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Semin Neurol 2019; 39(06): 739-748
DOI: 10.1055/s-0039-1700525
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Migraine Aura: Pathophysiology, Mimics, and Treatment Options

Clare L. Fraser
1   Save Sight Institute, Discipline of Ophthalmology, Faculty of Health and Medicine, The University of Sydney, Australia
,
Jenny L. Hepschke
1   Save Sight Institute, Discipline of Ophthalmology, Faculty of Health and Medicine, The University of Sydney, Australia
2   Department of Ophthalmology, Prince of Wales Hospital, Sydney, Australia
,
Bronwyn Jenkins
3   Department of Neurology, Royal North Shore Hospital, Sydney, Australia
,
Sashank Prasad
4   Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
› Author Affiliations
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Publication History

Publication Date:
17 December 2019 (online)

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Abstract

Recent insights into the clinical presentation and pathophysiology of migraine aura have paved the way for new treatments for this common but frequently debilitating condition. Marked efflux of cellular potassium and glutamate contributes to the cortical spreading depression that forms the electrophysiological basis of migraine aura phenomena. Secondary vascular perturbations also contribute to the various symptoms of a migraine attack. Calcitonin gene-related peptide (CGRP) plays a key role in many of these steps, and a growing class of CGRP-antagonists have emerged as a novel, efficacious preventative therapy. It is still not fully understood why a preponderance of migraine aura symptoms is visual, and this issue is an active area of research. In addition, the pathophysiological changes responsible for visual snow syndrome are under investigation. Before diagnosing a patient with migraine aura, it is important to consider the differential diagnosis of transient visual phenomena, with attention to clinical features that may suggest conditions such as retinal disorders, transient ischemic attack, or occipital epilepsy.

Keywords

migraine - aura - visual snow