aura

28 January 2019

Hard to Talk During a Migraine Attack? You’re not alone!

James Discoveries & Stats, Information 0

If you have trouble talking during a migraine attack – or even before it fully hits you – you’re not alone. Speech problems are a well known, but complex, part of migraine.

Journalist Lindsay Patton-Carson recently wrote about her migrainous struggle with words – and it’s not just speaking them, it’s writing them. She began to connect the dots, she writes, “I did notice that as my migraine frequency increased, my word recollection decreased.”

A recent study set out to look at various specific types of speech disturbances in migraine patients. These were people with “episodic” migraine (not chronic). Using a mobile app, everyone provided three speech samples per day, while tracking their migraine attacks.

This research was not so much studying whether or not people could remember words, but things like pitch of voice, how fast you speak, and how clearly you enunciate (clear pronunciation).

There were, as expected, speech differences in patients with migraine. Not just when they were in the middle of an attack, but all the time (as compared to the control group).

However, the main focus was on changes during the pre-attack phase (prodrome) and the main (normally headache) phase. About half of the patients had significant speech changes during an attack, and about a quarter experienced changes during the pre-attack.

The most significant changes were in how fast and clearly the patient spoke, and “phonatory duration”, an ability to hold a vowel sound (which tends to decrease with age).

Language difficulties (such as slurred speech) are common in migraine – and a common way to diagnose migraine with aura. In an online poll, 90% of our visitors had experienced some kind of language problem related to migraine. It’s well known that there are brain changes during an attack (see Is Your Brain “Slower” During A Migraine Attack?). Interestingly, none of the patients who experienced pre-attack speech issues knew it was happening – it was only found through research of the recordings they made.

This study, though very preliminary, may start to help us understand what types of speech changes are most common and why.

One of the study authors explains

Changes in speech patterns during migraine attacks might be expected given the relatively widespread alterations in brain function and functional connectivity that occur during migraine attacks. The ability to share our thoughts and ideas through spoken communication is a complex and fragile process . . .
Dr. Todd J. Schwedt [source]

Remember, changes in speech and language are not just one thing, and they are complicated. But they’re also common. Yet another reason to fight back against migraine.

Read more here: Migraines can cause altered speech

11 October 2018

Diagnosing Migraine with Aura – New Criteria

James Information 0

Following up on the report about the new International Classification of Headache Disorders 3rd edition (ICHD-3), one of the most interesting changes, though a little technical, was the change in the diagnostic criteria for migraine with aura. This is to say, new more precise ways of diagnosing migraine with aura (MA).

There are many types of migraine, of course, and also many types of migraine with aura. When the beta edition of ICHD-3 came out several years ago, there was concern that MA could be confused with transient ischaemic attacks, or mini-strokes. This is one reason why more specific details were added to the definition.

Migraine aura So let’s take a quick look.

First, in order to actually be diagnosed with MA, you need to have more than one attack. That hasn’t changed. Also, it’s still possible that you could fit the criteria below, but you better fit a different diagnosis.

Next, you obviously need to experience an “aura”. In migraine, aura is something temporary, or “reversible”. Possible aura types include:

visual (such as seeing flashing lights or patterns)
sensory (often a “tingling” sensation)
speech and/or language (such as slurred speech)
motor (weakness)
brainstem (various specific auras, including vertigo or impaired hearing)
retinal (for example, vision loss in one eye)

We won’t get into the details of all of these. Some of these will help doctors diagnose what type of MA you have – remember, there are several sub-types. All you need is one of these symptoms to receive the MA diagnosis.

It’s interesting that these symptoms usually come in a predictable order, as the migraine chain-reaction spreads.

