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Features of migraine aura in teenagers

  • Clinic of neurology and psychiatry
  • Faculty of Medicine University of Belgrade Serbia

Abstract and Figures

Complex migraine aura in teenagers can be complicated to diagnose. The aim of this study was to present detailed features of migraine aura in teenage migraineurs. This cross-sectional study was conducted in the period from 2008 till 2013. A total number of 40 teenage migraineurs (20 females and 20 males) met criteria for this study. The patients were interviewed using a specially designed questionnaire for collecting data about migraine aura features. Main outcome measures were frequency of visual, somatosensory and higher cortical dysfunction (HCD) symptoms in teenage migraineurs population during the aura, and also within each individual. Visual aura was reported in every attack, followed by somatosensory (60%) and dysphasic (36.4%) aura. Scintillating scotoma and blurry vision were mostly reported and predominant visual symptoms. The most common somatosensory symptom was numbness in hand. HCD were reported by 22 (55%) patients. Slowed speech was mostly reported symptom of HCD, followed by dyslexia, deja vu phenomenon, color dysgnosia, and dyspraxia. In patients with HCD, aura frequency per year (6.18 +/- 3.17 vs. 3.33 +/- 2.03, p = 0.003) and prevalence of somatosensory symptoms (77.3% vs. 38.9%, p = 0.014) were significantly higher than in patients without HCD. Aura symptoms vary to a great extent in complexity in teenage migraineurs. Consequently, results obtained in this study provide useful information for clinicians when faced with unusual migraine aura.
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R E S E A R C H A R T I C L E Open Access
Features of migraine aura in teenagers
Igor Petrusic
, Vera Pavlovski
, Dragana Vucinic
and Jasna Jancic
Background: Complex migraine aura in teenagers can be complicated to diagnose. The aim of this study was to
present detailed features of migraine aura in teenage migraineurs.
Methods: This cross-sectional study was conducted in the period from 2008 till 2013. A total number of 40 teenage
migraineurs (20 females and 20 males) met criteria for this study. The patients were interviewed using a specially
designed questionnaire for collecting data about migraine aura features. Main outcome measures were frequency
of visual, somatosensory and higher cortical dysfunction (HCD) symptoms in teenage migraineurs population during
the aura, and also within each individual.
Results: Visual aura was reported in every attack, followed by somatosensory (60%) and dysphasic (36.4%) aura.
Scintillating scotoma and blurry vision were mostly reported and predominant visual symptoms. The most common
somatosensory symptom was numbness in hand. HCD were reported by 22 (55%) patients. Slowed speech was
mostly reported symptom of HCD, followed by dyslexia, déjà vu phenomenon, color dysgnosia, and dyspraxia. In
patients with HCD, aura frequency per year (6.18 ± 3.17 vs. 3.33 ± 2.03, p = 0.003) and prevalence of somatosensory
symptoms (77.3% vs. 38.9%, p = 0.014) were significantly higher than in patients without HCD.
Conclusions: Aura symptoms vary to a great extent in complexity in teenage migraineurs. Consequently, results
obtained in this study provide useful information for clinicians when faced with unusual migraine aura.
Keywords: Migraine aura; Higher cortical dysfunction; Teenagers
The estimated overall mean prevalence of migraine in
children and adolescents worldwide was 7-11% [1].
Thereof, 25% of patients with migraine experience an
aura [2]. Migraine aura is commonly considered to pre-
cede headache [3]. Visual auras are the most common,
followed by somatosensory, and then dysphasic auras [4].
Motor aura is the least common and is a defining feature
of hemiplegic migraine [5].
Migraine aura is thought to arise due to a change in
cortical neural excitability and function [6]. Cortical
spreading depolarization followed by cortical spreading
depression (CSD), mostly originates in the occipital
region [7]. The involvement of other cortical areas
beyond the occipital region could be assumed because
of the existence of somatosensory and memory clinical
features during the aura in some patients [8,9].
Diagnosis of migraine in the developmental age is
more difficult and associated with imprecise description
of the symptoms. Moreover, acute confusional migraine
is primarily seen in children and adolescents [10]. The
confusional state often manifests with a wide diversity of
cortical dysfunctions, such as speech difficulties, amnesia,
dysgnosia and dyspraxia [11]. Knowledge of migraine aura
symptoms, clinical differences associated with develop-
mental age and features are very important in differenti-
ation with other disorders imitating migraine [12].
This study represents an attempt to present detailed
features of migraine aura in teenagers. Furthermore, the
aim of this study was to evaluate the frequency and
types of higher cortical dysfunctions (HCD) that occur
during the aura.
Total of 67 teenagers having migraine with aura, treated
from the beginning of 2008 to the end of 2013 (six years),
at the Clinic of Neurology and Psychiatry for Children and
Youth, Medical Faculty, University of Belgrade, were
called to participate in this study. The diagnosis was based
* Correspondence:
Faculty of Medicine, University of Belgrade, Doktora Subotica 8, 11000
Belgrade, Serbia
Full list of author information is available at the end of the article
© 2014 Petrusic et al.; licensee Springer. This is an Open Access article distributed under the terms of the Creative Commons
Attribution License (, which permits unrestricted use, distribution, and reproduction
in any medium, provided the original work is properly credited.
