It is the same topic as the common migraine except that the patient suffers not only from his headache but also from his aura. An aura is a sensation that usually appears before the pain develops. It may be visual which is the most common (like a flickering light perhaps), or a tickling or numb sensation in one hand or vertigo or mental disturbance which can go as far as ecstatic hallucinations, as it happened to Hildegard of Bingen.
Most interestingly the aura can prevail even without headache. In this case the patient feels only transient neurological or psychic symptoms which makes it difficult to distinguish them from epileptic or transient ischemic attacks.
Whereas there are different theories about the development of a migraine attack it seems that deficient symptoms are caused by a momentarily impaired blood perfusion of certain brain areas. In rare cases even strokes can occur.
The careful interview gives you good hints that you are dealing with a classical migraine but because of the aura you cannot be too sure. To differentiate from other diseases going along with auras you would like to perform some technical examinations.
The EEG shows the same items as it does the common migraine, namely frequently increased photosynchronisation also for slow frequencies and quite often intermitting temporal foci. Sometimes these are similar or even identical to epileptic changes. In these patients there is a good chance for a cure with anticonvulsives. A transcranial doppler examination allows you to rule out a symptomatic angioma with major blood steal mechanism. In migraine with visual aura you might find changes in the visual evoked potentials, likewise in cases with disturbances of equilibrium (as in basilar migraine) in the acoustic evoked potentials. Both seem to be symptomatic for ischemic functional disorders in the respective cerebral resp. pontocerebellar areas. Morphologic changes such as tumors or angiodysplastic malformations can be ruled out by CT or MRI. The latter shows quite often small ischemic lesions in the white matter of the cerebral hemispheres.
Basically the therapeutical principles in migraine with aura apply to those in migraine without aura. Patients with aura alone or very prologued auras (more than twenty minutes) should not treat their aura with vasoconstrictive drugs such as Ergotamine or Sumatriptane but should use a spasmolytic instead. As a prophylactic therapy these patients should use low dose AspirinŠ or Flunarizine, alone or in combination with other preventive therapy. In my opinion isolated auras without following pain are not to be treated at all. Since they are mostly harmless they can be considered as interesting phenomena and tolerated as such. However they may hinder the patient when driving a car or when working with dangerous machines.
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