Finally, to be diagnosed with MA you must have at least three of the following six characteristics:

At least one aura symptom spreads gradually over 5 minutes or more.
Two or more aura symptoms occur in succession (has this ever happened to you? It’s probably more common than you think. This was added for clarification since the beta version.)
Each individual aura symptom lasts 5-60 minutes (so, yes, auras could last several hours if there are several auras. Note that motor symptoms are an exception – they could last for 2-3 days.)
At least one aura symptom is unilateral – on only one side.
At least one aura symptom is positive (for example, seeing flashing lights is positive, partial blindness is negative.)
The aura is accompanied, or followed within 60 minutes, by headache (presumably the aura ends, and then within 60 minutes there’s a headache. Or they overlap.

Note that these are aura symptoms, not prodrome symptoms. The difference is that the prodrome may start hours or even a day or two before the attack. It’s often less defined, but may include feeling tired or “heavy”, or having neck stiffness, or having unusual trouble concentrating.

Many of the above symptoms are shared with transient ischaemic attack (TIA), but it’s hoped that the specific details will help rule out TIA. The key symptom of TIA is one-sided weakness or numbness, although other symptoms such as vertigo or vision loss are not uncommon. Learn more about transient ischaemic attack here.

Of course, in either case, it’s best to see a neurologist who can confirm a diagnosis for you, and help you avoid even more serious problems down the road.

For details about various types of migraine with aura, click through the list here.

7 September 2018

Another Reminder: Retinal Migraine may not be what it seems…

James Information, Tips 0

There has been a lot of confusion about retinal migraine over the years. We’ve all heard of migraine with aura – an attack which includes “aura” symptoms, usually visual.

Retinal migraine is a specific type of migraine with aura. It involves symptoms such as blindness, a blind spot, or patterns/flashes of light, but only in one eye. And always temporary.

Aura symtpoms - but what cause? Recently a report was published about a 47 year old woman who was diagnosed with retinal migraine. She had temporary blindness in one eye, and headache on the same side. This went on for a year, then 15 months.

Medication was a help – in this case, topiramate and propranolol.

But when these were discontinued, the symptoms eventually returned.

Now as we’ve talked about before (see “What is Retinal Migraine?”), it’s very important to see a doctor and rule out other possible diagnoses. In this case, it wasn’t migraine at all, but something else that looked a lot like it.

This woman actually had isolated orbital vasculitis, which involves an inflammation of the walls of certain blood vessels. When treatment for this condition was give (steroid pulse therapy), the symptoms cleared up completely.

The correct diagnosis was finally made using high-resolution vessel wall magnetic resonance imaging.

There are many conditions that “look like” various types of headache conditions, and may be resolve or temporarily resolve or appear to resolve using standard medication. But it’s still important to investigate other possibilities. In this case, it would have saved one woman months of disabling symptoms.

14 November 2016

Could You Diagnose This Man?

James Discoveries & Stats 0

He comes into the emergency room, helped along by a friend because he’s having trouble walking. He’s confused, and can’t really understand what the doctors and nurses are saying. He’s having trouble talking.

When you can’t communicate, it’s pretty hard to make a good diagnosis. And problems communicating certainly can be a reality with migraine. Difficulty speaking and/or understanding speech is one of the possible symptoms.

If you had been in the emergency room when this man came in, you might have thought he was drunk. But he wasn’t. You might then realize that he was having trouble with one side of his body. Could it be a stroke? Possibly. He’s in his early 20s, so stroke is possible, though a little more unexpected.

Hemiplegic Migraine Emergency Eventually you find out from his friend that this has happened before, and that the man has a history of migraine. Could it be a migraine attack? It could, but you have to rule out some other things first. And if it is migraine – what kind? And what treatment would be best?

Hopefully you’re not suffering as this man is, and you’re not going to have the frustration the doctor has, because I’m going to tell you his condition. This man is suffering from an attack of hemiplegic migraine.

Hemiplegic migraine is rare, but it’s actually tricky to know just how common it is, because it’s misdiagnosed so often. MS? Epilepsy? A stroke? But in this case, no. One-sided paralysis, confusion, a feeling of “pins-and-needles” – all symptoms of hemiplegic migraine (HM).

