Migraine: The Aura stage

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Stage 2: The aura stage
  • Experienced in about 20-25%
  • Can have associated allodynia: hypersensitivity of skin to the touch, burning skin pain.
  • Dizziness
  • Decreased hearing, muffled hearing, Tinnitus
  • Hemiplegia: One-sided paralysis (HM only)
  • One0sdies motor weakness (HM only)
  • Auditory hallucinations
  • Visual hallucinations: wavy lines, blurry vision, partial loss of vision, scotoma, phosphenes.
  • Olfactory hallucinations.
  • Paresthesia: Prickling, burning, numbness or tingling
  • Vertigo: sensations of spinning (internally or externally) or falling.

The aura is the flashy portion of the migraine. Often people without migraines think we all get it but in fa, t only about 25% do. Of those who actually do experience migraines with aura, they themselves do not necessarily get a migraine with every attack… it is around 20%. Some get the aura but Not the headache stage and this is a silent migraine. I have had a few of these myself.

Tactile auras- like numbness, tingling

paresthesia

Allodynia: is one of the worst symptoms that can occur in this stage. It is hypersensitivity to touch in a fiery nerve pain sense. Very common for people with migraines to get it on the scalp but can, in fact, occur anywhere. I get it severely on the back and clothes touching my skin is hellish pain.

Visual hallucinations, auditory hallucinations, olfactory hallucinations- all the weirdness of migraines.

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Dizziness and vertigo- both of these can get pretty nasty. And vertigo can make you feel very disorientated. Not to mention cause drop attacks; where you think the ground is there but your brain says ‘nope’ so you feel you are falling and do, or overcompensate and fall the other way to recover.

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Tinnitus is a EeeEeeeeEeeeing nightmare. It gets pretty high pitched with a migraine. Then your hearing goes out or goes muffled in one ear and All you hear is that ringing.

HM migraines have their paralysis symptoms and stroke like effects.

Here is a short visual representation of an aura that typically lasts 60 minutes

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Visual auras can be:

  • Scotoma; the area of decreased or lost vision.
  • Phosphenes; brief flashes of light.
  • Blurry vision.
  • Wavy lines: like seen through a heat wave
  • Scintillations
  • Other visual symptoms

Others

  • numbness or tingling
  • pins and needles
  • weakness on one side of the body
  • dizziness
  • Vertigo

What is the cause?

The scientific term cortical spreading depression (CSD) describes a local disturbance of the brain function that is characterised by a transient and local suppression (depression) of the spontaneous electrical activity in thecortex (cortical) that moves slowly across this brain region (spreading). Aristides A.P. Leão, a Brazilian studying for a PhD at Harvard University was the first to describe this phenomenon in 1944 (Figure 1). He made this discovery while studying epilepsy. One year later, a better characterisation of CSD, especially of its progression, allowed Leão and his colleague R.S. Morison to propose, for the first time, that the malfunction of cortical nerve cells suspected to cause the aura might well be CSD. Indeed, both the suspected nervous malfunction and CSD shared surprisingly many common properties.Migraine Trust

Criteria for migraine with aura:

  • A. At least 2 attacks fulfilling criteria B–D.
  • B. Aura consisting of at least one of the following, but no motor weakness*:
  • 1.Fully reversible visual symptoms including positive features (e.g., flickering lights, spots or lines) and/or negative features (i.e., loss of vision).
  • 2. Fully reversible sensory symptoms including positive features (i.e., pins and needles) and/or negative features (i.e., numbness).
  • 3. Fully reversible dysphasic speech disturbance.
  • C. At least two of the following:
  • 1. Homonymous visual symptoms1 and/or unilateral sensory symptoms.
  • 2. At least one aura symptom develops gradually over ≥5 minutes and/or different aura symptoms occur in succession over ≥5 minutes.
  • 3. Each symptom lasts ≥5 and D. Headache fulfilling criteria B–D for 1.1 Migraine without aura begins during the aura or follows aura within 60 minutes.
  • E. Not attributed to another disorder.
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