Treatment of a prolonged migrainous aura with intravenous furosemide.

Abstract

The migraine aura consists of reversible symptoms of focal cortical or brainstem dysfunction that develop gradually over more than 4 minutes and last less than 60 minutes. An aura that lasts longer than 60 minutes is defined as a prolonged aura.1 Cortical spreading depression (CSD) was first identified by Leao in animals in 1944.2 CSD is believed to cause migraine auras in humans, but this has not been proved. We present two patients with spells of prolonged aura that were treated and apparently aborted with IV furosemide. Furosemide was chosen because IV furosemide has inhibited the generation of CSD in animals.3 A 34-year-old woman with a 15-year history of episodic migraine with prolonged aura presented with a 1-week history of a continuous, severe migraine headache associated with a persistent right-sided visual field loss that started 30 minutes before the onset of her headache. She complained that her right visual field was grayed or blacked out. Her aura history included prolonged visual auras that involved loss of vision in her outer visual field …