Petrusic et al. The Journal of Headache and Pain 2014, 15:87
on the International Classification of Headache Disorders
criteria [13]. Excluding criteria were: other neurological
diseases, motor aura symptoms [13], chronic migraine
and patients who did not respond to a call. Forty patients
who met inclusion criteria have accepted to participate in
this study. A special questionnaire (Table 1) was designed
to collect data on migraine aura features and HCD during
the aura. Positive responses to each question of designed
questionnaire were followed by the sub-questions for the
purpose of collecting information how long this symptom
lasts, when this symptom starts in comparison to begin-
ning of headache, how frequent this symptom is present
in aura (in percentage) and whether symptom develops
gradually. The patients were interviewed by a doctor
(I.P. or V.P.), experienced in headache research. Research
protocol of this study was approved by the review board
of the Clinic of Neurology and Psychiatry for Children
and Youth, Medical Faculty, University of Belgrade.
The data are presented as arithmetic mean values ± SD
or as percentages. For analysis purpose, we formed a
group of patients who experienced one or more HCD
symptoms during the aura (HCD group) and a group of
patients who did not experience HCD (Standard aura
group). Independent samples t test was used to compare
the age of patients and the age at the time of the onset
of migraine with aura; Chi squared test was used to
compare gender, number of patients who reported
somatosensory symptoms in general and who reported
numbness in hand; Fisher's exact test was used to com-
pare the number of patients who reported numbness of
arm, leg, tongue, face and lips; and the MannWhitney
U test was used to compare aura duration and the number
of auras per year between the groups. The significance
level for the analysis was set beforehand at 5% (p < 0.05).
The study included 20 females and 20 males, aged
16.2 ± 2.0 (range 1319) years, who experienced migraine
with aura. Fifteen (37.5%) patients had visual aura only; 10
(25.0%) patients had visual and somatosensory auras; and
15 (37.5%) patients had visual with/or without somatosen-
sory and with dysphasic aura.
Visual and somatosensory symptoms of aura in teenage
migraineurs are described in Table 2. All patients had one
or more visual symptoms. Scintillating scotoma was the
most commonly reported (67.5%) and predominant (94%)
visual symptom during the aura. Somatosensory symp-
toms were less common than visual with occurrence of
60% in patients. Most common was numbness in the left
hand or both hands (2 patients) reported in 21 patients
(52.5%), followed by numbness in: lips and/or face (30%),
tongue (27.5%), and legs (15%). Two patients had acute
onset visual aura, followed by short presentation of
somatosensory symptoms and HCD. Also, two patients
had prolonged visual aura, who reported gradual develop-
ing of somatosensory and dysphasic symptoms. Overall, in
ten patients migraine aura proceeded during headache for
12.6 ± 10.2 (range 330) minutes and four patients re-
ported period of 7.5 ± 2.9 (range 510) minutes between
migraine aura and onset of headache. Twenty-six patients
reported onset of headache immediately after finish of
HCD were reported by 22 (55%) patients in this study.
A detailed description of HCD during the aura in teen-
age migraineurs analyzed group (40 patients) was given
in Table 3. The majority of patients with HCD during
the aura reported one, two, or four HCD symptoms, as
shown in Figure 1. Slowed speech was the most usually
reported (27.5%) symptom of HCD during the aura,
followed by dyslexia (25%), déjà vu phenomenon (22.5%),
color dysgnosia (20%), and dyspraxia (20%). Prosopagnosia
was reported in one (2.5%) patient, while difficulties in un-
derstanding speech or recognizing sounds and difficulties
in writing were not reported. Color dysgnosia, slowed
Table 1 Study questionnaire
During the aura of your migraine attack, have you ever noticed:
1. Shimmering or blurred dots in the visual field?
2. Twinkling zig-zag lines in the visual field?
3. Blurred vision (like looking through tick glass)?
4. Tunnel vision (narrowing of the visual field)?
5. Tingling or numbness in fingers, hand, leg, face (lips) and tongue?
6. Changes in colors? Did colors get brighter or paler?
7. Difficulties in recognizing faces, unrelated to the disturbance
of vision?
8. Difficulties in recalling names?
9. Difficulties in recalling events from the past?
10. Difficulties in remembering events during aura?
11. The feeling that you have already seen events (déjà vu
12. Difficulties in speaking even when you knew what you wanted
to say?
13. Did someone tell you that you speaking gibberish?
14. It takes more time to find the appropriate words when you try
to speak?
15. Difficulties in understanding speech or recognizing sounds
from the environment?
16. Difficulties in understanding writing, unrelated to visual disorders?
17. Difficulties in writing that were not caused by the disturbance
of vision?
18. Difficulties in calculating and/or memorizing numbers?
19. Difficulties in recognizing objects by touch?
20. Difficulties in performing normal movements with your hands?
21. Difficulties in orientation in space (in terms of left and right)?
22. Unawareness of one part of your body?
Petrusic et al. The Journal of Headache and Pain 2014, 15:87 Page 2 of 6
speech and manual dyspraxia were most frequently expe-
rienced symptoms. Moreover, 14 (35%) patients have ex-
perienced one or more HCD symptoms in more than one
third of their auras.
Patients with HCD during aura were classified as HCD
group. The 18 patients who did not experience HCD
during aura were classified as Standard aura group.
Comparison of demographic data and features of aura
between these groups are shown in Table 4. There was
no statistically significant difference in terms of gender,
age at the time of examination, age at migraine onset
and duration of aura. Also, these two groups did not sig-
nificantly differ in number of patients who reported
numbness in arms, face and lips as symptom during the
aura. Frequency of aura per year was significantly higher
in HCD group (6.18 ± 3.17 vs. 3.33 ± 2.03, p = 0.003), as
well as the number of patients with somatosensory
symptoms during aura (77.3% vs. 38.9%, p = 0.014). Also,
HCD group had significantly more patients who reported
numbness in hands, tongue and legs compared to Stand-
ard aura group.
These are the first detailed nosographic descriptions, to
our knowledge, of the symptoms experienced during the
aura reported by teenagers who have migraine with aura.
