Migraine aura without headache

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By Shih-Pin Chen MD

Migraine is a common neurologic disorder that is prevalent in the younger population. With age, migraine prevalence decreases, but some people continue to experience migraine auras without the preceding or associated headache pain. In this article, Dr. Shih-Pin Chen of Taipei Veterans General Hospital and National Yang-Ming University reviews the clinical manifestation, prevalence, pathophysiology, therapeutic options, and prognosis for this selective group of patients. Recent breakthroughs in understanding the pathogenesis, clinical manifestations, and differential diagnosis are highlighted.

Key points

  • Typical aura is consisted of visual, sensory, or speech symptoms with a mix of positive and negative features and complete reversibility.
  • Migraine aura could initiate from multiple distinct sites, propagate nonconcentrically with a variable extent in the occipital cortex, and can sometimes be clinically “silent”.
  • Differential diagnoses, including transient ischemic attack, should be considered when aura is late-onset with predominant negative features or is prolonged or of very short duration.
  • Cortical spreading depression, glutamatergic neurotransmission, channelopathies, neuronal-glial gap-junction communications, and microembolization might be important players in the pathogenesis of migraine aura.
  • Migraine with aura is associated with higher risks of subclinical brain lesions, ischemic or hemorrhagic strokes, and all cause mortalities; whether this remains true for “migraine aura without headache” requires further studies.

In This Article

Historical note and nomenclature
Clinical manifestations
Clinical vignette
Pathogenesis and pathophysiology
Differential diagnosis
Diagnostic workup
Prognosis and complications
References cited