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Visual aura and migraine
Neuro-Ophthalmology
Key Points
- •Visual aura results from cortical spreading depression propagating across the occipital cortex at 3–5 mm/min - the gradual march over ≥5 minutes distinguishes it from vascular events
- •Fortification spectra (zigzag lines) are pathognomonic of migraine visual aura; aura must last 5–60 minutes and be fully reversible (ICHD-3 criteria)
- •Combined OCP is relatively contraindicated in migraine with aura due to synergistic ischaemic stroke risk - especially in smokers
- •Triptans should be taken at the onset of headache, NOT during the aura phase; gepants (CGRP antagonists) are a safe alternative that can be used during aura
- •New-onset 'aura' in a patient over 50 years must be investigated to exclude TIA, occipital pathology, and GCA before attributing to migraine
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17 more sections are included with the Clinical plan.
- Definition
- Epidemiology
- Aetiology and causes
- Pathogenesis
- Classification
- Risk factors and associations