Migraine aura: differential diagnostics between ophthalmology and neurology
Abstract
Migraine aura is a common and diagnostically important phase of migraine. Approximately 25-35 % of individuals with migraine experience fully reversible focal neurological symptoms that typically develop gradually, spread over time, and occur in succession. Visual symptoms are the most common and include scintillating scotomas, fortification spectra, photopsias (flashes of light), and transient visual field defects. Sensory, language, motor, and brainstem symptoms may also occur. This article reviews the clinical spectrum of migraine aura based on the ICHD-3 diagnostic criteria and its characteristic temporal evolution. Particular emphasis is placed on the recognition of isolated aura without subsequent headache. The gradual onset, progressive spread, and complete resolution of symptoms within 5-60 minutes are key features for the differential diagnosis. Migraine aura should be distinguished from transient ischemic attacks, epileptic phenomena, and retinal disorders. The article also presents migraine aura simulations as a useful tool to support clinical history-taking and patient education.
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