specific genes suspected of being linked to migraines include the KCNK18 gene, which codes for a category of potassium channels, and the CSNK1D gene, which codes for a particular type of kinase. Identifying these genes in individuals with migraines may enable tailored preventative treatments based on their genetic profile in the future.
About 75% of people with migraines identify at least one trigger for their headaches. Common triggers include high stress or anxiety, menstruation, fasting, certain weather conditions, inconsistent sleep, certain foods like aged cheese, nitrates, obesity, neck pain, heat, sexual activity, alcohol, smoke, exercise, changes in caffeine intake, and exposure to bright lights, loud noise, or strong odors.
It’s worth noting that while patients often blame MSG as a headache trigger, its role in causing migraines is not confirmed. Also, smoking, certain odors, chocolate, and a compound called tyramine haven’t conclusively been proven to trigger migraines or general headaches.
Risk Factors and Frequency for Migraine With Aura
Migraines are common, affecting between 12% to 15% of the population. They are more common in women than in men, with 17% of women and 6% of men experiencing migraines each year. In fact, migraines are one of the leading reasons people visit the emergency room – they are responsible for 3% of all emergency room visits each year.
The likelihood of getting migraines begins to increase during puberty, peaking at around 35 to 39 years of age, and then decreases later in life, particularly after menopause. Besides, when comparing conditions in terms of years lived with disability, migraines rank second only to back pain.
Signs and Symptoms of Migraine With Aura
Migraines are recurring headaches that may last anywhere from a few hours to several days. There are typically four parts to a migraine: the prodromal phase, the aura phase, the headache itself, and the postdromal phase.
The prodromal phase occurs 24 to 48 hours before the headache in about 77% of migraine patients. This phase can include symptoms such as excessive yawning, feeling irritable or euphoric, neck stiffness, and specific food cravings.
About one in four migraine sufferers experience an aura, either before or during the headache. Auras usually develop slowly, last under an hour and consist of both positive and negative symptoms. These can be related to vision, hearing, movement, or sensation. Positive symptoms come from active neuron discharge, while negative symptoms come from loss or absence of function. Examples of these symptoms include:
- Positive: bright lights, ringing in the ears, tingling, jerky movements
- Negative: vision loss, hearing loss, loss of sensation, inability to move body parts
In rare instances, migraines can occur with all the normal signs but without the headache itself. This is termed an acephalic or equivalent migraine. Other examples of migraines with different symptoms include:
- Hemiplegic migraine: Unilateral paralysis or weakness
- Retinal migraine: Visual disturbance, swelling and bleeding in the retina in one eye
- Migraine with brainstem aura: Feelings of vertigo, dizziness, confusion, speech difficulties, tingling in limbs, and unsteadiness.
The next phase of a migraine is the headache itself. This typically happens on one side of the head and can be described as throbbing or pulsing. The pain generally intensifies over several hours, and sufferers may experience nausea, vomiting, light and noise sensitivity, and skin pain or sensitivity. Some people find relief in dark, quiet environments. Migraines may also resolve during sleep. Following the headache phase, the postdromal phase occurs, during which patients may experience transient headaches triggered by sudden head movements. This phase often leaves patients feeling exhausted, though some may feel relief or euphoria.
The standard neurological exam should not raise any concern in most migraine sufferers. However, some individuals might exhibit symptoms like muscle tenderness in the head or neck, redness in the eyes, high or low blood pressure, and abnormally slow or fast heart rate. Appearances of any unusual symptoms, such as vision loss, fever, lethargy, seizures, and mental status changes should prompt consideration for other conditions beyond migraines.
Testing for Migraine With Aura
Diagnosing migraines is mainly done through a careful consideration of your medical history and a physical exam. Some key details your doctor would want to know are:
* Your age
* When your headaches began
* Where your headache pain is located
* If your pain spreads
* The severity of your pain
* Pain quality (for example, if your headache is throbbing)
* How long your headaches last
* When during the day you get your headaches
* How your symptoms have changed over time
* How often the headaches happen
* Things that might trigger your headaches
* Any other symptoms you experience during your headaches
* How your headaches might affect your sleep
* Things that make your headache worse
* Things that help your headache
* The effectiveness and use of medications to relieve the pain
There are specific criteria used by doctors (as per the International Classification of Headache Disorders, 3rd edition) for diagnosing migraines with and without aura (a sensation or visual disturbance before the headache). These criteria are used as a guideline by doctors to accurately diagnose migraines.
