Aura (migraine)

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Classification according to ICD-10
G43.1 Migraines with aura (classic migraines)
G43.3 Complicated migraines
G43.8 Other migraines
ICD-10 online (WHO version 2019)

The aura is a common, focal neurological symptom of migraines , usually followed by headaches . It occurs in around 15 to 20% of migraine attacks and is the decisive diagnostic criterion for differentiating between a classic migraine (migraine with aura) and an ordinary migraine (migraine without aura). Dynamic, mostly visual or other sensory perception disorders are characteristic. The aura can occur without the typical migraine headache. Sometimes it can also be found popularly under the word eye migraine (ophthalmic migraine).

Symptoms

During the migraine aura, visual disturbances that slowly set in and subside again (for example scotomas , perception of jagged figures known as fortifications , loss of spatial vision, blurring up to a half-sided loss of vision), disturbances of the sense of smell, disturbances of sensibility (for example loss of the Sensations of touch or tingling sensations in the arms, legs and face), balance disorders, speech disorders or other neurological deficits occur. The aura is perceived and described differently from patient to patient. The visual symptoms of a migraine aura are perceived as an image disorder, regardless of whether one sees through both eyes or has one eye closed. The image disturbance arises in the brain. The dynamic of the process is characteristic, that means, for example, the "wandering" of the flickering scotoma in the field of vision or the wandering of the tingling sensation in the arm or through the individual fingers. A shift in the aura symptoms, for example from visual disturbances to sensory disturbances to speech disorders and paralysis, can also be observed. This dynamic is also evident in measurements in the brain in the form of a wandering disturbance front ( scattered polarization ). The dynamics of the symptoms as well as their slow onset and resolution are an important distinguishing feature from other neurological diseases, especially from a stroke . The aura has no damaging effects on the brain tissue, its signs are only temporary and usually last up to 60 minutes, in rare cases even up to half a day or a full day.

  • Visual symptoms of a migraine aura

  • Fortification with zigzag structures reminiscent of a fortress

  • Negative scotoma, local loss of structure

  • Positive scotoma, local additional perception of structures

  • Mostly one-sided loss of perception

  • Sickle-shaped aura of graphic structures that grows and then migrates and is superimposed on the real image; instead of static zigzag graphics, there are also shimmering color areas

Therapy and prophylaxis

Specific treatment of the migraine aura is usually not necessary. Avoidance of migraine triggers or prophylactic treatment of the underlying disease can reduce the frequency of migraine auras. The anti- epileptic lamotrigine , among others, has proven to be effective without affecting the occurrence of other migraine symptoms, including migraine headache.

Therapeutic measures for the acute treatment of a migraine aura have not yet been sufficiently validated. In a small study, ketamine as a nasal spray was able to interrupt the aura in some patients.

Meaning for art

Vincent van Gogh's “ Starry Night ” is considered to be an artistic work that was inspired by perceptual disorders of a migraine aura.

Inspirations from migraine aura-related visual disturbances and hallucination-like changes in perception are reflected in the artistic works of well-known migraine patients such as Vincent van Gogh , Giorgio de Chirico and Sarah Raphael . An obvious influence of migraine auras on Pablo Picasso's creative activity is controversial.

The miniatures with which Hildegard von Bingen illustrated her visions suggest migraine aura.

The British writer Lewis Carroll, who suffered from migraines, described perceptual disorders in his work “ Alice in Wonderland ”. These migraine auras with pronounced visual perception disorders were also referred to as Alice in Wonderland Syndrome . In addition, the figure of the Cheshire Cat , of which only the grin is partially visible, appears as the embodiment of the sickle-shaped aura in the images above.

See also

Web links

Commons : Migraine aura  - collection of images, videos and audio files

Individual evidence

  1. ^ J. Pascual, AB Caminero, V. Mateos et al.: Preventing disturbing migraine aura with lamotrigine: an open study . In: Headache . tape 44 , no. 10 , 2004, p. 1024-1028 , doi : 10.1111 / j.1526-4610.2004.04198.x , PMID 15546267 .
  2. ↑ H. Kaube, J. Herzog, T. Buyer, M. Dichgans, HC Diener: Aura in some patients with familial hemiplegic migraine can be stopped by intranasal ketamine . In: Neurology . tape 55 , no. 1 , July 2000, p. 139-141 , PMID 10891926 .
  3. ^ A b Richard Grossinger: Migraine Auras: When the Visual World Fails . North Atlantic Books, 2006, ISBN 1-55643-619-X , The Nature and Experience of Migraina Auras, pp. 1-96 .
  4. ^ Matthias Bormuth , Klaus Podoll, Carsten Spitzer: Art and illness: studies on pathography . Wallstein Verlag, 2007, ISBN 978-3-8353-0113-9 .
  5. ↑ K. Podoll, D. Ayles: Inspired by migraine: Sarah Raphael's 'Strip!' paintings . In: JR Soc Med . tape 95 , no. 8 , August 2002, p. 417-419 , PMID 12151496 , PMC 1279971 (free full text).
  6. ↑ K. Podoll, D. Robinson, U. Nicola: L'ipotesi di un'origine emicranica della pittura di Picasso: una rassegna critica. In: Confinia Cephalalgica . tape 12 , 2003, p. 11-23 .
  7. ↑ Oliver Sacks: Migraine: Understanding a Common Disorder. Berkeley 1985, pp. 106-108.
  8. ^ J. Todd: The syndrome of Alice in Wonderland . In: Can Med Assoc J . tape 73 , no. 9 November 1955, p. 701-704 , PMID 13304769 , PMC 1826192 (free full text).