Migraines with visual aura (commonly called “ophthalmic migraines”), sensory or phasic, are manifested by the appearance of neurological symptoms before the migraine headache. What to do ?
Ophthalmic migraine accompanied with aura is a neurological disease which causes symptoms visual and sensory. It concerns 20 to 30% of migraine sufferers depending on theInserm and affects women more. Alcohol or lack of sleep are among the factors favoring seizures. What are the treatments for a migraine with aura?
Definition: what is a migraine with aura?
In France, about one in five adults suffer from migrainewith a clear female predominance (women are three times more affected than men). This neurological disease results in severe headache attacks, called headaches, recurrent. We distinguish the migraines without aura (80% of seizures) migraine with aura (20%) for whom visual, sensory or phasic (language) disturbances are observed before the onset of the headache. These different symptoms can occur simultaneously. A few years ago, migraines with visual aura were nicknamed “ophthalmic migraines”, but this expression is no longer used.
What causes a migraine with aura?
The visual aura is a neurological phenomenon and not eye. She is related to activation of certain neurons in the brain region responsible for vision located in the posterior cortex. This abnormal activation triggers the appearance of light spots sometimes described as flashes or kaleidoscopic vision, during which vision is blurred. These signs are called scintillating scotomas. “There certainly exists a genetic component since several members of the same family can suffer from it. However, no gene has yet been identified“, indicates Dr. Caroline Roos, neurologist and head of the Headache Emergency Center at Lariboisière Hospital (AP-HP). Migraine patients would therefore have a brain predisposed to seizures. A susceptibility that makes them more vulnerable to multiple triggering factors such as:
- the alcohol,
- sudden changes in brightness,
- hormonal variations,
- lack of sleep,
- emotional changes.
What are the symptoms of a migraine with aura?
Migraines with aura are characterized by the appearance of visual disturbances (scintillating scotomas, loss of vision), sensitive (tingling, tingling around the mouth) and/or phasic (language disorder). These auras precede the migraine headache which is manifested by a headache often affecting only one side of the skull and felt like throbbing. It is accompanied by an intolerance to light and noise, as well as nausea and vomiting. This violent headache, aggravated by everyday actions such as climbing stairs, can last from 4 hours to 3 days.
To diagnose a migraine, with or without aura, the doctor relies on the symptoms described by the patient as well as clinical examinations, particularly neurological ones. Imaging examinations (MRI) are not necessary because this disorder cannot be explained by the existence of a lesion. “Diagnosis of migraine with aura is based on at least 2 of the following 6 criteria : present one of the neurological symptoms known as positive symptoms, the progressive installation of the aura, the succession of the different symptoms, the duration of the aura must be between 5 and 60 minutes, be unilateral, followed or be accompanied by a headache“, explains the neurologist.
The treatment of migraine is based on the eviction of the triggering factors as far as possible, the treatment of the crisis and the basic treatment. “The effectiveness of crisis treatment depends on its precocity. The sooner the patient takes his treatment, the faster the crisis will be relieved. The patient is advised to take 1g of aspirin at the time of the aura or a nonsteroidal anti-inflammatory drug (NSAIDs) to limit the duration of the aura and prevent headache“, says Dr. Roos.
Ophthalmic migraine attacks require resting if possible in total darkness
If the headache still occurs, patients are advised to take the standard treatment for migraine, triptans, which act on specific receptors in the brain. They can be combined to NSAIDs. However, the doctor will insist on the risks of abuse and will remind patients that NSAIDs should not be taken more than 15 days per month and triptans not more than 10 days per month. When this crisis treatment is no longer effective enough or when patients have frequent migraine attacks, doctors can offer a disease-modifying treatment. “This is based on daily intake of 1g of aspirin or amitriptyline, an antidepressant. In the most severe cases, we can offer drugs that are not initially intended for migraine, such as antiepileptics or certain antihypertensives“, describes Dr. Roos. Non-pharmacological approaches have also been proven to relieve patients such as relaxation-sophrology methods And cognitive behavioral therapies which help to better manage stress. On the other hand, the techniques of chiropractic, osteopathy or even homeopathy have not demonstrated their effectiveness. Typically, ophthalmic migraine attacks require a rest of the patient, if possible in total black.
Thanks to Dr Caroline Roos, neurologist and head of the Headache Emergency Center at Lariboisière Hospital (AP-HP).