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.

Outlines

00:00

👩‍⚕️ Introduction to Migraine with Aura

Dr. Rebecca Michael, a neurologist and headache specialist at UCSF, introduces the topic of migraine with aura. She explains that migraine aura is a short-lived sensory experience that typically lasts between 5 and 60 minutes, with visual disturbances being the most common symptom. Dr. Michael emphasizes that while aura often precedes the headache, it can also occur during or after it, and sometimes even without a headache. She invites participants to submit questions and outlines the talk, which will cover the identification of migraine aura, when to consider other conditions, associated risks, and treatment options.

05:01

🕵️‍♀️ Distinguishing Migraine Aura from Stroke

Dr. Michael discusses the importance of distinguishing migraine aura from stroke, highlighting that while both can present similar symptoms, the progression and nature of the symptoms can help differentiate between the two. She notes that migraine aura symptoms typically develop gradually and last no more than an hour, whereas stroke symptoms can have a sudden onset and persist. Dr. Michael advises that any aura lasting longer than four hours, with sudden onset, or significantly different from previous experiences should be reported to a healthcare provider immediately. She also addresses the fear and confusion that can accompany the first experience of aura and reassures viewers that it is a common and understandable reaction.

10:02

⚠️ Risks and Management of Migraine with Aura

In this section, Dr. Michael addresses the increased risk of stroke associated with migraine with aura, particularly in younger women. She stresses the importance of managing other stroke risk factors such as blood pressure and cholesterol levels, as well as maintaining a healthy lifestyle. Additionally, she warns against the use of birth control containing estrogen for those with migraine with aura, recommending consultation with a physician or OBGYN for alternative options. Dr. Michael also touches on the potential for aura symptoms to change and the need for medical evaluation in such cases.

15:04

💊 Treatment Options for Migraine with Aura

Dr. Michael discusses various treatment options for migraine with aura, noting the absence of a one-size-fits-all approach. She suggests that the onset of aura can be an opportunity to take acute medications sooner to prevent the headache from worsening. However, she clarifies that these medications may not shorten the duration of the aura itself. Preventive medications are also important, with some, like verapamil and magnesium, potentially beneficial for migraine with aura. Dr. Michael mentions other treatments such as IV medications and the use of transcranial magnetic stimulation (TMS) devices, which are approved for use in patients with migraine with aura. She concludes by summarizing the key points of the talk and preparing to answer audience questions.

Keywords

💡Migraine with Aura

Migraine with aura is a neurological condition characterized by recurrent headaches accompanied by a transient neurological disturbance known as an aura. In the script, Dr. Rebecca Michael discusses this condition extensively, emphasizing that it is a subtype of migraine that involves sensory experiences such as visual disturbances before the headache occurs. The aura can manifest as visual, sensory, or language symptoms and is a key focus of the video as it differentiates migraine with aura from other types of migraines.

💡Neurologist

A neurologist is a medical professional who specializes in diagnosing and treating disorders of the nervous system, including conditions like migraines. Dr. Rebecca Michael, the speaker in the script, is a neurologist and headache specialist at UCSF. Her expertise in neurology is central to the video's credibility and her ability to provide authoritative information on migraine with aura.

💡Visual Aura

Visual aura refers to the visual disturbances that can occur before a migraine headache. In the script, Dr. Michael describes visual auras as one of the most common types of aura, with symptoms such as seeing wavy lines or a scintillating scotoma, which is an area of vision that flashes and grows over time. Understanding visual aura is crucial for recognizing the onset of a migraine with aura.

💡Sensory Aura

Sensory aura involves sensations of numbness or tingling that typically start in the fingers and can progress to other parts of the body. Dr. Michael mentions this in the context of distinguishing migraine auras from other conditions like strokes, where the progression and nature of sensory symptoms can be indicative of the underlying cause.

💡Hemiplegic Migraine

Hemiplegic migraine is a rare subtype of migraine with aura where patients may experience weakness on one side of the body. This term is significant in the script as it highlights the severity and complexity of migraine symptoms, and the importance of differentiating it from other conditions like stroke, which can have similar presentations.