This story is based on a real person. 24 years old, he suffered from repeated attacks of migraine since he was 4 years old. His symptoms were temporary, followed by extreme sleepiness. And researchers in Luxembourg and Belgium hope that his case will help others learn how to diagnose HM more quickly.

In a case report published last month, the suggestion was made that doctors consider HM when migraine symptoms are very unusual – that is, there is aura, but not only aura. The key in HM is motor weakness – weakness or paralysis on one side of the body. This might not always be the case, or might not even be noticed or remembered. But with the help of the patient and friends and family, the diagnosis can be helped along.

Another possible symptoms that they mentioned is a temporary encephalopathy, or changed mental state, brought on by mild trauma to the head.

Weakness, trouble thinking/talking, paralysis – these should be signs that the doctor should dig a little deeper. When HM is suspected, genetic testing is helpful. A full family medical history is also critical.

To read the whole article, see Hemiplegic Migraine Presenting with Prolonged Somnolence: A Case Report. And remember – take migraine seriously, even if it takes some work to understand it.

6 August 2015

The Ophthalmic Migraine Kaleidoscope

James Information 7

Some people report a certain visual hallucination due to migraine – seeing kaleidoscopes. What exactly does this mean?

Some people talk about the ophthalmic migraine kaleidoscope. “Ophthalmic Migraine” is actually not a specific kind of migraine, but it’s a term that’s sometimes used to refer to migraine with visual disturbances or “aura”. Sometimes ophthalmic migraine refers specifically to a migraine attack in which there are visual symptoms but no headache. The diagnosis either way would be a type of migraine with aura.

But what is this ophthalmic migraine kaleidoscope?

As most people know, a kaleidoscope is made from a tube that has loose pebbles or beads or other colourful things that are reflected inside by mirrors. The when you look in the tube and turn it, the light shines in the other end and you see moving, colourful shapes, such as in the picture to the left.

Patients occasionally describe these migraine auras as kaleidoscopes. Podoll and Robinson’s Migraine Art describes the experiences of some patients as recorded in medical literature:

octagonal kaleidoscopic geometric figures fitted together in ten colors

kaleidoscopic images

a crimson area with an ever-moving pattern like a kaleidoscope

flower kaleidoscope Even though these auras are not always specifically described as kaleidoscopes, there are a number of similar descriptions. Flower patterns, for example. Webs, spirals and lattices. Very specific mosaic patterns are also described. Take for example this description from a patient:

It was an irregular shape composed of five-and-six-sided units, which were largest in the center of the shape and smaller at the edges. Clusters of units were revolving and each individual unit was revolving; it was all swirling and moving all the time. In the middle, the units tended to be blue and orange, those around them were red and green, but there was no very clear demarcation into zones. Colors were intense and brilliant like stained glass windows full of light…

Sounds like a kaleidoscope to me!

Of course not all auras are like an ophthalmic migraine kaleidoscope. But why patterns at all?

The aura images, such as the ones described above, are a result of activity in the brain. The cortical spreading depression is a kind of “brain storm” that spreads across the brain, bringing strange symptoms with it.

It has been hypothesized that the shapes some people see are actually a representation of how parts of the brain work. It’s like you’re seeing a “reflection” of the setup of part of your brain. (Read more in Why Migraine Auras are the way the are)

The visual disturbances are usually treated with ordinary migraine treatments, such as magnesium, triptan medications, lifestyle changes, and so on.

If you have experienced kaleidoscope auras, tell us about it – or better yet, draw a picture and submit your artwork here.

I’ll close with the words of someone else who took the time to represent their migraine aura in art:

I felt separate from the real world, and when I closed my eyes I could see flashes of color and light. . . . I became almost mesmerized by what I was seeing behind my eyelids.”

All quotes taken from Migraine Art: The Experience from Within.

Migraine Fractal