Chronic Migraine With Aura: What Patients Should Know

A migraine is a complex, neurological disorder that causes pulsating (repeated) and throbbing pain on one side of the head and can last anywhere from 4 to 72 hours. Migraine is the second most cause of disability across genders. Patients with chronic migraine suffer from headaches for at least 15 days a month with at least 8 days with migraine symptoms that stays for more than 3 months. Those who suffer for lesser than 15 days a month are termed to be suffering from episodic migraines. Annually, over 2.5 out of 100 individuals with episodic migraine have a tendency to develop chronic migraine and therefore it is essential to treat them. The pattern of chronic migraine differs from patient to patient. 

What is chronic migraine with aura?

Chronic migraine is generally followed by nausea or sensitivity to light or sound. However, individuals who suffer from chronic migraine with aura experience visual, sensory, or motor disturbances 30-60 minutes before the headache begins.  These warning signs normally last for less than an hour.

Some of these disturbances include:

1. Visual: Most common type of migraine auras are indicated by alterations in the vision, such as flashing lights, dots, sparks or zigzags.
2. Sensorimotor: Sensory or motor disturbances include tingling sensation or numbness in the face, body, hands, and fingers. At times a sensory aura can be accompanied by a visual aura.
3. Dysphasic: This is a rare form of migraine aura which affects speech and includes verbal symptoms like inability to produce words, mumbling or slurring.

Chronic migraine with aura is triggered by the same factors as typical chronic migraine. These include bright lights, certain foods, medication or dietary disturbances, stress, lack of sleep and hormonal fluctuation.

Research indicates that the aura may be caused by a slow wave of altered brain activity which leads to temporary changes in the chemicals and blood flow in the brain.
Six things you need to know about chronic migraine with aura

1.    Chronic migraine with aura is not common: Only 25% to 30% of people with migraines experience migraine with aura. Of these, 90-99% develop visual aura, 36% present with sensory aura and 10% develop dysphasic aura.

2.    Migraine with aura may not be followed by a headache:  It is possible for an aura to happen without a headache. However, the aura symptoms can still cripple daily activities.

3.    Migraine with aura can be hereditary: Migraine has a powerful genetic component. Therefore, there is a high chance that migraine with aura is inherited. Knowing about the patient's family history is helpful for treatment.

4.    Migraine with aura may mimic stroke symptoms: A migraine with aura can be mistaken for a stroke. Symptoms such as vision problems, and numbness in the arms, legs, or face are common in both conditions.

5.    Migraine with aura enhances stroke risk in women: Women are generally more prone to migraines than men. A study published at the International Headache Congress states that women below the age of 45 who have migraine with aura are at an increased risk of stroke. The risk of stroke is even higher in women who have other risk factors such as smoking, obesity, or high blood pressure along with migraine with aura.

6.    Migraine with aura may have symptoms similar to Alice in Wonderland syndrome: Alice in Wonderland syndrome (AIWS) is a disorder that comprises episodic visual hallucinations and perceptual distortions, during which objects or body parts seem to be altered in numerous ways. It may also involve an intense change in the perception of space and time.

In case you experience any symptoms of migraine with aura, reach out to a specialist to diagnose and seek appropriate treatment.

Content By: Dr. Anil Venkitachalam, Consultant, Neurologist, and Movement Disorders Specialist, Dr. L H Hiranandani Hospital, Mumbai

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