💡Stroke

A stroke is a medical emergency caused by a lack of blood flow to the brain, which can result in sudden loss of neurological function. In the script, Dr. Michael cautions that some symptoms of migraine with aura can mimic those of a stroke, emphasizing the need for prompt medical evaluation if symptoms are sudden or atypical.

💡Preventive Medications

Preventive medications are drugs taken regularly to reduce the frequency and severity of migraines. Dr. Michael discusses the importance of these medications in managing migraine with aura, suggesting that they can be particularly beneficial in reducing the occurrence of auras and subsequent headaches.

💡Acute Medications

Acute medications are taken at the onset of a migraine to alleviate symptoms. The script differentiates between acute and preventive medications, noting that while acute medications can be taken to address an immediate migraine, they may not reduce the duration of the aura itself.

💡Transcranial Magnetic Stimulation (TMS)

Transcranial magnetic stimulation is a non-invasive procedure that uses magnetic fields to stimulate nerve cells in the brain. Dr. Michael mentions TMS as a potential treatment for migraine with aura, suggesting that it may help to prevent or reduce the severity of migraines by interrupting the cortical spreading depression thought to be involved in aura onset.

💡Estrogen and Birth Control

The script discusses the increased risk of stroke for women with migraine with aura who use birth control containing estrogen. Dr. Michael advises against such birth control methods for this patient group, highlighting the importance of managing all potential risk factors for stroke.

Highlights

Introduction to migraine with aura by Dr. Rebecca Michael, a neurologist and headache specialist at UCSF.

Migraine with aura is a subtype of migraine that involves temporary sensory experiences.

Aura symptoms typically last between 5 minutes to 60 minutes.

Visual disturbances are the most common aura symptom, often described as wavy lines or scintillating scotoma.

Sensory disturbances, such as tingling starting in the fingers and progressing, are also common.

Language difficulties can occur, though less frequently, during a migraine with aura.

Hemiplegic migraine, a rare form, involves temporary weakness on one side of the body.

Migraine auras can occur before, during, or after the headache, and sometimes without headache.

Distinguishing migraine aura from stroke symptoms is crucial; aura symptoms typically progress gradually.

Sudden onset of symptoms or loss of vision in one eye may indicate a stroke and requires urgent medical attention.

Migraine with aura is a risk factor for stroke, especially in younger women.

Managing other stroke risk factors, such as blood pressure and cholesterol, is important for those with migraine with aura.

Birth control pills containing estrogen may increase stroke risk for those with migraine with aura.

There are no clear treatment guidelines for migraine with aura, but preventive medications can help reduce frequency.

Verapamil, magnesium, and depakote are among the medications considered for preventing migraine with aura.

Transcranial magnetic stimulation (TMS) is a device approved for treating migraine with aura.

TMS is thought to help stop the cortical spreading depression associated with migraine aura.

Dr. Michael emphasizes the importance of discussing treatment options with a healthcare provider.