Our data show that neurological non-visual symptoms,
including HCD, during the aura in teenage migraine are
notable. Also, the findings of this study clearly demon-
strate the variability of aura symptoms. To our opinion,
these are important information for pediatricians and
other physicians when facing new cases of migraine with
unusual aura.
The most common manifestation of migraine with aura
is visual phenomenon [14], reported by all our patients.
Besides the simple positive or negative phenomena, high
number of patients have also reported some form of
complex visual disturbances. The most frequent visual
Table 2 Visual and somatosensory symptoms during the aura
Visual and somatosensory
aura features
Number of patients Onset time X ± SD
Time duration
X ± SD (min-max)
Frequency X ± SD
n = 40 (%)
Scintillating scotoma 27 (67.5) 21.24 ± 15.87 (2560) 18.67 ± 16.62 (275) 94.26 ± 17.25 (25100)
Zig-zag lines 10 (25) 23 ± 12.06 (545) 19.5 ± 12.12 (545) 90 ± 23.09 (30100)
Blurry vision 24 (60) 22.22 ± 12.12 (245) 19.29 ± 14.53 (245) 85 ± 27.54 (10100)
Tunnel vision 16 (40) 24.69 ± 14.54 (560) 18.44 ± 12.48 (560) 74.38 ± 35.02 (10100)
Somatosensory symptoms 24 (60) 22.06 ± 17.3 (260) 17.5 ± 16.9 (260) 62.5 ± 31.21 (10100)
Onset time - aura onset in regard to beginning of headache expressed in minutes; Time duration - expressed in minutes; Frequency - frequency of symptom
compared to all experienced auras in individual (expressed in percentages).
Table 3 Features of HCD during the aura reported in teenage migraineurs
HCD Number of patients Onset time X ± SD
Time duration
X ± SD (min-max)
Frequency X ± SD
n = 40 (%)
Color dysgnosia 8 (20) 8.5 ± 6.48 (220) 7.13 ± 6.1 (220) 60 ± 40.71 (10100)
Dysnomia 3 (7.5) 15.67 ± 14.01 (230) 15.67 ± 14.01 (230) 46.67 ± 46.19 (20100)
Retrograde amnesia 4 (10) 16.75 ± 15.35 (230) 16.75 ± 15.35 (230) 41.25 ± 21.75 (2070)
Anterograde amnesia 2 (5) n/a n/a 10
Déjà vu phenomenon 9 (22.5) 20.25 ± 11.17 (230) n/a 30.56 ± 14.24 (1050)
Expressive dysphasia 5 (12.5) 21 ± 15.59 (330) 15.6 ± 13.39 (330) 47 ± 36.33 (20100)
Gibberish speaking 2 (5) 16.5 ± 19.09 (330) 16.5 ± 19.09 (330) 45 ± 35.35 (2070)
Slowed speech 11 (27,5) 19.75 ± 19.51 (360) 18.64 ± 17.44 (260) 59.55 ± 39.9 (10100)
Dyslexia 10 (25) 21.5 ± 944 (1030) 21.5 ± 17.89 (360) 41.5 ± 27.49 (10100)
Dyscalculia 2 (5) 37.5 ± 31.82 (1560) 25 ± 28.28 (545) 30 ± 28.28 (1050)
Astereognosis 2 (5) 16.5 ± 19.09 (330) 8 ± 9.9 (115) 55 ± 63.64 (10100)
Manual dyspraxia 8 (20) 21.13 ± 20.25 (460) 18.75 ± 21.96 (260) 46.88 ± 37.51 (10100)
Right-left confusion 5 (12.5) 18.75 ± 17.97 (545) 13.6 ± 17.74 (345) 51 ± 45.33 (10100)
Neglecting hand symptom 2 (5) 17.5 ± 17.68 (530) 17.5 ± 17.68 (530) 50 ± 28.28 (3070)
Onset time - aura onset in regard to beginning of headache expressed in minutes; Time duration - expressed in minutes; Frequency - frequency of symptom
compared to all experienced auras (expressed in percentages); n/a - not applicable.
Petrusic et al. The Journal of Headache and Pain 2014, 15:87 Page 3 of 6
symptom was scintillating scotoma, followed by blurry
vision, tunnel vision and zig-zag lines. These symptoms
had gradual development which corresponds with typic-
ally described migraine aura [13]. High prevalence of
blurry vision and tunnel vision (shrinking of visual field)
in our patients, not typically considered to be an aura
phenomenon of cortical origin, support recent findings
towards heterogeneous symptoms of visual aura [15].
Moreover, visual dysgnosia during the aura was frequently
reported by our patients in contrast to findings in litera-
ture [16]. Color dysgnosia, in terms of this - colors get
brighter and patients had difficulties in recognition of
color shades, was most commonly reported symptom of
visual types of dysgnosia and most frequently experienced
symptom in patient auras. This could be explained by the
fact that visual auras could arise from the primary visual
cortex, as well as from other extrastriate areas (e.g. V2,
V3yVP, V3A, and V4v) [17,18]. In the other hand,
prosopagnosia was reported in only one patient. This
could be due to the fact that this function is localized
bilaterally [19].
The second most common type of aura in our group
of patients was somatosensory phenomena (60%). The
most frequently reported somatosensory symptom was
Figure 1 Distribution of patients by number of HCF disturbances. HCF: higher cortical function.
