Migraine with aura is a paroxysmal primary cephalgia, before the appearance of which visual disturbances, disorders of the sensitive sphere or speech are observed. It differs from a simple migraine that occurs 10-60 minutes before the headache and disappears before its appearance with bright dots, lightning, dark or light spots in the eyes, distortion of visual perception, slowing or slurred speech, tingling or numbness of the limbs, auditory or olfactory hallucinations, paresis. Diagnosis of migraine with aura is based on neurological and ophthalmological examinations, EEG, MRI and CT of the brain. Treatment includes prevention and relief of seizures.
General information
Migraine with aura is one of the forms of primary cephalgia (headache), i.e. it occurs completely autonomously, and not as one of the symptoms of any disease. According to experts in the field of clinical neurology, migraine occurs in 18% of women and 6% of men. About a quarter of migraine cases are migraines with aura. The aura is formed in 10-60 minutes. before the attack of migraine cephalgia, temporary visual, sensory, speech disorders, changes in taste, smell or auditory perception. As a rule, a migraine aura lasts no more than 60 minutes. Sometimes it does not lead to a headache.
Among the classic cases of migraine with aura, migraine attacks with the so-called elongated aura can be observed. An elongated aura is spoken of when at least one of its symptoms lasts for more than 60 minutes, but at the same time, the data of neurological examination and neuroimaging methods do not reveal any pathology. If the migraine aura lasts more than 7 days, then it is highly likely that the development of such a complication as a migraine infarction, the presence of which is confirmed by neuroimaging methods, can be assumed.
Causes
According to modern ideas, migraine is based on increased excitability of cerebral pain receptors. The appearance of the aura is caused by a change in the biochemical and bioelectric activity of neurons in a certain area of the brain. Thus, it is assumed that the most common aura of a visual nature arises due to hyperexcitation of neurons in the occipital cortex, which is responsible for the “processing” of visual information.
Migraine with aura is a polyetiological disease. Among the reasons for its appearance, stressful situations and mental overstrain are primarily called. Since the level of stress in a given situation is individual for different people and depends on their subjective reaction, it can be argued that the occurrence of migraine with aura is largely due to the repeated incorrect attitude of a person to the circumstances. It is significant that people who manage to maintain a friendly attitude in various life situations are much less likely to suffer from migraines than those who find it difficult to resist discontent, anger and irritability.
Migraines with aura can be triggered by: lack of sleep, weather changes, too bright light, monitor flickering, noise, pungent odor, excessive sexual activity, etc. In women, the trigger factors are: the onset of menstruation, taking oral contraceptives or hormonal therapy of menopause. Migraine with aura can be observed in patients with depressive neurosis, chronic fatigue syndrome, hypochondriacal neurosis, insomnia and other sleep disorders.
The occurrence of a migraine attack with an aura was noted when using certain foods. Most often, such “provocateurs” are tyramine-containing foods: bananas, cheese, nuts, citrus fruits, fish caviar, as well as red wine. However, the reaction of patients to various products is very individual. In this regard, neurologists suggest that the regular occurrence of an attack after eating a certain product is not due to the product itself, but to the fact that once its consumption coincided with the occurrence of a migraine attack and the brain “fixed” it.
Symptoms
The nature of the attack of cephalgia in migraine with aura is no different from a normal migraine. A throbbing or pressing headache usually captures only half of the head, accompanied by nausea, light dizziness, increased perception of sounds and light stimuli. Migraine with aura, like a simple migraine, can have a prodrome in the form of mood changes, drowsiness or increased excitability, frequent yawning, general weakness, etc. The main difference is the presence of aura. At the same time, the latter should not be confused with prodromal symptoms that appear several hours (sometimes 1-2 days) before a migraine attack.
Usually, the disease is characterized by the appearance and increase of cephalgia within the first hour after the disappearance of the phenomena of migraine aura. In some cases, aura symptoms reappear during the headache period, and sometimes persist even after its cessation. An attack of cephalgia can last from 4 hours to several days. After it, the patient feels some weakness and weakness. In other cases, he falls asleep and wakes up completely healthy, which is more common in children.
Types
Most often, patients have a visual aura. In the classic version, it begins with the appearance of an uneven and shimmering spot, which may have a white, iridescent or golden color. This spot or scotoma is located homolateral in both eyes, i.e. either in both right or in both left halves of the visual fields. Gradually expanding, the spot can completely fill half of the field of vision in each eye. Then vision is restored and a typical attack of cephalgia occurs.
