Migraine-Related Symptoms: Clinical Assessment
Yes, her current symptoms could very well be migraine-related, particularly given her documented history of 30 migraines between 2020-2024 and 5 episodes of aura without migraine, which establishes her as having recurrent migraine disorder with both typical and atypical presentations. 1, 2
Why This History Strongly Suggests Migraine
Her pattern of aura without migraine is a recognized migraine variant that occurs when patients experience the characteristic visual or sensory disturbances without the subsequent headache phase. 2 The American Academy of Otolaryngology-Head and Neck Surgery confirms that visual aura symptoms can occur without subsequent headache in some patients, and this remains part of the migraine spectrum. 2
Key Diagnostic Considerations
Frequency pattern matters: With 30 migraines over 4 years (averaging 7-8 per year), she falls within the episodic migraine category, though this frequency warrants monitoring for potential progression to chronic migraine (≥15 headache days per month). 3, 4
Aura without headache is diagnostically significant: Her 5 episodes of aura without migraine represent a well-recognized phenomenon where the neurological symptoms occur independently, and these episodes should be counted as part of her overall migraine burden. 1, 2
Migraine is a multisystem disorder: The condition involves multiple neuronal systems functioning abnormally, not just pain pathways, which explains why symptoms can vary widely between attacks and why some attacks may present without headache. 5, 6
Clinical Features to Assess
When evaluating whether current symptoms are migraine-related, specifically inquire about:
Visual phenomena: Bright scintillating lights, zigzag lines, scotomas (blind spots), or gradual spreading of visual disturbances over 5-20 minutes—these are highly characteristic of migraine aura. 2
Temporal pattern: Symptoms that develop gradually over at least 5 minutes and last 5-60 minutes with complete resolution strongly support migraine over vascular events like TIA. 2
Associated symptoms: Photophobia, phonophobia, nausea, or motion intolerance occurring before, during, or after the primary symptom. 1, 6
Triggers: Light sensitivity, motion intolerance, or specific environmental factors that may have preceded symptom onset. 1
Important Differential Considerations
Vestibular migraine should be considered if she experiences vertigo or dizziness, as this can present with short (<15 minutes) or prolonged (>24 hours) episodes and may closely mimic other conditions. 1
Vestibular migraine requires at least 5 episodes of moderate-to-severe vestibular symptoms lasting 5 minutes to 72 hours, with migraine features present in at least 50% of episodes. 1
Visual auras are more commonly described in vestibular migraine, and hearing complaints (if present) are typically bilateral and related to sound processing rather than true hearing loss. 1
Critical Red Flags to Exclude
Loss of consciousness is never a symptom of migraine and should prompt immediate evaluation for alternative diagnoses. 1
Persistent neurological deficits that do not completely resolve suggest alternative diagnoses and require urgent neuroimaging. 2
New-onset symptoms in the context of her established migraine history still warrant careful evaluation to ensure they fit her typical pattern. 1
Clinical Approach
Document the specific characteristics of her current symptoms using the ICHD-3 criteria framework: onset pattern, duration, quality, associated symptoms, and complete reversibility. 1, 3
A headache diary should be implemented to track attack frequency, duration, associated symptoms, and medication use, which will help determine if her migraine pattern is evolving. 1
Her established history of recurrent migraine with and without aura provides strong context that current symptoms fitting the migraine phenotype are likely migraine-related rather than a new pathological process. 3, 5