Migraine with aura used to be called CLASSIC MIGRAINE. The diagnosis requires at least two attacks with any three of the following four features: [1] One or more fully reversible aura symptoms; [2] aura developing over a course of more than four minutes; or [3] lasting less than sixty minutes; and [4] headache following aura within sixty minutes. The majority of the auras are VISUAL; however, sometimes motor or other sensory phenomena precede the headache. The headaches of classic migraine tend to be more compact and intense, rarely lasting more than 12 hours; most often 2 to 3 hours.

Many general characteristics are shared by common and classic migraine. Both varieties affect men and women and can occur at any age, often seemingly triggered by a significant event such as puberty, school graduation, or marriage. A family history is usually present both in classic and common migraine and there may be an earlier history of colic as a baby or car sickness as a small child. The full history of a complete migraineur would include migraine with aura in the teens, migraine without aura with nausea and vomiting in the second and third decades, followed by simple periodic headache or isolated migrainous auras in later life.

Migraine with aura is subclassified into migraine with typical aura (homonymous visual disturbance, unilateral numbness or weakness, or aphasia); migraine with prolonged aura (or lasting longer than 60 minutes); familial hemiplegic migraine; basilar migraine; migraine without headache and migraine with acute-onset aura.

The auras of migraine, although most commonly only visual, have many other associated manifestations, such as hemihypesthesias, perioral anesthesia, vertigo, and transient aphasia. The aura or prodromes of classic migraine may be precipitated by intense stimuli: bright lights, loud noises, head trauma, or the intake of certain foods in susceptible individuals.

In the usual sequence of migraine with aura the sensory prodrome precedes the onset of the headache (in accord with the traditional concept of vasoconstriction followed by vasodilatation). The visual disturbance rarely may have a simultaneous onset with headache or, once having disappeared, may recur following the onset of headache. Such unusual patterns, or strict unilaterality for all attacks, should increase suspicion of a mass lesion or vascular malformation. As opposed to definite periodicity with symptom-free intervals and predictable circumstances, as in migraine without aura, migraine with aura may occur "out of the blue" and in multiple attacks over a few days.

Migraine with aura attacks tend to diminish in the third and fourth decades. While most migraine patients experience a stereotyped clinical pattern, there is a well-recognized group in which both classic and common migraine attacks are admixed.{47} Some patients with classic migraine may lose the headache component eventually and suffer only isolated auras thereafter. This monosymptomatic pattern stresses the importance of accurate history-taking when confronted by a patient with isolated visual phenomena (migraine dissociée).

 

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