For a diagnosis of migraine without aura:
* You must have had at least 5 occurrences of
* Headaches lasting 4 to 72 hours (whether treated or untreated)
* Headaches with at least two of characteristics such as one-sided location, pulsating quality, moderate or severe pain, or worsening with physical activity
* Experience of at least one of symptoms, such as nausea, vomiting, sensitivity to sound or light
* No other medical conditions that could explain your symptoms
For a diagnosis of migraine with aura:
* You must have had at least 2 occurrences where
* You experience one or more reversible warning symptom(s) such as changes in vision, sensation, speech, language, movement, or some symptom affecting the lower part of the brain
* Three out of six characteristics are present, such as one aura symptom that spreads over five minutes, at least two aura symptoms occurring in succession, individual aura symptoms lasting 5 to 60 minutes, at least one one-sided aura symptom, at least one positive aura symptom, and headache appearing within an hour after aura symptoms
* No other medical conditions that could explain your symptoms
There’s no specific test to diagnose migraines, it’s based on your symptoms and medical history. For older patients with scalp tenderness, they might do a blood test to check for inflammation.
Scans of the brain are usually unnecessary unless you have new or severe symptoms that could point to another problem. If a scan is necessary, MRI is the preferred choice, while CT scans are used for emergencies. Reasons for requiring a scan may include a sudden severe headache, new signs of nervous system problems, headaches not responding to treatment, headache lasting more than three days, new headaches in patients age 50 or older, change in headache pattern, describing the headache as the worst in your life, new headaches in a patient who has weakened immunity, or symptoms suggesting meningitis or stroke.
Sometimes, a lumbar puncture (a procedure to obtain spinal fluid) may be required if you’ve experienced extremely severe headaches, sudden onset headaches that return, headaches that keep getting worse, or long-term, unresponsive headaches.
Before performing a lumbar puncture, your doctor may order an imaging test to check for any issues in the brain. This is a safety measure to ensure optimal care for you.
Treatment Options for Migraine With Aura
To manage your migraines, you should try to identify and avoid anything that might trigger a migraine. Keeping a diary of your headaches can also be useful to understand the progression of the issue and how well different treatments are working. Other steps to take can include sticking to a regular meal schedule, exercising regularly, and making sure you have good sleep practices.
In addition to these lifestyle adjustments, there are also a variety of treatment options available. Treatments for migraines are grouped into two categories: abortive and prophylactic therapy. Abortive treatments aim to stop a migraine that is currently happening, while prophylactic treatments aim to reduce the frequency or severity of migraines, improving the patient’s quality of life. Treatments commonly used to stop a migraine in progress include medications like nonsteroidal anti-inflammatory drugs (NSAIDs) and triptans. Antiemetics, or anti-nausea medications, can be used to deal with the associated nausea and vomiting.
If a person has frequent migraines (more than two a month) or very long-lasting migraines (lasting more than 24 hours), they may be given prophylactic, or preventative, medication. This medication is started at a low dose, which is gradually increased until the medication successfully reduces the migraines’ frequency or severity. A number of different medications can be used for this purpose, including certain beta-blockers, antidepressants, and anticonvulsants.
There are also additional treatment options that are still being studied, and more research is needed to determine their effectiveness. These include using botulinum neurotoxin A, coenzyme Q10, riboflavin, and magnesium. Some studies have also found that the combination of a cholesterol-lowering medication called simvastatin and vitamin D can be effective.
In cases of severe migraine, patients are typically advised to rest in a quiet, dark environment and may require a combination of treatments to alleviate their symptoms. In some cases, patients may need to be treated in a hospital if their symptoms are very severe or do not improve with treatment. But generally, a combination of medications and lifestyle changes can help to manage migraines and reduce their impact on a person’s life.
What else can Migraine With Aura be?
When doctors are trying to figure out if a patient has a migraine, they also consider other conditions that can cause similar symptoms. These conditions are:
- Tension-type headache
- Cluster headache
- Mini-strokes or Transient ischemic attack (TIA)
- Fainting, also known as Syncope
- Disorders affecting balance, known as Vestibular disorders
- Headache caused by other reasons like a head injury or brain lesions
- Tearing in the wall of one of the neck arteries, referred to as Cervical artery dissection
A tension-type headache often feels like a pressure or tightness around the head and it comes and goes. Unlike migraines, people with tension-type headaches usually do not have sensitivity to light, nausea, or vomiting. The pain from these headaches can get severe and peak within minutes.