Table 4 Comparison of demographic data and aura features between HCD group and standard aura group
Demographic data, aura characteristics HCD group (n = 22) Standard aura group (n = 18) Statistics
Gender girls (%) 10 (45.5) 10 (55.6) p = 0.525
Age of patients, X ± SD, years 16.32 ± 1.98 16.06 ± 2.1 p = 0.687
Age at the time of the onset of migraine, X ± SD, in years 13.18 ± 1.74 12.17 ± 2.97 p = 0.212
Aura duration, X ± SD, in minutes 30.91 ± 20.85 27.5 ± 10.04 p = 1.000
Number of auras per year, X ± SD 6.18 ± 3.17 3.33 ± 2.03 p = 0.003
Somatosensory symptoms (%) 17 (77.3) 7 (38.9) p = 0.014
Numbness in hands (%) 16 (72.7) 5 (27.8) p = 0.005
Numbness in arms (%) 9 (40.9) 2 (11.1) p = 0.073
Numbness of the face and lips (%) 9 (40.9) 3 (16.7) p = 0.165
Numbness of the tongue (%) 10 (45.5) 1 (5.6) p = 0.011
Numbness in legs (%) 6 (27.3) 0 (0) p =0.024
Petrusic et al. The Journal of Headache and Pain 2014, 15:87 Page 4 of 6
numbness in hand (52.5%), while 15% of the patients
reported numbness in legs with marchingphenomenon,
which is in line with previous similar study in adult popu-
lation with migraine [20]. Interestingly, patients with
visual and somatosensory aura mainly reported 5 to 10
minutes delay of beginning of somatosensory symptoms
after beginning of visual aura, but also in eight patients
somatosensory aura onset occurred at the same time or
before visual aura. These findings could indicate multiple
origin of CSD in some of patients, which is previously
proposed [17,20]. It is noteworthy that all patients had
normal imaging examinations that excluded a structural
lesion which might either account for or be caused by the
hyperexcitability that triggers migraines [21].
Beyond the visual and somatosensory symptoms, phe-
nomena reported during the migraine include mispercep-
tions, impaired gnosis, praxis, and memory [8]. In our
study, HCD during the aura were notable. Slowed speech
and problems in reading as symptoms during the aura
were the most usually reported. Moreover, 36% of teenage
migraineurs had some type of dysphasic disturbances dur-
ing the aura, which is high in comparison to 15% reported
by Russell MB and Olesen J [16], but less than in our pre-
vious study where dysphasic symptoms were reported by
53% of adults with migraine [11]. Furthermore, in teen-
agers with migraine symptoms of expressive dysphasia
were less common (12%) in comparison to adultsmi-
graine [14]. We can only speculate that in teenage
migraineurs CSD rarely reach Broca's region. Also, in
our opinion, it is very important to focus on the diver-
sity of dysphasic presentation among migraineurs in
further investigations.
One of ten of our patients had memory disturbances
during the aura, such as difficulties in remembering the
events or more frequently in recalling past events. In pa-
tients who had these symptoms every second migraine
aura was accompanied by retrograde amnesia. Memory
processes involve regions in the medial temporal lobes
including the hippocampus, which may be implicated
during CSD [8]. Déjà vu phenomenon was reported by
22.5% of our patients, mostly in one third of their auras.
Also, our patients reported difficulties in calculating, nam-
ing, performing precise movements with hands, orienting
in space, recognizing objects by touch, as well as neglecting
hand symptom. Frequency of all these HCD occurrences
point out the variety of possibilities of CSD propagating
through the cortex [8,21].
Further, we compared two subgroups of patients who
experienced one or more HCD symptoms during the
aura (HCD group) and those who did not experienced
HCD (Standard aura group). Main findings were that
these subgroups did not differ in terms of gender, age
of patients, age at the time of the onset of migraine,
aura duration and location of the beginning of visual
disturbances in the visual field. This is in line with
findings in adult migraine population, except for aura
duration, where migraineurs with HCD during the aura
had significantly longer duration of aura [11]. Also,
HCD group has significantly higher number of auras
per year compared to Standard aura group. We can only
speculate that this could be due to networks immaturity
in teenagers with migraine, which is demonstrated in
adolescents [22-24]. Also, we found higher prevalence
of somatosensory symptoms in HCD group compared
to Standard aura group. Furthermore, we can assume
that wideness of somatosensory cortex affected region
and CSD intake of secondary somatosensory regions is
linked to the number and types of HCD, because the
somatosensory cortex plays major importance in mul-
tisensory integration processes [25-27].
It should be also mentioned that we had ten patients
whose migraine aura proceeded after onset of headache
for some period of time. This finding could be of interest
for further investigation and more deeply understanding
of aura features influence on quality of pain.
The main limitations of our study are the facts that
data were collected between attacks and that HCD were
determined by patientsreports. Nevertheless, as the ma-
jority of our patients experienced more than 10 auras with
a monthly appearance of aura, we could suppose that their
descriptions are relevant. Although complex or less
clear cognitive changes are particularly susceptible to
recall biases, the results clearly indicate that certain
cortical dysfunctions must be largely underestimated
in migraine because specific questioning is not part of
the routine clinical evaluation.
The analysis of the present cases and general experience
[8,11,16] indicates that aura symptoms, regardless of their
form, vary to a great extent in duration and complexity
from patient to patient, and also within each individual.
Hence, we have concluded from our nosographic analysis
of migraine aura in teenagers that higher cortical distur-
bances should be examined more profound in patients.
Also, continuously reporting of aura features in teenagers
with migraine with HCD during the aura represent great
opportunity for neuroimaging investigation of CSD impact
on cortex development in adolescents.
Written informed consent was obtained from the patients
parent for the publication of this report.
Competing interests
The authors declare that they have no competing interests.
Petrusic et al. The Journal of Headache and Pain 2014, 15:87 Page 5 of 6
IP carried out study design, interviews with patients, analysis and
interpretation of data and drafted the manuscript. VP participated in data
collection. DV participated in patient selection and provided database of her
patients. JJ carried out study supervision, provided database of her patients
and revised the manuscript for content. All authors read and approved the
final manuscript.
