Prolonged migraine aura: new insights from a prospective diary-aided study

Michele Viana,Peter J Goadsby,Cristina Tassorelli,Grazia Sances,Farihah Khaliq,Giuseppe Nappi,Mattias Linde

doi:10.1186/s10194-018-0910-y

Abstract

BackgroundThere is limited literature on prolonged aura (PA - defined as an aura including at least one symptom for > 1 h and < 7d), and there are no prospective studies.The aim of this study is to characterize prospectively the phenotype and prevalence of PA.FindingsTwo hundred and twenty-four patients suffering from migraine with aura were recruited from the Headache Centers of Pavia and Trondheim. Patients prospectively described, on an ad hoc diary, each aura symptom (AS), the duration of AS and headache, and headache features. Seventy-two patients recorded three consecutive auras in their diaries. 19 (26.4%) of patients suffered at least one PA. Out of 216 recorded auras, 38 (17.6%) were PAs. We compared PAs with non-PAs with respect to 20 features; PAs were characterized by a higher number of non-visual symptoms (non-VS) (p < 0.001). No other differences were found. We obtained similar results when we compared auras with at least one symptom with a duration of > 2 h (n = 23) or > 4 h (n = 14) with the the others (n = 193 and n = 202 respectively).ConclusionPAs are quite common. They do not differ from the other auras (even when their duration extends to 2 and/or 4 h) with the exception of a higher number of non-VS.

Highlights

Worldwide migraine is the third most common disorder [1] and around 30% of sufferers experience migraine auras [2]
Inclusion criteria were: patients suffering from migraine with aura for at least 1 year which met the International Classification of Headache Disorders [4–6] (ICHD)-2 criteria for 1.2.1 [G43.10] typical aura with migraine headache,1.2.2 [G43.10], typical aura with non-migraine headache, 1.2.3 [G43.104] typical aura without headache, excluding point 3 of C criteria (“each individual aura symptom lasts 5-60 minutes”) and where only one of point C1 or C2 had to be verified to fulfill C criteria; ii) age between 16 and 65 years
The only differences found between prolonged aura (PA) and other auras was a higher number of non-visual symptoms

Summary

Introduction

Worldwide migraine is the third most common disorder [1] and around 30% of sufferers experience migraine auras [2]. All of the first three editions of the International Classification of Headache Disorders [4–6] (ICHD) have considered the individual symptoms of aura to be typical if the duration is more than five and less than 60 min. These symptoms can last longer in a rare subtype of migraine with aura, namely hemiplegic migraine, which is not discussed in this paper. A prolonged non-hemiplegic migraine with aura (NHMA) is classified as ‘persistent aura without infarction’ if the duration is equal or longer than 7 days. The aim of this study is to characterize prospectively the phenotype and prevalence of PA

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