Aura, then Headache? What’s Your Sequence?
When we talk about the different phases of migraine – we throw around words like prodrome, aura, headache, and so on – you might get the idea that the phases come in a sequence, one after another.
Well, there does tend to be a sequence – in other words, usually you don’t have aura and then headache. But the phases are not always clear-cut stages.
Dr. Jakob M. Hansen from Glostrup Hospital in Denmark, has done some work on auras and migraine. He gave a report about aura at the annual meeting of the American Headache Society.
His study suggested that the headache phase – and other symptoms – may start sooner in many patients.
This is what seemed to happen within 15 minutes of the start of migraine aura:
How does that compare with your experience?
Dr. Hansen, as quoted at Clinical Neurology News:
These results do not seem to be consistent with the current ICHD-2 [International Classification of Headache Disorders, second edition] classification that states that migraine headache usually follows the aura symptoms; that’s not the case here.
“Furthermore, we have already headache at the onset of aura, and that does seem to conflict with the idea that you have to have a [cortical] spreading depression to activate the trigeminovascular system to cause headache.
These data suggest that the phases of migraine attack may not be as discrete as originally believed. This is food for thought.
Dr. Hansen is not the only one who has seen this in real life. Dr. Alexander Mauskop has seen a few (though a minority) of patients report aura and headache starting at the same time. Dr. Werner Becker of the University of Calgary also reported seeing nausea, and sensitivity to light and sound, very early in the migraine chain-reaction.
This report is a change from what many migraine specialists have long believed. On the other hand, some like Dr. Mauskop intend to question their patients more closely regarding the sequence of events. Knowing what happens when gives us clues into what goes on in the brain, and helps us get the proper treatment sooner.