Persistent and Repetitive Visual Disturbances in Migraine: A Review

Area of Science:

• Neurology
• Ophthalmology
• Neuroscience

Background:

• Migraineurs often experience episodic visual disturbances (aura) linked to headache attacks.
• Some patients present with dominant, persistent, or complex visual symptoms like visual aura status, persistent migraine aura, and visual snow syndrome.
• These rare syndromes are challenging to classify, hindering research into their pathophysiology and treatment.

Purpose of the Study:

• To describe clinical features and pathophysiological concepts of typical migraine aura, focusing on cortical spreading depression.
• To differentiate typical migraine aura from non-typical migraine aura syndromes.
• To discuss nomenclature and specifics of rare migraine aura variants and related visual disturbances.

Main Methods:

• Review of clinical features and pathophysiological concepts related to migraine aura.
• Focus on cortical spreading depression as a key mechanism for typical aura.
• Discussion of nomenclature and classification of various migraine-associated visual phenomena.

Main Results:

• Typical migraine aura is linked to cortical spreading depression.
• Rare syndromes like migraine aura status, persistent migraine aura, and visual snow present unique diagnostic challenges.
• The term 'migraine with prolonged aura' may bridge typical and persistent aura classifications.

Conclusions:

• Clarifying the distinction between typical and atypical migraine aura is crucial for diagnosis and treatment.
• A practical approach is presented to aid physicians in diagnosing and managing these rare visual disturbances.
• Further research is needed to evaluate the impact of revised classification categories on patient care.