In childhood, migraine with an aura of a visual nature is often expressed in the form of “Alice’s syndrome”, when the size, shape and contours of objects are visually distorted, visual hallucinations appear. The visual (ophthalmic) aura also includes such phenomena as black spots and sparkling dots in front of the eyes, blurred vision, “fog” and “lightning flashes” in the eyes. In rare cases, there is a retinal aura, expressed in the appearance of a central scotoma followed by transient blindness.
Migraine with aura may be characterized by transient sensory disturbances preceding the headache. The most typical occurrence for a sensitive aura is tingling and/or numbness (hypesthesia) in the fingertips of one hand with the spread of this phenomenon to the entire arm, half of the head and neck, and in some cases to the entire half of the body. Such phenomena as ringing in the ears, the appearance of unusual sounds or smells can act as an aura.
Some patients have an aura in the form of temporary speech disorders: aphasia, slow pronunciation of phrases, slurred conversation, difficult word selection. Aura is less common in the form of motor disorders caused by transient muscle weakness in the arm and leg of one half of the body.
Diagnostics
Consultation of patients with migraine attacks with aura is carried out by a neurologist. Its main diagnostic task is to exclude organic (intracerebral tumor, cyst, encephalitis) and vascular (TIA, discirculatory encephalopathy, ischemic stroke) pathology of the brain that can cause symptoms similar to migraine aura. For this purpose, a neurological examination, MRI or CT scan of the brain is performed; an ophthalmologist’s consultation is prescribed with the definition of visual fields and ophthalmoscopy.
An important point in the diagnosis of migraine with aura is electroencephalography (EEG), which allows to obtain data on the functional activity and individual characteristics of the bioelectric rhythm of the patient’s brain. The results of the EEG are further used in the selection of drugs for drug therapy.
Treatment
Drug therapy has 2 directions: relief of the attack and prevention of its occurrence in the future. It is selected individually, taking into account the severity of seizures and EEG data.
NSAIDs (naproxen, ibuprofen, diclofenac) or combined analgesics are usually used to stop an attack. In attacks with high intensity of cephalgia, drugs from the group of triptans are prescribed: zolmitriptan, naratriptan, eletriptan, sumatriptan. If such attacks are accompanied by repeated vomiting, then antiemetics (metoclopramide), chlorpromazine or domperidone are additionally used. The therapy of a migraine attack is more effective the earlier the cupping drug was taken. Patients suffering from migraine with aura can completely prevent the occurrence of an attack if they take such a drug at the first symptoms of aura.
Treatment aimed at preventing seizures is usually indicated when they occur 2 or more times a month. This is a long-term, sometimes taking several months, therapy. It can be based on antidepressants (venlafaxine, duloxetine, milnacipran), anticonvulsants (valproates, topiramate) or psychotropic drugs. As a rule, preventive treatment of migraine with aura is carried out with one carefully selected drug. Combination therapy is used only in difficult cases.
The search for more effective ways to treat migraines continues at the moment. In Europe, studies are underway on the use of a CGRP receptor antagonist that prevents the expansion of cerebral vessels that occurs during a migraine attack. American scientists are investigating the possibility of using transcranial magnetic stimulation (TMS) to interrupt seizures. A migraine aerosol is undergoing clinical trials, the effectiveness and speed of which are comparable to intravenous administration.
Non-drug aspects of migraine treatment with aura
Migraine therapy is not just about taking medications. Equally important is the patient’s attitude to his disease and the efforts he makes to cope with it. In fact, the patient needs to rebuild his lifestyle. You should avoid drinking tea, coffee, cola, lemonade, etc., because they overload the nervous system. It is useful to drink herbal teas, compotes, uzvar and just water. If a migraine attack occurs in response to the use of a certain product, it is better to exclude it from the diet.
Along with the introduction of a feasible daily routine, full sleep and proper nutrition, the patient should understand exactly what situations, what his actions and relationships provoke another migraine attack with or without aura. If possible, you need to avoid trigger situations, and even better, change your attitude to them. Patients who are not trying to understand the causes of their disease and possible non-drug ways to prevent another attack risk receiving long-term treatment with increased doses of drugs without the desired effect.