Cluster headaches can cause symptoms like redness and tearing of the eye on the same side as the headache, a runny nose, blocked nose, sweating and they often respond to oxygen therapy.
On the other hand, a migraine aura differs from a mini-stroke (TIA) in that a migraine aura comes on gradually before going away completely. Furthermore, patients suffering from a TIA are less likely to have positive aura symptoms like seeing twinkling lights or feeling pins and needles, along with other migraine symptoms like sensitivity to light and sound, nausea, and vomiting.
What to expect with Migraine With Aura
Migraines, while usually not severe, can greatly impact a person’s enjoyment of life. As a chronic condition, migraines tend to happen less often and become less severe as you age. For women who experience migraines during their menstrual cycle, these often improve after menopause.
Making certain changes to your lifestyle, like maintaining a regular eating schedule and practicing good sleep habits, can help improve overall wellbeing.
Possible Complications When Diagnosed with Migraine With Aura
Migraines can lead to a number of complications:
- Status migrainosus: This refers to a severe migraine that lasts over 72 hours. The pain can be so intense that patients may need to be hospitalized.
- Migrainous infarction or stroke: Patients suffering from migraines with aura symptoms are particularly at risk. The aura symptoms last over an hour and may result in a stroke. Women under 45 who use oral contraceptives, as well as patients with patent foramen ovale, are at a higher risk. If you’ve ever had migraines, it’s important to know this can also increase your potential for significant heart diseases. Specifically, patients with migraines accompanied by aura are shown to have a 2.3 times higher risk of dying from heart disease. However, if you get migraines without aura, your risk is the same as the general population. Strokes caused by migraines range from 0.8 to 3.4 cases per 100,000 people each year.
- Persistent aura without infarction: Sometimes, aura symptoms persist for more than a week after the headache ends. These symptoms are similar to those of a stroke, except that no stroke is detected using brain scans.
- Migraine-aura triggered seizure: This is a seizure triggered by a migraine with aura, typically occurring within one hour.
- Psychiatric disorders: Some people with migraines are at an increased risk for certain psychiatric disorders. These may include major depressive disorder, bipolar disorder, and posttraumatic stress disorder.
Preventing Migraine With Aura
Migraines are common headaches that can affect both adults and children. However, more women seem to experience these than men. Migraine headaches typically cause a throbbing pain on one side of the head. Along with this pain, many people also feel sick, throw up, and become overly sensitive to light and sounds. Also, about 25% of people with migraines experience what’s known as an ‘aura.’
An ‘aura’ is a sign that a migraine is about to start or has already begun. It often shows up as vision problems. People may see bright lights, lines, or shapes and may lose some vision. Some also feel a numbing or tingling sensation on their face or limbs, and others might hear a ringing sound in their ears. These aura symptoms usually grow in intensity over a span of 5 minutes and then go away within an hour. Some people may even experience warning signs including excessive yawning, feeling depressed, being irritable, craving foods, constipation, or a stiff neck up to 48 hours prior to the migraine headache.
Doctors can diagnose migraines by taking a careful note of the symptoms and checking the patient’s physical health. They usually don’t need to perform specific diagnostic tests until the situation requires further diagnostics, such as blood tests and brain MRI, to rule out other possible reasons for the headaches.
Many patients have noted that certain foods, medications, stress, hormonal changes, flashing lights, and alcohol can trigger their migraines. Keeping a headache diary can be a useful way of understanding how often and how severe these headaches can be and what might be causing them. Avoiding anything that triggers the headaches is key in preventing them. Regular sleep, stress reduction techniques, exercise, and a healthy diet can all help reduce the number of migraines.
There are a range of medicines available to treat migraines; over-the-counter options like acetaminophen and ibuprofen can help to lessen mild symptoms. For severe migraines, doctors may prescribe medicines called ‘triptans.’ Moreover, for people facing regular migraines, there are preventative medicines available that can reduce the frequency and intensity of these headaches. It’s important to take the migraine medicine as soon as the headache begins for the best results. Rest or sleeping in a dark, quiet room can also provide relief.
Further treatments are accessible to manage other symptoms like feeling sick and throwing up. For people who experience migraines with auras, it’s crucial to avoid oral contraceptives, as it can increase their risk of stroke. People should avoid self-medicating migraines as this can actually lead to more headaches.
