What is the duration of a migraine with aura?

Duration of Migraine with Aura

According to the International Classification of Headache Disorders (ICHD-3) criteria, each individual aura symptom in migraine with aura typically lasts 5-60 minutes. 1

Characteristics of Migraine Aura

Migraine with aura is characterized by:

• Recurrent attacks of fully reversible neurological symptoms that usually develop gradually
• Most commonly visual symptoms, occurring in over 90% of patients with aura 2
• Other possible symptoms include sensory, speech/language, motor, brainstem, or retinal symptoms 1
• Complete reversibility of all symptoms

Timing of Aura Symptoms

• Individual aura symptoms: Each symptom typically lasts 5-60 minutes 1
• Multiple symptoms: When multiple symptoms occur during an aura, the acceptable maximal duration is calculated as the number of symptoms multiplied by 60 minutes 1
• Motor symptoms: These are rare but may last up to 72 hours 1
• Progression pattern: Symptoms typically follow one another in succession, often beginning with visual, then sensory, then aphasic 2

Important Clinical Considerations

Relationship Between Aura and Headache

• Contrary to traditional understanding, headache is often present during the aura phase
• Research shows that in 73% of migraine attacks, headache is already present during the aura phase 3
• Other migraine symptoms frequently reported during aura include nausea (51%), photophobia (88%), and phonophobia (73%) 3

Variations in Aura Duration

• Population studies show that aura can last longer than 60 minutes in a significant proportion of patients:
  • Visual aura lasting >1 hour: 6-10% of patients
  • Sensory aura lasting >1 hour: 14-27% of patients
  • Aphasic aura lasting >1 hour: 17-60% of patients 4

Warning Signs for Further Investigation

Certain atypical features warrant emergency evaluation:

• Sudden onset (rather than gradual development)
• Neurological symptoms corresponding to a specific vascular territory
• Aura duration exceeding one hour (except for motor symptoms)
• Late onset of aura or dramatic increase in aura attacks 2

Diagnostic Criteria

According to ICHD-3, migraine with aura requires:

1. At least 2 attacks fulfilling criteria
2. One or more fully reversible aura symptoms
3. At least 3 of the following characteristics:
   • At least 1 aura symptom spreads gradually over ≥5 minutes
   • Two or more symptoms occur in succession
   • Each individual symptom lasts 5-60 minutes
   • At least 1 symptom is unilateral
   • At least 1 symptom is positive
   • Aura is accompanied or followed within 60 minutes by headache 1

Common Types of Visual Aura

The most common visual aura manifestations include:

• Scintillating scotoma (most common)
• Zigzag lines
• Blurred vision
• Tunnel vision 5

Understanding the typical duration and characteristics of migraine aura is crucial for accurate diagnosis and distinguishing it from other neurological conditions such as transient ischemic attack.