From the Guidelines
Migraine prodrome and aura are closely linked, with aura symptoms often preceding the headache phase of a migraine attack 1.
Key Characteristics of Aura
- Visual disturbances, such as fortification spectra, occur in over 90% of individuals with migraine aura 1
- Sensory symptoms, including unilateral paresthesia, are experienced by approximately 31% of affected individuals 1
- Aura symptoms are fully reversible and typically last between 5-60 minutes 1
Diagnostic Criteria for Migraine with Aura
The diagnosis of migraine with aura is based on the presence of at least two attacks that fulfill specific criteria, including:
- One or more fully reversible aura symptoms, such as visual, sensory, or speech and/or language disturbances 1
- At least three of the following six characteristics:
- Aura symptom spreads gradually over ≥5 min
- Two or more aura symptoms occur in succession
- Each individual aura symptom lasts 5–60 min
- At least one aura symptom is unilateral
- At least one aura symptom is positive
- The aura is accompanied with or followed by headache within 60 min 1
Relationship between Prodrome and Aura
While the exact relationship between migraine prodrome and aura is not fully understood, prodrome symptoms often precede the onset of aura, which in turn precedes the headache phase of a migraine attack 1.
Treatment and Management
Treatment with triptans, such as sumatriptan 50-100mg or rizatriptan 5-10mg, administered orally at the onset of aura, may reduce the severity and duration of subsequent headache 1. Additionally, prophylactic medications like topiramate 25-50mg twice daily or valproate 250-500mg twice daily may be effective in reducing the frequency and severity of migraine attacks with aura 1.
From the Research
Migraine Prodrome and Aura Relationship
The relationship between migraine prodrome (premonitory phase) and aura in migraine headaches is complex and not fully understood. However, some studies provide insight into the characteristics of aura and its connection to the prodrome phase:
- Aura is a fully reversible focal neurological phenomenon involving visual, sensory, speech, and/or motor symptoms that develops gradually and usually precedes the headache phase 2.
- The prodrome phase, which occurs before the aura, is characterized by non-specific symptoms such as mood changes, fatigue, and increased sensitivity to light and sound.
- Some studies suggest that the prodrome phase may be related to the development of aura, as some patients experience aura symptoms during the prodrome phase 3.
- The pathophysiology of migraine aura is thought to involve cortical spreading depression, which is a wave of abnormal brain activity that can trigger aura symptoms 4, 5.
Aura Characteristics
Aura symptoms can vary widely between patients, but common characteristics include:
- Visual aura is the most common type of aura, occurring in over 90% of patients 2, 3.
- Sensory, speech, and motor aura symptoms are less common, but can also occur 2, 3.
- Aura symptoms typically develop gradually and last for less than an hour 2.
- Some patients may experience aura relapses within 24 hours 3.
Treatment and Management
Treatment for migraine aura typically focuses on managing the headache phase, rather than the aura itself:
- Non-steroidal anti-inflammatory drugs (NSAIDs) and triptans are commonly used to treat migraine headaches, including those with aura 2, 3.
- Preventive treatments, such as CGRP receptor antagonists and monoclonal antibodies, may also be effective in reducing the frequency and severity of migraine attacks, including those with aura 5.