Migraine aura symptoms: Duration, succession and temporal relationship to headache

As there are no biological markers, a detailed description of symptoms, particularly temporal characteristics, is crucial when diagnosing migraine aura. Hitherto these temporal aspects have not been studied in detail.

We conducted a prospective diary-aided study of the duration and the succession of aura symptoms and their temporal relationship with headache.

Fifty-four patients completed the study recording in a diary the characteristics of three consecutive auras ( ITALIC! n = 162 auras). The median duration of visual, sensory and dysphasic symptoms were 30, 20 and 20 minutes, respectively. Visual symptoms lasted for more than one hour in 14% of auras ( ITALIC! n = 158), sensory symptoms in 21% of auras ( ITALIC! n = 52), and dysphasic symptoms in 17% of auras ( ITALIC! n = 18). Twenty-six percent of patients had at least one aura out of three with one symptom lasting for more than one hour. In aura with multiple symptoms the subsequent symptom, second versus first one or third versus second, might either start simultaneously (34 and 18%), during (37 and 55%), with the end (5 and 9%), or after (24 and 18%) the previous aura symptom. The headache phase started before the aura (9%), simultaneously with the onset of aura (14%), during the aura (26%), simultaneously with the end of aura (15%) or after the end of aura (36%).

We provide data to suggest that symptoms may last longer than one hour in a relevant proportion of auras or migraine with aura patients, and that there is a high variability of scenarios in terms of time relationship among aura symptoms and between aura and headache.