Migraine with Aura

Symptoms:

The most common feature of migraine aura is visual disturbances. The following may be included in the signs and symptoms:

• Blind spots (scotomas)
• Shimmering spots or stars
• Flashes of light
• Loss of vision
• Zigzag lines that gradually float across the field of vision

In the center of the visual field is where these types of visual disturbances tend to start and they move outward, or spread.

The visual disturbances may be accompanied by other types of sensations, such as:

• Confusion
• Difficulty with language or speech
• Feelings of numbness, which is typically felt as tingling in an extremity or on the face.

A migraine aura generally lasts from 10 to 30 minutes before disappearing and it usually occurs within an hour before head pain begins. Aura may occur with no headache in some rare cases.

The following are included in other signs and symptoms of migraine with aura that come along with the aura:

• Nausea and vomiting
• Severe head pain, often one-sided
• Painful skin (cutaneous allodynia); as many as 2 out of 3 people with migraine also experience painful skin sensations during normal activities, such as wearing tight clothes, brushing hair or wearing contacts.
• Sensitivity to light

A person should get medical help immediately if he/she experiences the signs and symptoms of migraine with aura such as floating spots or zigzag lines in the field of vision or temporary vision loss, to rule out more serious conditions such as retinal tear or stroke. Unless the symptoms change, future migraines with aura don't need to be considered a potential sign of a more serious condition and won't require a visit to the doctor once these conditions have been ruled out.

When having the following and a headache, a person should seek medical attention:

• Pain in the ear or eye
• A loss of consciousness or confusion
• Seizures
• Having experienced a blow to the head
• Inability to perform everyday tasks
• Fever or a stiff neck

Causes:

It's not clearly understood what exactly causes a migraine with aura. However, a visual aura is believed to be like an electrical or chemical wave that moves across the part of the brain that processes visual signals (visual cortex). The wave may cause these visual hallucinations as it spreads.

Listed below are some of the factors that may trigger a migraine:

• Certain medications
• Hormonal changes
• Head trauma
• Certain foods, especially those with preservatives
• Stress
• Hunger
• Sensory stimuli, such as unusual smells or bright lights
• Fatigue
• Changes in the environment

The risk of migraine with or without aura may increase due to several factors such as:

Hormonal changes in women:
When a woman takes hormone replacement therapy or birth control pills, her migraine may worsen. During menopause, pregnancy or menstruation, migraine may also change or become worse.

Sex:
Women are three times more likely to have migraines than men.

Family history:
Migraines are more common in people with a family history of migraines.

Complications:

The risk of stroke is slightly higher in people who have migraine with aura. If women have high blood pressure, take birth control pills or smoke, they have an even higher risk of stroke.

Migraine could be connected to changes in the blood vessels or blood flow in the brain, although the link between stroke and migraine isn't well understood.

Treatments:

To treat migraines, several drugs are available. Those drugs range from over-the-counter NSAIDs to prescription medications. To decide which medications are best for the patient's situation, the doctor can help.

The following medications can be used to treat the pain of migraine:

Triptans:
By acting on the nerves and blood vessels, these drugs can quickly relieve migraine symptoms when taken early in the course of a migraine. A combination drug that includes sumatriptan plus naproxen, frovatriptan, zolmitriptan, sumatriptan, rizatriptan, almotriptan, eletriptan and naratriptan are all included in this class of medications. Dizziness, drowsiness, nausea and, rarely, heart attack, are the side effects of triptans. These medications shouldn't be taken by women who are pregnant, people with a history of high blood pressure, stroke and heart disease.

These medications should be used with caution for people who take the antidepressant medications known as selective serotonin reuptake inhibitors (SSRIs) or serotonin and norepinephrine reuptake inhibitors (SNRIs), because there is a small risk of developing serotonin syndrome when these drugs are combined.

Analgesics:
Over-the-counter pain relievers may be all a person needs to relieve the headache pain, such as a combination of acetaminophen, acetylsalicylic acid and caffeine, acetaminophen, naproxen and ibuprofen. Prescription-strength analgesics are available as well. Analgesic drugs can lead to what's known as a medication-overuse headache, so they shouldn't be taken for more than 10 days a month.

Anti-nausea drugs:
Anti-nausea medications may be prescribed along with other migraine drugs because nausea with or without vomiting is a common symptom of migraine. Metoclopramide, chlorpromazine and prochlorperazine are some examples.

Ergots:
An older migraine treatment that tends to have more side effects than do triptan medications is ergotamine. For people who have migraines with auras, this treatment is not recommended. Dihydroergotamine is more commonly prescribed because it's more effective and has fewer side effects, though it works in a similar manner to ergotamine.


PREVENTIVE MEDICATIONS:
To reduce the severity and frequency of migraine attacks, preventive drugs may be recommended because overuse of analgesics can cause medication-overuse headaches. If patients are disabled by the migraines, their headaches last more than 12 hours, or are having more than four headaches a month, preventive medications may be recommended. The following preventive medication options are available:

Anti-seizure drugs:
Though not clear why, certain anticonvulsants are effective in reducing the frequency of migraines. Migraines may be prevented by gabapentin, divalproex sodium and topiramate. These medications may cause weight gain and they can't be used by pregnant women.

Cardiovascular medications:
To help prevent the migraines, certain classes of heart and blood pressure medications including calcium channel blockers, angiotensin-converting enzyme (ACE) inhibitors, angiotensin II receptor blockers (ARB), and beta blockers may be prescribed. The most-studied treatments are beta blockers such as timolol and propranolol. These medications are not recommended for people with low blood pressure, and it may take several weeks to months before they are effective.

Antidepressants:
Migraines may be prevented by tricyclic antidepressants, such as amitriptyline. Heart palpitations, dry mouth, weight gain, drowsiness and constipation are included in the side effects of these medications.

Botulinum toxin type A (Botox) was previously suggested to be an effective treatment for migraine. But nowadays, botulinum toxin isn't recommended for migraine treatment because more recent studies have failed to find a benefit.

STRESS MANAGEMENT:
The number of migraines one has may be reduced by a technique that teaches the patient more appropriate ways to deal with stressful situations. This technique is called cognitive behavioral therapy.

Prognosis:

Not Available

Expert's opinion: