From the Guidelines
Migraines can indeed have an orthostatic aura beforehand, characterized by symptoms such as dizziness, lightheadedness, or visual disturbances triggered by positional changes. According to a recent consensus statement on the diagnosis and management of migraine, published in Nature Reviews Neurology in 2021 1, migraine manifests clinically as recurrent attacks of headache with a range of accompanying symptoms, including transient neurological disturbances referred to as migraine aura. While the statement does not specifically address orthostatic aura, it highlights the complexity of migraine pathophysiology, which involves peripheral and central activation of the trigeminovascular system and cortical spreading depression.
Key Points to Consider
- Migraine aura, including orthostatic symptoms, occurs in approximately one third of individuals with migraine 1
- The autonomic nervous system, which controls involuntary bodily functions including blood pressure regulation, is often involved in migraine pathophysiology
- Maintaining hydration, changing positions slowly, and avoiding triggers like prolonged standing may help reduce orthostatic symptoms
- Certain medications, such as beta-blockers or those that help regulate blood pressure and cerebral blood flow, might be recommended to target both the migraine and the orthostatic component
Given the potential for orthostatic aura to precede a migraine headache, it is essential for individuals experiencing these symptoms to discuss them with their healthcare provider to develop an appropriate management plan, as emphasized in the consensus statement 1. This approach can help improve treatment adherence and satisfaction with care provision, ultimately enhancing the quality of life for those affected by migraines.
From the Research
Migraines and Orthostatic Aura
- Migraines are a complex neurological disorder characterized by multiple phases, including premonitory, aura, headache, postdrome, and interictal phases 2
- The aura phase is a fully reversible focal neurological phenomenon involving visual, sensory, speech, and/or motor symptoms that develops gradually and usually precedes the headache phase 3
- However, there is no direct evidence in the provided studies to suggest that migraines can have an orthostatic aura beforehand
- Orthostatic symptoms are not explicitly mentioned in the context of migraine aura in the provided studies 3, 2, 4, 5, 6
Aura Characteristics
- Aura is characterized by gradual development, duration of each symptom no longer than one hour, a mix of positive and negative features, and complete reversibility 3
- Visual aura is the most common type of aura, occurring in over 90% of patients 3
- Motor symptoms, which are rare, are often longer lasting than other aura symptoms 3
Migraine Treatment and Pathophysiology
- The pathophysiology of migraine involves a complex interplay between various cortical and subcortical brain regions, including the hypothalamus and brainstem nuclei that modulate nociceptive signaling 2
- Treatment options for migraine include triptans, nonsteroidal anti-inflammatory drugs, acetaminophen, dihydroergotamine, and calcitonin gene-related peptide receptor antagonists, among others 4, 5, 6