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Abstract Background There is limited literature on prolonged aura (PA - defined as an aura including at least one symptom for > 1 h and 2 h (n = 23) or > 4 h (n = 14) with the the others (n = 193 and n = 202 respectively). Conclusion PAs are quite common. They do not differ from the other auras (even when their duration extends to 2 and/or 4 h) with the exception of a higher number of non-VS.

Migraine is a common headache disorder characterized by often-severe headaches that may be preceded or accompanied by a variety of visual symptoms. Although a typical migraine aura is not difficult to diagnose, patients with migraine may report several other visual symptoms, such as prolonged or otherwise atypical auras, “visual blurring”, “retinal migraine”, “ophthalmoplegic migraine”, photophobia, palinopsia, and “visual snow”. Here, we provide a short overview of these symptoms and what is known about the relationship with migraine pathophysiology. For some symptoms, the association with migraine is still debated; for other symptoms, recent studies indicate that migraine mechanisms play a role.

Background: According to ICHD-II, and as proposed for ICHD-III, non-hemiplegic migraine aura (NHMA) symptoms lastbetween five and 60 minutes whereas hemiplegic migraine aura can be longer. In ICHD-III it is proposed to label auralonger than an hour and less than a week as probable migraine with aura.We tested whether this was appropriate basedon the available literature.Methods:We performed a systematic literature search identifying articles pertaining to a typical or prolonged duration ofNHMA. We also performed a comprehensive literature search in order to identify all population-based studies or caseseries in which clinical features of NHMA, including but not restricted to aura duration, were reported, in order to gain acomplete coverage of the available scientific data on aura duration.Results: We did not find any article exclusively focusing on the prevalence of a prolonged aura or more generally ontypical NHMA duration. We found 10 articles that investigated NHMA features, including the aura duration. Five articlesrecorded the proportion of patients in whom whole NHMA lasted for more than one hour, which was the case in 12%-37% of patients. Six articles reported some information on the duration of single NHMA symptoms: visual aura disturbanceslasting for more than one hour occurred in 6%-10% of patients, sensory aura in 14%-27% of patients andaphasic aura in 17%-60% of patients.Conclusions: The data indicate the duration of NHMA may be longer than one hour in a significant proportion ofmigraineurs. This seems to be especially true for non-visual aura symptoms. The term probable seems inappropriatein ICHD-III so we propose reinstating the category of prolonged aura for patients with symptoms longer than an hourand less than one week. [ABSTRACT FROM AUTHOR]

Background: Hemiplegic migraine (HM) is a rare variety of migraine with aura, characterized by motor deficits during the aura, often beginning in childhood. The hemiplegic attacks can be severe and prolonged but the prognosis is usually good. Data on neuroimaging, including diffusion-weighted imaging (DWI) and spectroscopy, during prolonged attacks of HM are quite limited, particularly in children.Case: An eight-year-old female had a prolonged attack of sporadic HM characterized by right-sided hemiplegia, global aphasia, fever and impairment of consciousness. MRI nine hours after hemiplegia onset was negative, while the following MRI scans (days 4 and 11) documented a progressive increase in cortical swelling in the left hemisphere with mild hyperintensity on DWI and mild reduction of apparent diffusion coefficient values. Proton MRI spectroscopy (MRS) (day 15) showed a decrease in the N-acetylaspartate/creatine ratio in the left hemisphere. 99mTc-ECD single-photon emission tomography (SPET) (day 27) showed marked left hemispheric hypoperfusion. The patient recovered completely after 40 days and neuroimaging follow-up (MRI and SPET) after six months was normal. The patient carried a missense mutation of the ATP1A2 gene.Conclusion: Multimodal neuroimaging (MRI, DWI, MRS, SPET) in a prolonged HM attack supports evidence for a primary neuronal dysfunction. [ABSTRACT FROM PUBLISHER]

Hemiplegic migraine is a rare form of migraine characterized by periodic attacks of migraine with neurologic aura and transient hemiplegia. There are familial and sporadic cases, both on a genetic basis; we describe the case of a 6-year-old boy affected by sporadic hemiplegic migraine, showing a novel ATP1A2 gene missense mutation (p.Gly715Arg) in exon 16. Long-term treatment with flunarizine resulted in good clinical response and prevention of further attacks. [ABSTRACT FROM AUTHOR]

Migraineurs with frequent aura (>or=1 per month) are at a 12-fold increased risk of posterior circulation infarctions. Although the mechanism is unclear, these lesions are located in the arterial borderzone of the cerebellum. This case illustrates, for the first time, crossed cerebellar diaschisis in a patient with migraine with prolonged aura, and raises the possibility that hypoperfusion may be responsible in part for the development of these lesions. [ABSTRACT FROM AUTHOR]

There have been many reports of the association between migraine headaches and psychiatric disorders as well as of the utility of dopamine antagonists in the treatment of migraine headache. There is increasing evidence to support the activation of dopaminergic systems as a primary component of migraine pathogenesis. This report documents 3 cases of female migraineurs who received the dopamine modulator aripiprazole for treatment of co-occurring psychiatric disorders and experienced a decrease in migraine frequency and severity. A hypothesis as to the mechanism of action of dopamine regulation in migraine treatment is discussed. [ABSTRACT FROM AUTHOR]

Ten patients with migraine with prolonged aura were studied for the presence of mitochondrial DNA point mutations utilizing DNA isolated from blood and hair samples. We analyzed for nine point mutations reported in patients with MELAS (A3243G, C3256T, T3271C, T3291C, A5814G, T8356C, T9957C, G13513A, and A13514G) and three secondary LHON mutations (T4216C, A4917G, and G13708A). None of the patients tested had any of these mutations in mitochondrial DNA. However, one patient was found to have a tRNA(Gln) A4336G mitochondrial DNA variant. From this study it appears that migraine with prolonged aura is not an oligosymptomatic form of MELAS and is not related to secondary LHON mutations. The significance of the tRNA A4336G variant is unknown. [ABSTRACT FROM AUTHOR]

Prolonged migraine auras can be disabling and potentially can cause permanent neurologic deficits. Several medicinal agents have shown some efficacy in aborting prolonged auras, but results are inconsistent. Greater occipital nerve blockade can alleviate the pain of migraine and in 1 case report the migraine aura. Hemiplegic migraine attacks are marked by motor weakness that can last for minutes to days. Two case patients with a history of hemiplegic migraine with prolonged auras are presented, who both had complete alleviation of their aura symptoms with GON blockade. A hypothesis on how GON blockade may inhibit cortical spreading depression is also presented. [ABSTRACT FROM AUTHOR]

Migraine is a common headache disorder characterized by often-severe headaches that may be preceded or accompanied by a variety of visual symptoms. Although a typical migraine aura is not difficult to diagnose, patients with migraine may report several other visual symptoms, such as prolonged or otherwise atypical auras, "visual blurring", "retinal migraine", "ophthalmoplegic migraine", photophobia, palinopsia, and "visual snow". Here, we provide a short overview of these symptoms and what is known about the relationship with migraine pathophysiology. For some symptoms, the association with migraine is still debated; for other symptoms, recent studies indicate that migraine mechanisms play a role., Competing Interests: No competing interests were disclosed.No competing interests were disclosed.No competing interests were disclosed.