What is Migraine with Aura?
Migraine is a neurological condition with neurovascular sequalae. It can be one of the most severe and debilitating forms of headache and affects approximately 6% of men and 18% of women globally1.
The WHO and the Global Burden of Disease study ranked Migraine in the top three most prevalent disorders in the world1, and among the top seventh highest causes of disability worldwide1. Migraine can be devastating and disruptive with up to 91% of sufferers reporting an inability to perform their usual daily tasks and 53% experiencing severe functional impairment2, with the most common being self-imposed bed rest.
The International Headache Society suggests the most common presentation is unilateral (one side of the head) throbbing pain from moderate to extremely severe in intensity with attacks commonly lasting from 4 to 72 hours3.
Migraines are also often accompanied by other symptoms like nausea (present in almost 90% of sufferers during an episode), and vomiting (in approximately 30%) and very commonly some sensitivity to light, sound or smell (approximately 75%).
The typical migraine episode has 4 phases:
- Premonitory “warning signs” Phase
- Aura phase
- Headache pain phase
- Post dromal “hangover” phase.
About 1 in 5 people with migraine develop an “aura” that begins before the headache or starts along with it. An aura may not occur with every headache3.
An aura can include:
- Visual symptoms. (spots, scintillating lines, flickering, jagged shapes, arcs of light, an area of vision loss or black spots, difficulty focussing, hallucinogenic like symptoms in extreme cases)
- Skin sensations. (numbness in the face,scalp or neck is common, tingling or “pins and needles” sensations in the body, prickles or heat sensations)
- Language problems. (Slurred speech, tangling or missing words, difficulty expressing thoughts, speaking, writing, concentrating or comprehending)
- Temporary Paralysis. (“stroke-like” loss of some or part of the function or strength in a limb or limbs, muscle weakness often on one side of the face – similar to Bell’s palsy, ptosis or a droopy eyelid).
These symptoms may morph, change or grow over several minutes or hours before the next phase of the attack or even concurrent with the main Headache phase.
Some sufferers we treat have silent migraine. In this instance a migraineur may not have pain during a given attack, but the aura symptoms alone, this is commonly referred to as a “silent migraine”.
What is the Cause Migraine and Aura?
On the surface, the cause may be attributed to stress, tension, fatigue, certain foods, chemical or hormonal imbalances, but in reality these are more accurately triggers and not “the” cause.
So what is the real cause of Migraine and aura?
Thankfully, research is now revealing what every migraine sufferer knew all along, namely it’s not “all in your head!” In fact, what is emerging is the fact of a common pathway or “headache headquarters” in the brainstem where multiple neurons converge. This specific region is called the Trigeminocervical complex (TCC) and is a “holy grail” of sorts for both researchers and sufferers alike. Furthermore, recent studies have revealed that one of the most powerful causes of brainstem sensitivity is the upper neck or Cervical spine4,6,7.
Even between an episode or attack, research shows that migraineurs exhibit a sensitized brainstem. This explains why normal stimuli is registered by a migraineurs nervous system as a stressor or trigger for an attack…it is normal everyday stressors activating an already sensitized brainstem. Therefore, the real cause of the neurovascular event we call a migraine with aura, is this underlying neurological condition.
During an attack an already sensitized brainstem (by the neck or other causes) is activated by a trigger, which then sets off an explosive positive feedback loop from the brain cortex and back to the brainstem. The already “cranky” hyper sensitized brainstem fires and the cortical brain cells respond with cortical spreading depression causing inflammation of the blood vessels, dura and local tissues in the face, head and neck. The trigeminal nerve (a nerve that supply’s sensory and some motor control to the face, head, jaw and upper teeth) then picks up this amplified signal and becomes inflamed and sensitized itself lighting up pain in the face, head and scalp which then sends powerful signals back to the brain stem and the pain neuromatrix…and the vicious cycle continues amplifying and causing intense pain and multiple aura effects.
The good news is this brainstem sensitivity can be treated with an integrated and combined therapy approach, with a critical step being expert screening of the upper neck as a primary contributor of sensitivity in the brainstem3,4.
Our unique combined therapy approach is logical and evidence-based and aimed at decreasing the sensitivity in the brainstem at the “headache headquarters” with a number of safe treatment options individualized to your headache type.
Click the links for more information on how we perform Our Assessment or Our Treatment or to learn more about our revolutionary 4 phase S.T.E.P. into FREEDOM TM program to help you live life headache free!
- Vos T, Flaxman AD, Naghavi M, et al. (2010) Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries 1990-2010: A systematic analysis for the Global Burden of Disease Study 2010. Lancet 2012; 380: 2163–2196
- Lipton RB et. al. (2001) Prevalence and burden of Migraine in the United States. Headache 2001:41 646-657
- Headache Classification Committee of the International Headache Society. The International Classification of Headache Disorders, 3rd edition. Cephalalgia 2013; 33: 629–808.
- Watson D, (2015) “Sensitive New Age Migraine”; video lecture
- Goadsby, P,J, (2009) The vascular theory of Migraine. A great story wrecked by the facts. Brain, 132 (1), pp 6-7.
- Steiner TJ, Birbeck GL, Jensen R, et al. (2010) Lifting The Burden: The first 7 years. J Headache Pain (2010); 11: 451–455.
The Headache + Migraine Clinic
Telephone: 1300 HOPE 4 YOU (1300 467 349)
Brisbane West (Springfield Central)
Suite 3, Level 1, Orion Springfield Central
1 Main Street, Springfield Central QLD 4300