With Aura or Without: Should My Treatment Change?

The study of migraine with aura and migraine without aura has been complicated for a number of reasons. For example,

There may be very few migraine studies on a specific topic, therefore there will be even fewer differentiating between the two types.
Patients who have migraine aura attacks usually also have attacks without aura.
We're still not sure what the difference is. Are these two types of migraine with different causes? Or two manifestations of the same thing? Or perhaps the aura itself is a distinct condition?

There are most certainly differences between the two, but in general it's going to take a lot more study to have clear treatment guidelines for one or the other.

Quick Definitions

Before we discuss some of the latest research, let's do a quick review. "Aura" usually refers to visual symptoms that are experienced before or along with the headache, such as seeing flashing lights or zigzags.

But there are other types of aura, such as feeling pins and needles, numbness, or even having trouble speaking.

The symptoms are often only on one side, and last a few minutes. For the more detailed description, see The International Classification of Headache Disorders.

Important differences?

A report published in April in The Journal of Headache and Pain reviewed the current literature to give an overview of the differences between the two conditions. Aside from the obvious differences in symptoms, yes, there are differences. But often they're not clear enough to really be practical. However, there are some exceptions. For example:

Anxiety and Depression: Depression, although common in both types of migraine, seems to be more common in women with migraine with aura. This should probably be something your doctor talks to you about, no matter what type of migraine you have. However, it would be wise to pay special attention to this group.
Cardiovascular disease/stroke: Without going into the details, generally speaking, studies have shown a higher risk in patients with aura. This is not a high enough risk to guarantee problems, but it does mean that you should include migraine with aura in your risk factors, and watch for problems.

Treatment decisions

These factors could affect your treatment decisions if you have two possible treatments that are similar, but might cause/alleviate depression or cardiovascular problems. But sometimes one treatment seems a little better or worse for one type of migraine. For example:

Single-pulse transcranial magnetic stimulation (sTMS) seems to help with both types of migraine, but one recent study points to a special benefit to patients with aura.
Triptans may be less effective for patients with aura.

But triptans still may be helpful for migraine with aura - so at this point, unless you're really wavering between two options, these findings may not make a difference to you.

Treating aura?

There are some researchers that are interested in specifically treating aura - and maybe even treating it as a seperate condition. The report mentions ketamine, magnesium sulphate, aspirin, ginkgolide, and tonabersat as possible aura treatments, though more research is needed.

The Most Important Thing

In spite of the current lack of strong evidence for a specific migraine with aura treatment, it is still important to talk to your doctor about your aura symptoms. Keep track of your symptoms and talk to your doctor whenever you notice something new. It may help the doctor find a better treatment, avoid one that won't work as well, or even discover a related condition that can be treated.

For detailed information, here's the full report: Migraine with and without aura—two distinct entities? A narrative review

A few things to read...

A few related articles to read, as well as recent articles at Headache and Migraine News:

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