Just how “different” is Migraine with Aura?

Migraine with aura actually refers to a whole set of clinically different types of migraine. It’s characterized by temporary symptoms such as seeing flashing lights or patterns (visual aura), or a feeling of “pins and needles”, numbness, or problems with speech. (Read more here – Migraine with aura)

So obviously experiencing or not experiencing aura means that the symptoms are somewhat different. But is migraine with aura actually a different disease? Should it be treated differently? Is it doing something different to your body than migraine without aura?

These are questions that doctors and researchers have been struggling with for many years. A new report in The Journal of Headache and Pain is helping to direct the discussion toward future research.

If you really want to delve into the details, you can read the report (and use all the footnotes!) here: Differences in treatment response between migraine with aura and migraine without aura: lessons from clinical practice and RCTs. But here are a few brief thoughts, based on the article, about migraine with aura.

Is Migraine with Aura a “different disease”?

There is a lot of discussion about whether or not we should call migraine a “disease”, but researchers use the word “etiology”. That means, does migraine with aura have a different basis, a different cause. We don’t know what causes migraine, but we have clues.

There are hints that migraine with aura may have a different etiology, but we don’t know for sure. As we’ll see below, it does sometimes respond differently to treatment, and it can affect the body in different ways. Is it just a variation of migraine? Or is it really different?

And this is complicated by the fact that many people experience both migraine with and without aura.

Should treatment be different for Migraine with Aura?

Generally speaking, there has not been a different treatment regimen for migraine with aura. And with good reason – most studies show similar results for both. However, there are some exceptions.

For example, magnesium may work better for those who have aura. Botox may be another example.

A rather interesting example was tonabersat. Don’t feel bad if you haven’t heard of it. It’s a “gap-junction modulator” that actually inhibits the cortical spreading depression in the brain which happens during a migraine attack – and which seems to directly influence aura. In trials, tonabersat at first didn’t seem very effective – until patients with migraine with aura were separated out. Then it was shown that it seems to help only patients with aura.

So if we target the cortical spreading depression (CSD), would that stop the attack in patients with this type of migraine? Well, the jury is still out. We often talk about migraine as a “chain reaction” here, but we’re still not sure if the CSD is just a link in the chain, or if it’s more part of a “web” of biological changes.

However, the study of tonabersat may give us new insights into how migraine should be treated.

Does Migraine with Aura affect the Body differently?

Yes, it seems to. Although other types of migraine may raise your risk of cardiovascular problems (think heart attack, stroke, etc), migraine with aura does seem to uniquely increase your risk of ischemic stroke in particular. There may also be differences in blood flow and the effect on the brain itself.

In many trials, migraine with aura was also more difficult to treat – it simply didn’t respond as well to typical treatments.

Interestingly, one study showed that women with migraine with aura are more likely to suffer from anxiety and depression, compared to those with other types of migraine.

Conclusion

Researchers want to see more studies on targeting migraine aura itself. They also feel that it would be worth it to differentiate more between the two major types of migraine in studies, so that more information can be gathered.

At this point, very little is understood about the difference between types of migraine, other than the differing symptoms. However, it is clear that there are differences beyond symptoms – migraine with aura may be harder to treat, may respond better (or worse) to individual treatments, and does seem to change the brain and body in some different ways.