Transcripts

hi good evening everyone my name is

Rebecca Michael and I am a neurologist

and headache specialist at UCSF and

tonight we are going to be talking about

migraine with aura so I'm going to give

a few seconds for a few more people to

join in I see there's some more people

joining can everybody hear me okay

hi Johnny

all right well we're giving a few more

minutes for people to join I'll just

introduce myself again Rebecca Michael

from UCSF I'm a neurologist and a

headache specialist here the tonight

we're going to be talking about migraine

with aura which is a very great topic

it's a particular interest to me it's

one of the areas of migraine that I find

the most interesting it's part of why I

wanted to go into migraine the field so

so it's particularly interesting I'll

give it a few more minutes I see other

people joining in great and then if you

guys have any specific questions about

migraine with aura you can go ahead and

post them now I'll try and get to them

towards the end of the talk all right so

so just to give an outline to so this

talk is on migraine with aura and what

we're gonna be talking about I had when

should we consider other types of

Steen what are some things that could

mimic a migraine aura when should you be

concerned or bring up different

conditions like this to your physician

the third thing is we'll talk about

risks that are associated with migraine

with aura and then the last thing we'll

talk about our different treatment

options specifically geared towards

migraine with aura and then at the end

I'll take some questions from everybody

and I see we've got a lot more people

who have joined great so so again my

name is Rebecca Michael and let's go

ahead and get started so what is

migraine aura so migraine aura it's a

short-lived temporary sensory experience

it usually lasts between 5 minutes to 60

minutes and the most common or what we

say are the typical aura symptoms are

either visual sensory or disturbances in

speech so about 25% of migraine or

suffer from migraine with aura and the

one thing to note is not every migraine

can is accompanied with the aura and you

can also have aura without the headache

so so typically in classically an aura

comes before the onset of the headache

but it can also come at the beginning of

the headache it can also come during and

it can also come after and like I

mentioned it can also happen without a

headache so so I mentioned that the

three most common are visual sensory and

problems with language so visual it can

be anything from seeing some type of

wavy lines

some people say they feel like it looks

like there's some kind of heat wave the

most common is something that we call a

scintillating scotoma which means that

there is an area of the vision that's

flashing and then

kind of grows over a period of time and

then it goes away and the headache comes

on for sensory or as the most typical

that we hear are that people have it

that start in their fingers it then

progresses up through the hand it goes

into the face it can actually even

involve the tongue to that's something

that we can commonly see with migraine

with aura we also can sometimes see

people have a little bit of difficulty

with their language although that isn't

as common as the visual auras very

rarely we can see people have weakness

on one side of their body that can

happen with a migraine that's actually

called a hemiplegic migraine what's very

important to know about that is you need

to make sure that there aren't other

conditions that could be causing that

like a stroke I'll talk about that in a

minute

some people can also get symptoms of

feeling confused or have dizziness or a

double vision with their migraine or

before their migraine as well again

those are less common but those are

called vestibular migraine or a migraine

with a brain stem or so that's just a

little bit about exactly what an aura is

some things to to think about in terms

of the other things that a migraine aura

could represent and when we as a

neurologist and your physician might

consider doing some other kind of

testing so the first thing is like I

mentioned a typical migraine aura lasts

five minutes to 60 minutes so if your

auras are consistently lasting longer

than that or if you have an aura

particularly we start to think more than

four hours that's a reason to mention

that to your provider or your a

neurologist is we might consider doing

other types of testing to make sure

something else isn't going on one really

important distinction that I

like to make is that a migraine aura you

know in some ways also looks like

symptoms that can look like a stroke and

I even see in some of the comments right

now as I'm talking that you know some

people are very scared the first time

they experience their auras and that's

that's completely typical you are not

alone than that we like to say that

something that distinguishes a migraine

aura from a stroke typically and again

this isn't always the case but it's the

progression of the symptoms so for

example with the numbness and the

tingling it starts in the fingers and it

goes up in terms of the vision it also

tends to to grow in the vision if there

is anything that's very sudden onset in

terms of all of a sudden you cannot feel

your arm or a side of the face

that is something that's more concerning

and then we also tend to think of things

that are more of a loss of symptoms so

for example if you have difficulty seen

out of one eye that's also concerning

more for a stroke than it is a migraine

aura oh I just figure it's hard to hear

can you guys hear me a little bit better

now all right so so anything that

happens much more suddenly or abruptly

is more concerning or if you are having

any kind of change in what you see as

your typical aura symptoms that

definitely needs to be something that

you bring up to your primary care sorry

I'm trying to turn up my volume here can

you guys hear me better all right

but but typically if it's something

that's new and sudden you should have

urgent evaluation for that okay good

thank you somebody's telling me that the

volume is better excellent

so other things to consider other than

if it's lasting more than four hours if

it's sudden onset if it's any kind of

change from something you've experienced

before

those those are the three things that

are very important to bring up to your

physician to make sure that there isn't

