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Modeling Neural Immune Signaling of Episodic and Chronic Migraine Using Spreading Depression In Vitro
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Episodic Migraine With and Without Aura: Key Differences and Implications for Pathophysiology, Management, and
Angeliki Vgontzas1, Rebecca Burch2
1Graham Headache Center, Brigham and Women's Hospital, Harvard Medical School, 1153 Centre St Suite 4H, Jamaica Plain, Boston, MA, 02130, USA.
Current Pain and Headache Reports
|October 7, 2018
Summary
Migraine with aura shares similarities with migraine without aura, but distinct pathophysiologic mechanisms and stroke risks warrant further investigation. Research continues to clarify these differences and optimize treatment strategies.
Area of Science:
- Neurology
- Neuroscience
- Epidemiology
Background:
- Migraine classification distinguishes between migraine with aura and migraine without aura.
- Understanding the distinctions is crucial for accurate diagnosis and treatment.
Purpose of the Study:
- To review evidence on similarities and differences in pathophysiology, epidemiology, and clinical aspects of migraine with and without aura.
- To assess current understanding and identify research gaps.
Main Methods:
- Review of existing literature on migraine pathophysiology, epidemiology, and clinical trials.
- Analysis of diagnostic criteria refinements and imaging studies.
- Evaluation of treatment efficacy and safety data.
Main Results:
- Diagnostic criteria for aura have been refined, differentiating it from transient ischemic attack (TIA).
- Cortical spreading depression is implicated in visual aura, but its role in headache pain is unclear.
- Migraine with aura is linked to a slightly increased risk of ischemic stroke, with unclear etiology.
- Limited evidence exists for migraine with aura-specific treatments; current treatments are often similar to those for migraine without aura.
- Certain medications (lamotrigine, aspirin, flunarizine) show efficacy in migraine with aura prevention, while others (magnesium, ketamine) are used for acute treatment.
Conclusions:
- The debate on whether migraine with and without aura are distinct entities persists.
- Further research using advanced imaging and genetic studies is needed to elucidate differences and guide clinical practice.
- Reconsideration of contraindications for certain acute treatments, like triptans, is occurring based on emerging safety data.
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