Migraine with Aura
Summary
TLDRIn 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
👩⚕️ 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.
🕵️♀️ 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.
⚠️ 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.
💊 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.
Mindmap
Keywords
💡Migraine with Aura
💡Neurologist
💡Visual Aura
💡Sensory Aura
💡Hemiplegic Migraine
💡Stroke
💡Preventive Medications
💡Acute Medications
💡Transcranial Magnetic Stimulation (TMS)
💡Estrogen and Birth Control
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
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