This work was supported by a grant from the Ministry of Science and
Technology of the Republic of Serbia (project no. 41020).
Assoc. Professor Dr. Jancic has received research grant support by the
Ministry of Education and Science, Republic of Serbia (project no. 175031).
Author details
Clinic of Neurology and Psychiatry for Children and Youth, CCS, Doktora
Subotica 6a, 11000 Belgrade, Serbia.
Faculty of Medicine, University of
Belgrade, Doktora Subotica 8, 11000 Belgrade, Serbia.
Received: 10 October 2014 Accepted: 7 December 2014
Published: 12 December 2014
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Petrusic et al. The Journal of Headache and Pain 2014, 15:87 Page 6 of 6
... Migraines with visual aura, hemiparaesthetic aura, and speech/language aura are classified as migraines with typical aura. Of these, visual aura is the most common type of aura followed by sensory, then speech and/or language [5,6,26]. A typical visual aura is characterized by unformed black and white patterns (e.g., zigzags, crescents, flickering) that first appear in the center of the visual field and then move to the periphery, followed by a scotoma [26]. ...
... Of these, visual aura is the most common type of aura followed by sensory, then speech and/or language [5,6,26]. A typical visual aura is characterized by unformed black and white patterns (e.g., zigzags, crescents, flickering) that first appear in the center of the visual field and then move to the periphery, followed by a scotoma [26]. However, there is substantial variability in the characteristics of visual auras [27]. ...
... Often the tingling is followed by numbness. However, numbness may be the only symptom [26]. Speech and/or language auras are usually described as aphasias but may also include slowed speech or difficulty reading, especially in adolescents [26,28]. ...
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Migraine headache is a common cause of pain and disability in children and adolescents and is a major contributor to frequently missed school days and limitations in activities. Of children and adolescents with migraine headache, approximately one-third have migraine with aura (MA). MA is often considered to be similar to migraine without aura (MO), and thus, many studies do not stratify patients based on the presence of aura. Because of this, treatment recommendations are often analogous between MA and MO, with a few notable exceptions. The purpose of this review is to highlight the current evidence demonstrating the unique pathophysiology, clinical characteristics, differential diagnosis, co-morbidities, and treatment recommendations and responses for pediatric MA.
... The results show that the mean age of patients in the two groups is not statistically significant. To evaluate the severity of headache based on Midas score, LITTLE Disability score (5-0), MILD disability score (6-10), Moderate disability score (11)(12)(13)(14)(15)(16)(17)(18)(19)(20), and more than 21 severe disability scores were considered. To study the severity of headache before and after treatment, according to a study performed on migraine patients in the group with normal brain MRI, 11% were in the moderate group, and 88.89% were in the severe group. ...
... The present study observed that a visual atmosphere existed for 32 patients in two groups, equal to 31.6%. A 2014 study by Igor Petrusic and colleagues on adolescents found that visual acuity was present in 37.5% of patients alone (16). ...
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Objective and background: Migraine is one of the most common diseases and causes of parenchymal lesions in the brain, which is associated with symptoms of nausea and vomiting, visual impairment, and olfaction. One way to diagnose migraine headaches is to study magnetic resonance imaging (MRI). MRI T2 hyperintense lesions in migraines are usually found in the white matter and sometimes in the cerebral cortex. Methods: 114 patients with informed consent were included in the study. They were then referred for MRI. Patients were then divided into two case and control groups according to the presence or absence of lesion in MRI. A complete neurological examination was performed, and clinical symptoms were recorded. The MIDAS headache questionnaire was. After three months of the treatment period, the patients again filled up the MIDAS questionnaire, and a complete neurological examination was performed. Results: In this study, 101 patients with migraines were studied. Also, in a separate survey of patients' symptoms with headaches, the frequency of visual aura and night headache was statistically significant in both groups. The results show no significant difference between the mean scores of Midas after treatment in the two groups. The results show that the mean scores of Midas after the study decreased in all patients with abnormal MRI. But in patients who have lesions in BS, the mean scores of Midas have not been significant.
... (4) The complexity of the networks involved in the etiopathogenesis of the headache and migraine aura is further complicated in its phenotypic expression in the developmental age by the development of the central and peripheral networks of the nervous system and the related processes of maturation and myelination in continuous evolution [28]. ...
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Migraine is a complex neurologic disorder by which several systems of the central nervous system (autonomous system, affective, cognitive, sensory and motor system) may be affected on different levels. About a fourth of migraine patients have migraine auras. The most common aura is the visual aura followed by the sensorial aura but motor deficits, as well as deficits of higher cortical centers (disorders of thinking, orientation, coherence, or concentration), may occur as well. In analogy with a headache diary, an aura diary can deliver important help in the diagnostic process of rare migraine manifestations and prevent the under-diagnosis of unusual migraine manifestations. Complex migraine manifestations are a diagnosis of exclusion, and a broad diagnostic work-up is necessary in order to exclude dangerous neurologic pathologies. In addition, here, we discuss the atypical clinical presentation and possible physio-pathogenetic related aspects of these atypical migraine aura features in the developmental age. In addition, we wanted to stress and analyze the clinical aspects of our children/adolescents with atypical auras, which seem to be more difficult to frame with the mechanisms originally proposed to explain the physio-pathogenetic relationship between CSD and aura. Finally, we discuss in detail the complex aspects of this topic on the basis of available data and propose new terminology: “Multiple, Synchronous and Asynchronous, Cortical and Subcortical Spreading Depression”.
