A computational perspective on migraine aura

The classical visual aura of migraine is characterized by a unilateral hallucination, composed of a zigzag fortification pattern followed by a trailing scotoma. This pattern usually starts in central vision, expands and spreads to the periphery, and then disappears. We review a number of historical attempts to explain the migraine aura in terms of brain events, then summarize recent theories of the pathophysiology of the aura. We describe an approach to the computational modeling of migraine aura, based on the principles of (a) cortical organization, and (b) active wave propagation in an excitable medium. We demonstrate correspondences between properties of the model system and aspects of the pathophysiology of the aura. The simulations produced by the model are in agreement with descriptions and drawings of visual aura from migraine patients. We outline several testable predictions stemming from the implementation of the model, and explain how model-based empirical research has the capacity to (a) improve recording of the phenomena of the visual aura, (b) improve understanding of the spatio-temporal dynamics of other types of aura, in particular somatosensory and dysphasic aurae, and (c) clarify the theoretical requirements for the initiation of aura in the brain.