Migraine with aura results in violent headaches, preceded by impressive, but fortunately transient, neurological disorders called aura. In the majority of cases, the aura is visual and generates flickering, inverted images in the field of vision, and blurred shapes. Its chronicity can have a major impact on the person’s daily life. Find out what migraine with aura is, how it manifests, how to diagnose and treat it.
1. What is migraine with aura
Migraine refers to a headache of moderate to severe intensity, which occurs for periods of 4 hours to 3 days, if left untreated. According to the National Institute of Health and Medical Research (Inserm), 15% of the adult population suffers from migraines. Women are more affected by this pathology than men (in a proportion of 2 women for 1 man). If migraine can occur at any age, including children, it is especially present in the 30 to 40 year old age group. Still according to Inserm, in 2 to 3 cases of migraine out of 10, the migraine is preceded by an aura. By aura we mean a transient neurological disorder. This neurological disorder is most often visual (90% of cases encountered), but it can also involve language disorders (speech problems), motor disorders or sensory disorders (paresthesia in the face or neck). extremities of the limbs). The origin of this pathology is still poorly understood, but genetic predispositions have been highlighted, as well as potential triggering factors.
2. What are the symptoms of migraine with aura?
Migraine with aura results in several characteristic symptoms, including the fact that transient neurological disorders develop before the intense headache. In rare cases, neurological disorders occur at the same time as the headache, specifies the Headache Institute. We then speak of accompanied migraine. In case of migraine with aura, we can observe:
- Visual neurological disorders: appearance of black or shiny spots in the field of vision, called scotomas. In other cases, half of the visual field becomes black, which greatly handicaps the person, particularly when driving. In other people, these visual disturbances result in the appearance of geometric figures, inverted or blurred images.
- Sensory neurological disorders: paresthesias may appear, that is to say sensations of tingling or numbness of the face and/or the ends of the hands and feet.
- Language disorders: speech difficulties, or even total (but temporary) inability to speak.
- An intense migraine headache: this headache is intense, throbbing (throbbing, in tune with the heartbeat) and unilateral. It is usually located behind the eye or at the back of the eye. This pain appears once the aura has stopped and gradually intensifies.
These symptoms are more likely to occur if the person is tired, stressed, alcoholic, smoker, subject to hormonal variations (menstruation, etc.) or climatic variations (travel, etc.). Migraine with aura is also often favored by exposure to intense or stroboscopic light or to a significant sound source (concert, nightclub, jackhammer, etc.).
3. Diagnosis of migraine with aura
It is important to consult your doctor in the event of migraine with aura. Indeed, even if this pathology is benign, it can seriously affect the personal, social and professional life of the person. However, there are treatments to relieve the pain caused by migraine with aura and thus improve quality of life. The doctor may, if he considers it necessary, refer the person to a neurologist. The diagnosis of migraine with aura is made on the basis of clinical signs. The Haute Autorité de Santé recommends using the criteria defined by the International Headache Society (IHS) to diagnose migraine with aura. These criteria relating to a migraine with aura are:
- The observation of at least two intense headache attacks lasting 4 hours to 3 days when there is no medical treatment undertaken.
- The presence of at least 3 of the following 4 signs: one or more completely reversible aura symptoms (i.e. signs that disappear between two migraine attacks); the gradual appearance, over at least 4 minutes, of the aura, and the non-accumulation of several signs of aura (the symptoms must be successive); each symptom disappears within 1 hour maximum; the headache follows the aura within a maximum interval of 1 hour (in rare cases it may precede it or be simultaneous).
- The clinical examination should not detect anything abnormal. If in doubt, the doctor can order tests such as Doppler, CT or MRI. The aim of these examinations is to rule out other pathologies responsible for these headaches or aura. But in the majority of cases, the clinical examination alone is sufficient, and additional examinations are only reserved for atypical migraines or patients at risk of comorbidities.
4. Drug treatments for migraine with aura
The treatment of migraine with aura varies according to the intensity of the headaches and neurological disorders, but also according to the duration and frequency of the attacks. In this respect, we distinguish the treatment of migraine attacks with aura from basic treatment (also called prophylactic treatment). The French Society for the Study of Migraines and Headaches recommends:
- For crisis treatment: the doctor or neurologist prescribes non-steroidal anti-inflammatories and/or triptans (vasoconstrictors). The goal here is to reduce the diameter of the small blood vessels in the head that have dilated during the headache. However, these treatments have contraindications. Anti-inflammatories are not recommended for people with a history of peptic ulcer or kidney failure. Triptans, for their part, should be excluded in people who suffer or have suffered from cardiovascular problems (myocardial infarction, stroke, chronic high blood pressure, etc.). Finally, it is important to limit the duration of taking nonsteroidal anti-inflammatory drugs to 8 days per month and that of triptans to 10 days per month. Paracetamol is not very effective for this type of headache, and opiate analgesics should also be avoided due to the risk of developing chronic headaches due to medication overuse.
- In prophylactic treatment: if the attacks become chronic or if the relief of symptoms is not sufficient with the attack treatment, then a basic treatment can be considered. This basic treatment aims to reduce the frequency of migraine attacks with aura by around half. He does not claim to cure them. Prophylactic treatment can combine various medications, initially intended for other pathologies, but which have proven beneficial in relieving migraine with aura. These medications are certain antiepileptics, certain antihypertensives, beta-blockers, tricyclic antidepressants prescribed at low doses, in particular.
5. Natural treatment for ophthalmic migraine
There are relatively simple behaviors to adopt to limit the intensity of migraine with aura. During a migraine attack, you must rest in a room immersed in darkness and silence. In fact, physical exertion only intensifies the symptoms. This also involves good hydration, or even practicing stress management exercises. This better stress management can be achieved through relaxation exercises (deep abdominal breathing, sophrology, meditation, yoga) or through the implementation of cognitive-behavioral therapy. Finally, acupuncture and hypnosis can also provide valuable help to people prone to migraines with aura. Osteopathy like homeopathy, conversely, does not have any notable beneficial effects, according to the scientific studies carried out.
6. Treatments under study for migraine with aura
Inserm specifies that new treatments for migraine with aura are currently in the testing phase. This involves, on the one hand, the development of specific monoclonal antibodies, responsible for destroying the neuropeptide CGRP involved in migraine. To date, tests have shown that this treatment reduces the number of migraine days each month. On the other hand, it involves studying the effects of botulinum toxin injections in the cranial and facial muscles. These injections are intended for patients who suffer from migraines with aura for at least two weeks per month and for whom drug treatments have not had the desired effect.
7. Preventive treatment of migraine with aura
Preventive treatment of migraine with aura consists in particular of limiting the identified risk factors. This involves avoiding nightclubs or places with strobe lights and/or loud music, but also by respecting a sufficient number of hours of sleep, stopping smoking, reducing alcohol consumption. Conversely, you must practice an endurance sport (brisk walking, running, cycling, etc.), because endurance has a beneficial effect on the occurrence of migraine attacks. And finally, you must ensure that you adopt a balanced diet and avoid letting yourself be overcome by stress as much as possible (relaxation, meditation, yoga can help).
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