... Concerning the presence of higher cortical dysfunction, there was no difference in gender, age, age at onset of migraine, and aura duration. Although no formal neuropsychological evaluation was performed and the study group was small, the authors concluded that the presence of complex auras was more frequent than expected [13]. ...
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Purpose of Review To review the literature on the clinical characteristics of the symptoms other than headache that occurs during a migraine attack in childhood and adolescence. Recent Findings Premonitory symptoms (42–67%) and postdrome phase (82%) are frequent. The most frequent auras were visual. There was no association between age or sex and the occurrence of auras. Cranial autonomic symptoms are also frequent (40–70%) and are most often bilateral. Most studies suggest that age is not associated with the frequency of nausea, vomiting, photophobia, and phonophobia. Cephalic cutaneous allodynia (15–37%) and osmophobia (20–53%) are common symptoms in children with migraine. Osmophobia has low sensitivity and high specificity for the diagnosis of migraine and is associated with the severity of the migraine. Summary Migraine is a complex disease, and although headache is its best-known symptom, other symptoms also occur frequently during migraine attacks in children and adolescents.
... The search strategy identified 378 published studies (Fig. 1). Seventeen papers fulfilled our case definition [2,[14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29]. One study was excluded since "scintillating scotoma" (79.3%) was the only VS reported [27]. ...
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Background Migraine aura (MA) is a common and disabling neurological condition, characterized by transient visual, and less frequently sensory and dysphasic aura disturbances. MA is associated with an increased risk of cardiovascular disorders and is often clinically difficult to distinguish from other serious neurological disorders such as transient ischemic attacks and epilepsy. Optimal clinical classification of MA symptoms is important for more accurate diagnosis and improved understanding of the pathophysiology of MA through clinical studies. Main body A systematic review of previous prospective and retrospective systematic recordings of visual aura symptoms (VASs) was performed to provide an overview of the different types of visual phenomena occurring during MA and their respective frequencies in patients. We found 11 retrospective studies and three prospective studies systematically describing VASs. The number of different types of VASs reported by patients in the studies ranged from two to 23. The most common were flashes of bright light, “foggy” vision, zigzag lines, scotoma, small bright dots and ‘like looking through heat waves or water’. Conclusions We created a comprehensive list of VAS types reported by migraine patients based on all currently available data from clinical studies, which can be used for testing and validation in future studies. We propose that, based on this work, an official list of VAS types should be developed, preferably within the context of the International Classification of Headache Disorders of the International Headache Society.
... The common symptoms of migraine are unilateral headache, photophobia, phonophobia, nausea, dizziness, worsening of pain during physical activity and the aura which increases with time [9,10]. Scintillating scotoma and blurry vision are the predominant visual symptoms during the aura, followed by slowed speech, dyspraxia and somatosensory symptoms such as numbness in the hand [11]. The most common premonitory symptoms of migraine in childhood are fatigue, emotional changes and neck stiffness [12]. ...
As a vascular-inflammatory disease, migraine affects the brain and some other organs, such as the eye. The aim of this study was to measure and compare the peripapillary retinal nerve fiber layer (RNFL) thickness, macular ganglion cell layer thickness and optic nerve head parameters to detect structural damage in children with migraine using swept-source optical coherence tomography. Twenty-four children with migraine in the painless period and 26 controls were included in the study. The vast majority of the groups consisted of females (75% for patients and 77% for controls). Certain RNFL quadrants and optic disc parameters revealed significant differences between the patients and controls. In the right and left eyes of children with migraine, nasal quadrant RNFL was significantly thicker than that in healthy subjects (88.82 ± 11.03 vs 77.80 ± 13.77, P = 0.004 for right eyes and 87.71 ± 11.79 vs 77.80 ± 13.77, P = 0.01 for left eyes). Temporal quadrant RNFL in the left eyes was thinner (78.67 ± 9.57 vs 84.44 ± 9.68, P = 0.04). Disc area in the left eyes of the patients was greater (2.29 ± 0.46 vs 1.94 ± 0.28, P = 0.003). There were significant expansions in cup volumes in favor of the patients for right and left eyes (0.15 ± .0.19 vs 0.05 ± 0.05, P = 0.03 and 0.17 ± 0.14 vs 0.05 ± 0.05, P = 0.001, respectively). The only significant difference between the left and right eyes of the migraineurs was the RNFL thickness in the superior quadrant. Ganglion cell layer thickness did not differ between the right eyes, left eyes and controls. In conclusion, children with migraine showed significant variations in specific RNFL and optic disc parameters compared to control subjects.
Purpose Recently, altered visual cortical processes i.e., lack of habituation to visual evoked potentials (VEP), has been highlighted in both photosensitive epilepsy and in a specific i.e., analytic mode of processing visual inputs. In this study we aimed at evaluating the relationship between photosensitivity (PS) and analytic style of processing visual information, in a sample of 30 patients with Idiopathic Generalized Epilepsy (IGE) and matched healthy controls. Methods At our Epilepsy unit of the Sapienza University of Rome, we consecutively enrolled 15 patients with IGE with PSand matched them with 15 patients with IGE without PS and 15 Healthy Volunteers. All patients underwent EEG recording in basal conditions during hyperventilation (3 Min), and intermittent light stimulation. The most effective frequencies comprised from 12 to 16 Hz. The instruments used to gather psychological cognitive behavioral data, consisted of participation in two tests: the Sternberg-Wagner Self-Assessment Inventory and the Mariani Learning Style Questionnaire. Results Compared to controls, both IGE groups show significantly higher scores for the analytic style (One-way ANOVA, F(2,44) = 110.3, p < 0.0001). Epilepsy groups thereby showed very distinctive cognitive styles as measured with the Sternberg test. In the visual style, scores of the photosensitive Individuals with IGE were significantly higher than the non-photosensitive individuals with IGE (p < 0.0001, Tukey’s post hoc test). Conclusions An association between analytic style of processing visual information and PS in IGE has been shown. The common neurophysiological features between these two factors, suggest the possibility to evaluate this cognitive behavior as a potential target for nonpharmacological therapeutic strategies in photosensitive epilepsy.
