Migraine with Aura

The migraine aura is a recurrent neurologic symptom that develops gradually (in more than 4 min) and persists for less than 1 hr. Headache, nausea, and/or photophobia usually follow within 60 min after resolution of the aura but may not necessarily develop (acephalgic migraine). Visual aura is most frequently reported (99%), followed by sensory (31%), aphasic (18%), and motor aura (6%). The stereotypical visual aura is a serrated arc of scintillating, shining, crenelated shapes that begins near the point of fixation and

Table V

Diagnostic Criteria for Chronic Migraine

A. Daily or almost daily (>15 days/month) headache for > 1 month

B. Average headache duration of >4hr/day if untreated

C. At least one of the following

History of episodic migraine meeting any IHS criteria History of increasing headache frequency with decreasing severity of migrainous features over at least 3 months

Headache at some time meets IHS criteria for migraine 1.1-1.6 other than duration

D. Does not meet criteria for new daily persistent headache or hemicrania continua

E. At least one of the following

There is no suggestion of a secondary disorder as the cause Such a disorder is suggested, but it is ruled out by appropriate investigations

Such a disorder is present, but first migraine attacks do not occur in close temporal relation to the disorder slowly expands, leaving a partial homonymous visual field disturbance. Symptoms referable to more than one brain region (e.g., visual and somatosensory symptoms) usually develop in sequence, and when they do occur they can prolong the total duration of the aura to more than 1 hr. Aura symptoms that persist for more than 1 hr but less than 1 week are called prolonged aura (if neuroimaging studies are normal). Symptoms that persist for longer than 7 days or are associated with ischemic infarction on neuroimaging are classified as migrainous infarction.

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