anything else that's going on that could

be contributing I'm seeing a lot of

comments come in which is great so then

when we start thinking about well now

that you know that you have migraine

with aura what does that mean in terms

of other types of conditions associated

with that there's something that's

always important to mention that

neurologist and your primary care will

likely mention to you is that having

migraine with aura is a risk factor for

stroke and it's something that we know

can happen even with younger people

especially women women even younger than

35 so it's very important that you're

also managing other stroke risk factors

making sure that blood pressure is well

controlled making sure that cholesterol

small controlled that you're eating as

healthy as possible exercising and

really making sure that all of those

things are in control so that you're

minimizing other stroke risk factors

another thing that's important to know

is that if you do have migraine with

aura that there's a risk of taking birth

controls with estrogen with that and so

it's recommended to avoid birth controls

with estrogen if you also have migraine

with aura so that's also something

that's important to know if you've had a

migraine with an aura for the first time

mention it to your to your physician

your OBGYN because they should consider

switching there's plenty of other

options of birth control out there that

don't contain estrogen but we like to

really make sure that all of your risk

factors are managed so so now that we've

gone through what is a migraine aura

what are some things to consider when

you have it what's a typical now what's

the risk with migraine and stroke and

then the last thing are what are

different types of treatment for

migraine with aura because as I'm

continuing to see in these comments and

it's great that I'm getting so many

comments people are mentioning the

different kinds of auras that they have

and that they can be very troublesome

and even for some of my patients it's

it's one of the most concerning things

about their migraine are these symptoms

because they do have difficulty with

their vision or sensation so there are

unfortunately no clear treatment

guidelines for just migraine with aura

one thing that we often say is that when

you do have a migraine with aura it can

be an opportunity to take your acute

medications sooner in order to help

prevent the severe headache but that

actually taking those acute medications

might not necessarily reduce the length

of the aura so that's when the

preventive medications

very important and I'm sure a lot of you

on here know but the difference between

the acute and the preventive medications

the acute are what you take when you

actually are getting the migraine or the

aura or the headache and the preventive

medications are what you take every day

in order to prevent the headache

so in terms of some of the preventive

medications again there's no clear

guidelines on one specific one to take

for aura but there are some thoughts

that a medication like verapamil

actually might be helpful for migraine

with aura some other medications one of

the the natural supplements magnesium

has been thought to be helpful for

migraine with aura some providers will

even suggest a baby aspirin again these

are all things that you really need to

talk to your specific provider about but

there are some thoughts of different

medications that can be helpful so so in

terms of then there are also some

medications that are thought to be

helpful for people who have prolonged or

as if you do tend to have more of these

prolonged or as again like I mentioned

you need to mention that to your

provider they might look at other things

to make sure there isn't anything else

that's contributing but sometimes some

IV medications can be very helpful for

that

depakote has been thought to be helpful

for that some other medications Diamox

has been thought to be helpful for that

as well lastly I'll just mention some of

you may have heard there is a device

called transcranial magnetic stimulation

that is only approved for patients with

migraine with aura one of the ways that

migraine aura is thought to occur is

from a type of

process in the brain called cortical

spreading depression which is just a

fancy term for this electrical wave this

specific device TMS is thought to help

stop that it can be used as a preventive

and as an acute treatment so so if you

do have a lot of migraine with or as

that might be something the TMS device

to consider talking to your provider

about so I just have a few minutes here

where I'm gonna summarize what I talked

about and then I'll start answering your

questions so again so a migraine aura is

a short-lived sensory experience

the most typical are visual visual is by

far the most common the others are a

sensory or also a language very rarely

are weakness called a hemiplegic

dizziness called a vestibular or

confusion which is called a migraine

with brain stem aura

again those are much more rare so then

when it comes to these auras things to

really watch out for are atypical or if

it's lasting longer than an hour if you

had any of the ones that I mentioned are

atypical like the weakness the double

vision or the confusion definitely

either seek more urgent medical care

talk to your physician about those and

if it's any kind of change from the aura

that you've had before and then in terms

of we talked about migraine aura is a

risk factor for stroke especially if you

are a woman so really making sure that

you're managing all of the other things

that might contribute to a stroke high

blood pressure cholesterol the last

thing to is if you have migraine with

aura being on a birth control with

estrogen would also increase that risk

so I would recommend

talking to your provider about going on

a birth control with out estrogen and

then the last thing we talked about

treatment options again I mentioned

there's no clear specific guidelines on

the treatment options for migraine with

aura but it it can be seen the aura is

an opportunity to take medications

sooner to help prevent the headache and

then the preventive medications can be

very helpful at helping reduce the

frequency and some of those included the

verapamil magnesium depakote some IV

medications as well and then it's also

thought the device the TMS device can be

helpful

you