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Purpose of the Review Although visual and somatosensory disturbances are the most common migraine aura (MA) symptoms, patients can also experience other symptoms during their MA. The aim of this review is to provide an overview of studies that report symptoms of dysphasia and other higher cortical dysfunctions (HCDs) during MA, as well as to determine the frequency of HCDs. Recent Findings Five studies met the inclusion criteria, corresponding to 697 patients overall. The most frequently reported HCDs were those of the language group (range 10–53%). The occurrence of visual HCDs was noted in 12–40 patients, somatosensory HCDs in 12–20%, and memory disturbances in 10–22% of the patients during MAs. Summary MA is associated with a wide range of neurological symptoms, including symptoms of HCD. A better strategy for investigation of the HCD symptoms is needed to correctly stratify patients thus allowing meaningful studies of aura pathophysiology.
Background Migraine is one of the most debilitating disorders with its chronic nature seen in childhood characterized by episodic bilateral or unilateral throbbing pain on the head that strikes at any time. It is divided into two categories as with or without aura and is diagnosed according to the 2013 International Headache Society criteria. Aim and method This study aims to present the pictures depicted by adolescents aged 14–18 who were diagnosed with migraine with visual aura by Ankara Training and Research Hospital Child Neurology Department. Results They were told to draw their visual auras as a picture that they depict or as a draft via changing another picture. In this article, five adolescents with migraine and their pictures related to their visual aura were presented. Conclusion The diagnosis of migraine with visual aura in patients under 18 years of age would be supported by picturing of their visual images. Thus, pediatric patients could better express themselves and the clinician would better manage the process both in diagnosis and follow-up of the migraine with aura.
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Imaging studies of spontaneous migraine aura have proved challenging because of the episodic and unpredictable nature of migraine attacks. Two patients with signs of acute ischemic stroke were evaluated for thrombolysis and turned out to suffer from familial hemiplegic migraine. It was possible to record the early phase of the hemiplegic aura with computed tomography with perfusion sequences and magnetic resonance imaging. We found cerebral hypoperfusion in the relevant cortical areas within the first hour after onset of aura symptoms. This report supports the concept that migraine aura across the migraine spectrum is caused by similar mechanisms. In a setting with efficient cooperation between headache and stroke neurologists, thrombolysis centers provide the setup and opportunity to record aura symptoms at an early phase. Furthermore, in the time of ready access to acute systemic thrombolysis treatment, these cases underscore the importance of an accurate headache history, especially in younger patients.
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The migraine attack is characterized by alterations in sensory perception, such as photophobia or allodynia, which have in common an uncomfortable amplification of the percept. It is not known how these changes arise. We evaluated the ability of cortical spreading depression (CSD), the proposed mechanism of the migraine aura, to shape the cortical activity that underlies sensory perception. We measured forepaw- and hindpaw-evoked sensory responses in rat, before and after CSD, using multielectrode array recordings and two-dimensional optical spectroscopy. CSD significantly altered cortical sensory processing on a timescale compatible with the duration of the migraine attack. Both electrophysiological and hemodynamic maps had a reduced surface area (were sharpened) after CSD. Electrophysiological responses were potentiated at the receptive field center but suppressed in surround regions. Finally, the normal adaptation of sensory-evoked responses was attenuated at the receptive field center. In summary, we show that CSD induces changes in the evoked cortical response that are consistent with known mechanisms of cortical plasticity. These mechanisms provide a novel neurobiological substrate to explain the sensory alterations of the migraine attack.
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The present study investigated the development of visuospatial working memory (VSWM) capacity and the efficiency of filtering in VSWM in adolescence. To this end, a group of IQ-matched adults and adolescents performed a VSWM change detection task with manipulations of WM-load and distraction, while performance and electrophysiological contralateral delay activity (CDA) were measured. The CDA is a lateralized ERP marker of the number of targets and distracters that are selectively encoded/maintained in WM from one hemifield of the memory display. Significantly lower VSWM-capacity (Cowan's K) was found in adolescents than adults, and adolescents' WM performance (in terms of accuracy and speed) also suffered more from the presence of distracters. Distracter-related CDA responses were partly indicative of higher distracter encoding/maintenance in WM in adolescents and were positively correlated with performance measures of distracter interference. This correlation suggests that the higher interference of distracters on WM performance in adolescents was caused by an inability to block distracters from processing and maintenance in WM. The lower visuospatial WM-capacity (K) in adolescents in the high load (3 items) condition was accompanied by a trend (p<.10) towards higher CDA amplitudes in adolescents than adults, whereas CDA amplitudes in the low load (1 item) condition were comparable between adolescents and adults. These findings point to immaturity of frontal-parietal WM-attention networks that support visuospatial WM processing in adolescence.
