Migraine with Aura

Summary

In this talk, neurologist and headache specialist Dr. Rebecca Michael from UCSF discusses migraine with aura, a neurological phenomenon that affects about 25% of migraine sufferers. She explains that aura symptoms, often visual, sensory, or language disturbances, can last from 5 minutes to an hour and may occur before, during, or after a headache. Dr. Michael emphasizes the importance of distinguishing migraine auras from more serious conditions like stroke and highlights the increased stroke risk associated with migraine with aura, especially in women. She also covers various treatment options, including preventative medications and the potential use of transcranial magnetic stimulation (TMS) for those experiencing frequent or prolonged auras.

Takeaways

• 👩‍⚕️ Rebecca Michael, a neurologist and headache specialist at UCSF, is discussing migraine with aura, a topic of personal and professional interest.
• 🕒 Migraine aura typically lasts between 5 to 60 minutes, often preceding the headache but can also occur during or after it, and sometimes without a headache.
• 👀 The most common aura symptoms are visual disturbances, such as seeing wavy lines or scintillating scotoma, which is a flashing area in the vision that grows over time.
• 🔍 Sensory disturbances, like numbness starting in the fingers and progressing, and speech difficulties, are also common aura symptoms.
• ⚠️ Hemiplegic migraine, a rare type with weakness on one side of the body, requires immediate medical attention to rule out conditions like stroke.
• 🚫 Auras lasting more than four hours, sudden onset, or significant changes from typical aura symptoms should prompt further medical evaluation.
• ❗ Migraine with aura is a risk factor for stroke, especially in younger women, emphasizing the importance of managing other stroke risk factors.
• 💊 Preventive medications for migraine with aura include verapamil, magnesium, and possibly baby aspirin, though there are no clear treatment guidelines.
• 🚫 Birth control with estrogen is not recommended for those with migraine with aura due to increased stroke risk.
• 🛠️ Transcranial magnetic stimulation (TMS) is a device approved for migraine with aura, potentially helpful as both preventive and acute treatment.

Q & A

What is a migraine with aura?

A migraine with aura is a type of migraine that is preceded, accompanied, or followed by temporary neurological symptoms known as an aura. These auras can include visual disturbances, sensory changes, or speech difficulties and typically last between 5 minutes to 60 minutes.

What are the most common symptoms of a migraine aura?

The most common symptoms of a migraine aura are visual disturbances, sensory changes, and speech difficulties. Visual disturbances often manifest as wavy lines or scintillating scotoma, while sensory changes can start in the fingers and progress upwards.

Can a migraine aura occur without a headache?

Yes, it is possible to experience an aura without a headache. This phenomenon is known as an 'acephalgic migraine' or 'silent migraine'.

How can migraine auras be distinguished from stroke symptoms?

Migraine auras typically have a gradual progression, starting in the fingers or visual field and spreading over minutes. Stroke symptoms, on the other hand, can have a sudden onset and may involve a loss of function, such as blindness in one eye or weakness on one side of the body.

What are the risks associated with migraine with aura?

Migraine with aura is a risk factor for stroke, especially in younger women. It's important to manage other stroke risk factors such as blood pressure and cholesterol levels to minimize the risk.

Is there a connection between migraine with aura and birth control containing estrogen?

Yes, there is a connection. Birth control containing estrogen can increase the risk of stroke in women who have migraine with aura, so it's recommended to avoid such birth control methods.

What are some treatment options for migraine with aura?

Treatment options for migraine with aura include acute medications to be taken at the onset of a migraine, and preventive medications such as verapamil, magnesium, or baby aspirin. Additionally, transcranial magnetic stimulation (TMS) devices can be used for both preventive and acute treatment.

What should you do if your migraine aura symptoms change or last longer than usual?

If your migraine aura symptoms change significantly or last longer than an hour, it's important to seek urgent medical attention or consult with your healthcare provider to rule out other conditions.

How can you differentiate between a hemiplegic migraine and a stroke?

A hemiplegic migraine is a rare type of migraine with aura that can cause temporary weakness on one side of the body. It's crucial to differentiate this from a stroke, as the latter requires immediate medical intervention. While both can cause weakness, the onset and progression of symptoms can provide clues, and medical evaluation is necessary for accurate diagnosis.

What is the significance of the progression of symptoms in differentiating a migraine aura from a stroke?

The progression of symptoms is significant because a migraine aura typically has a gradual progression over minutes, while a stroke may present with sudden and severe symptoms. A stepwise progression in the aura, such as numbness starting in the fingers and moving upwards, is more characteristic of a migraine.

Why is it important to manage other stroke risk factors if you have migraine with aura?

Managing other stroke risk factors is important because having migraine with aura already increases the risk of stroke. By controlling factors like blood pressure and cholesterol, the overall risk can be reduced, thus preventing potential health complications.