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What is Persistent Migraine Aura?

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Persistent Migraine Aura

Persistent Migraine Aura (PMA)

persistent aura without infarction

Migraine aura (ie visual) which hangs around for more than a week (and could last for years).

Proper diagnosis:

To be diagnosed, it must occur in a patient who has had previous migraine attacks with aura.  Death of brain cells (infarction), and other related disorders must be ruled out.

Symptoms

Aura symptoms, and especially visual aura symptoms such as:

  • Visual snow
  • Flashing lights
  • Patterns

Treatments

Drugs such as acetazolamide, valproic acid, furosemide, verapamil, and lamotrigine

Nothing has been found that works for everyone.
PMA can be very difficult to treat.

For more information, read Persistent Migraine Aura and Visual Snow? and Visual Snow and Persistent Migraine Aura – tests and treatments

Selected References:  The visual aura rating scale as an outcome predictor for persistent visual aura without infarction. Cephalalgia 2008; The International Classification of Headache Disorders 2nd edition 2003; Is ‘visual snow’ a symptom of migraine? Dr Paul Shanahan; Is Visual Snow a Migraine Aura?; Migraine with Persistent Visual Aura: Response to Furosemide Clinics 2009; It’s snowing! Seven cases of persistent migrainous visual aura Saint Louis University; The visual aura rating scale as an outcome predictor for persistent visual aura without infarction. Cephalalgia 2008

Is Valproic Acid Helpful for Acute Confusional Migraine?

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Valproic acid, and the related compound divalproex acid (Depakote) are very common migraine preventatives.  But their use as abortives – to kill a specific migraine attack – has never been established.

However, some researches still see possibilities, especially in the emergency room.

One case in Israel concerned an adolescent with Acute Confusional Migraine (ACM).  This is a rare migraine manifestation in children, generally those ages 5-16.  During an attack, the patient becomes confused, and usually agitated.  There may be headache before or after this phase of the attack.  The full attack usually lasts from 30 minutes to 24 hours.  The suggestion has been made that this is a clear link between migraine and epilepsy.

In this particular case, a 12 year old girl with ACM was given valproic acid intravenously 3 hours and 45 minutes into the attack.  Within 30 minutes, the girl had recovered fully, and had no symptoms for at least several months.

Another case study, involving a 10 year old girl, involved valproic acid as a preventative (2007).

Further research certainly needs to be done into the use of valproic acid in the emergency room, and especially its use in ACM patients, since there has been very little research done for the treatment of this rare type of migraine.

For the full case report, read Acute Confusional Migraine in an Adolescent: Response to Intravenous Valproate

Visual Snow and Persistent Migraine Aura – tests and treatments

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In the last post we introduced two concepts – visual snow (VS) and persistent migraine aura (PMA).  The first is a specific symptom which can have a number of causes; the second a diagnosis which can include the first.

First, persistent migraine aura (PMA) is diagnosed when other causes are ruled out.  But as we’ve said there are a number of things that can cause visual snow (VS).

Doctors will take a careful drug history for patients with VS, because one cause is hallucinogenic drugs.  The drug may only have been taken once, and time may have passed since it was taken, but it can have permanent effects.

Optic neuritis, an inflammation of the optic nerve, can also be a cause.  Optic neuritis usually develops from an autoimmune disorder.  Read more about optic neuritis here.

There are many other things that can be involved – even vitamin deficiencies.

Dr. Klaus Podoll, Dr. Markus Dahlem and Sofia Greene list common tests that are done for persistent aura symptoms here.  These include:

  • Ophthalmologic examination
  • Neurological examination
  • Psychiatric examination
  • Thorough headache history and family history
  • Thorough drug history (including illegal drugs, especially hallucinogens: LSD, Ecstasy, mushrooms, other?)
  • CAT or MRI of head (the MRI is important to rule out what is called a migrainous infarction)

Other examinations may follow, including an EEG, evoked potentials (a testing of the functioning of the nervous system), blood work, and a lumbar puncture.

Obviously, if anything shows up on these tests, you’ll be following that up.

Assuming these treatments are out of the way, there are some treatments that have been tried, with some success.  There is no tried-and-true established treatment, but some options include:

  • valproic acid
  • acetazolamide
  • lamotrigine (particularly for VS not classified as PMA)
  • topiramate (Topamax)

Sometimes injections of furosemide (frusemide) are used, if other treatments fail.  Clonazepam is also used for patients who have symptoms from hallucinogenic drugs.

Do you have experience with ongoing migraine aura, or visual snow?  Have you found anything that has helped?  How did the symptoms start?

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The articles on Headache and Migraine News are © 2004-2024 J. Cottrill.
Every effort is made to ensure the accuracy of each article, and to point you to further sources of information. However, this site is for informational purposes only and should never replace a visit to your doctor.