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Patients suffering from migraine with aura (MWA) and migraine without aura (MWoA) show abnormalities in visual motion perception during and between attacks. Whether this represents the consequences of structural changes in motion-processing networks in migraineurs is unknown. Moreover, the diagnosis of migraine relies on patient's history, and finding differences in the brain of migraineurs might help to contribute to basic research aimed at better understanding the pathophysiology of migraine. To investigate a common potential anatomical basis for these disturbances, we used high-resolution cortical thickness measurement and diffusion tensor imaging (DTI) to examine the motion-processing network in 24 migraine patients (12 with MWA and 12 MWoA) and 15 age-matched healthy controls (HCs). We found increased cortical thickness of motion-processing visual areas MT+ and V3A in migraineurs compared to HCs. Cortical thickness increases were accompanied by abnormalities of the subjacent white matter. In addition, DTI revealed that migraineurs have alterations in superior colliculus and the lateral geniculate nucleus, which are also involved in visual processing. A structural abnormality in the network of motion-processing areas could account for, or be the result of, the cortical hyperexcitability observed in migraineurs. The finding in patients with both MWA and MWoA of thickness abnormalities in area V3A, previously described as a source in spreading changes involved in visual aura, raises the question as to whether a "silent" cortical spreading depression develops as well in MWoA. In addition, these experimental data may provide clinicians and researchers with a noninvasively acquirable migraine biomarker.
The mechanisms underlying the initiation and propagation of the migraine aura, and the visual percept that is produces, remain uncertain. The objective of this study was to characterize and quantify a large number of visual auras recorded by a single individual over nearly two decades to gain insight into basic aura mechanisms. An individual made detailed drawings of his visual percept of migraine aura in real time during more than 1000 attacks of migraine aura without headache over 18 years. Drawings were made in a consistent fashion documenting the shape and location of the aura wavefront or scotoma in the visual field at one minute intervals. These drawings were digitized and the spatial and temporal features of auras were quantified and analysed. Consistent patterns of aura initiation, propagation and termination were observed in both right and left visual fields. Most aura attacks originated centrally (within 10° eccentricity), but there were also other distinct sites of initiation in the visual field. Auras beginning centrally preferentially propagated first through lower nasal field (69-77% of all auras) before travelling to upper and temporal fields, on both sides. Some auras propagated from peripheral to central regions of the visual field-these typically followed the reverse path of those travelling in the opposite direction. The mean velocity of the perceived visual phenomenon did not differ between attacks starting peripherally and centrally. The estimated speed of the underlying cortical event (2-3 mm/min) was in the same range as has been previously reported by others. Some auras had limited propagation and spontaneously 'aborted' after a few minutes, despite being initiated in similar locations to those that spread throughout the entire visual field. The visual percept of the aura changed corresponding with the presumed propagation from the V1 to the V2 region of the occipital cortex. In some cases the visual percept disappeared for several minutes before reappearing in a distant location, providing direct evidence that the aura can be clinically 'silent'. These results indicate that there can be multiple distinct sites of aura initiation in a given individual and suggest that the spatial pattern of propagation in the occipital cortex is non-concentric with a variable extent of propagation. The visual percept of migraine aura changes depending on the region of the occipital cortex that is involved.
Migraine and headache are global disabling conditions causing considerable individual suffering and impaired quality of life in adults as well as in children and adolescents. Therefore, epidemiological studies are essential to assess the scope of the problem. This review covers epidemiological studies on migraine and headache in children and adolescents published in the past 25 years. A total of 64 cross-sectional studies have been identified, published in 32 different countries and including a total of 227,249 subjects. The estimated overall mean prevalence of headache was 54.4 % (95 % CI 43.1-65.8) and the overall mean prevalence of migraine was 9.1 % (95 % CI 7.1-11.1). There is a lack of population-based studies from low and low-middle income countries. In addition, there is very little information about the prevalence of probable migraine and chronic migraine and no information about menstrual migraine in the young.
IntroductionAura occurs in 20-30% of patients with migraine. Some descriptions of aura go far beyond the most frequent visual and sensory symptoms, suggesting the involvement of different cortical areas. The aim of this prospective study was to evaluate the frequency and types of disorders of higher cortical functions (HCF) that occur during visual and/or sensory aura.Methods We interviewed 60 patients with visual and/or sensory aura about HCF disorders of praxia, gnosia, memory, and speech, during aura. Patients were divided into two groups, with and without HCF disorders, and were compared in terms of demographic data and aura characteristics.ResultsFrom all 60 patients, 65% reported at least one HCF disorder during aura. The patients with HCF disorders had longer-lasting auras (28.51 ± 16.39 vs. 19.76 ± 11.23, p = 0.016). The most common HCF disorders were motor dysphasia (82.05%) and dysnomia (30.74%). Motor dysphasia was more often reported by patients with visual as well as sensory aura (p = 0.002). The number of HCF disorders correlated with the aura duration (p = 0.003).Conclusion According to our results, HCF disorders during aura occur more often than previously thought. The aura duration has some influence on the HCF disorders.
Objectives: Migraine aura is commonly considered to be a distinct phase of a migraine attack that precedes headache. The objective of the study was to examine a large number of prospectively recorded attacks of migraine with aura and determine the timing of headache and other migraine symptoms relative to aura. Methods: As part of a clinical trial we collected prospective data on the time course of headache and other symptoms relative to the aura. Patients (n = 267) were enrolled from 16 centers, and asked to keep a headache diary for 1 month (phase I). They were asked to record headache symptoms as soon as possible after aura began and always within 1 hour of aura onset. A total of 456 attacks were reported during phase I by 201 patients. These patients were then randomized and included in phase II, during which a total of 405 attacks were reported in 164 patients. In total, we present data from 861 attacks of migraine with aura from 201 patients. Results: During the aura phase, the majority of attacks (73%) were associated with headache. Other migraine symptoms were also frequently reported during the aura: nausea (51%), photophobia (88%), and photophobia (73%). During the first 15 minutes within the onset of aura, 54% of patients reported headache fulfilling the criteria for migraine. Conclusion: Our results indicate that headaches as well as associated migraine symptoms are present early, during the aura phase of the migraine attack in the majority of patients.