6Ĭertain clinical clues help differentiate the possible competing diagnoses. Why refer?Īura without headache is benign 6 but pharmacists should immediately refer people who report symptoms (see Table 1) to exclude, for example, transient ischaemic attacks (TIA), stroke and epilepsy. “Attacks of migraine aura without subsequent development of headache become relatively common as people with a history of migraine with aura become older,” says Susan Haydon, support services manager at the Migraine Trust. 1 Auras typically develop over at least five minutes and can last for up to an hour. 1,5 This ‘cortical spreading depression’ (CSD) affects many parts of the brain causing, for example, visual symptoms, muscle weakness, sensory problems such as paraesthesia and language disturbances. 4Īuras seem to arise from a wave of electrical depolarisation that spreads through the neurones and glial cells, which support and protect nerve cells, in the cortex (grey matter). The smell could occur up to two or three times a day and last for up to an hour. A 53-year-old woman, for example, reported smelling a “dirty dog” as part of her aura, which, usually, did not develop into a migraine. Occasionally, patients experience olfactory hallucinations. Apart from lights and blurred vision, migraine auras can cause Lilliputian or Brobdingnian hallucinations (where objects seem too small or too large), misperceptions of distance and tunnel vision. 3Īuras vary widely between people and in the same person over time. 2 As with Jack, people can experience migraine aura without ever developing headaches, which can cause confusion with diagnosis. 1 In about a fifth of migraines with aura, headaches start before or with the aura 1 but only 19 per cent of people who experience migraine with aura experience the visual and other symptoms every time. I’ve experienced it several times now and I know it’s a migraine aura, but I’ve never had the headache.”Īuras occur during or before at least a third of migraines. “The first time it happened, I was really worried. After a few minutes, I couldn’t see the computer screen. This developed into a shimmering, colourless, bright, irregular zig-zag that fragmented and distorted my vision as it wobbled across my sight. “I saw a flashing light in the corner of my right eye.
“I was terrified,” admits 56-year-old Jack. Could you tell the difference between a migraine aura and a transient ischaemic attack or stroke?
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