Causes and risk factors
Exact cause of aura is not known. Two neurochemicals are found to be responsible for development of aura such as dopamine and serotonin. Dysfunctioning of these chemicals cause immune system to overreact. Immune response cells are flooded through the blood vessels to the brain. This leads to constriction of blood vessels causing ‘aura’. This is followed by dilatation of blood vessels causing migraine headache. Migraines may be caused by abnormal brain activity, which are triggered by number of factors like alcohol, smoking, stress, anxiety, certain odours or perfumes, loud noises, bright lights. But the exact cause is not understood. It is believed the attack begins in the brain, and involves nerve pathways and chemicals. Other factors that trigger migraine include caffeine withdrawal, hormonal changes during menstrual cycle, use of birth control pills, changes in sleep patterns, change in weather, exercise or other physical stress, missed meals, certain foods that trigger migraine include baked goods, chocolate, nuts, peanut butter, and dairy products, and certain beans, fruits such as avocado, banana, processed, fermented, pickled, or marinated foods etc.
Clinical presentation
Patients may experience few changes, one or two days before a migraine, which include constipation, food cravings, hyperactivity, irritability, depression, stiffness of neck, uncontrollable yawning. The person has a warning sign, called as aura. An aura is a group of symptoms usually visual disturbances. Seeing various shapes, bright spots or flashes of light, vision loss is experienced. Sometimes it may include movement or speech disturbance. There is a pins and needles sensation in an arm or leg. It is followed by actual symptoms of migraine. Pain on one side or both sides of your head starts as a dull ache and get worse within minutes, throbbing and pulsating pain, sensitivity to light, sounds and sometimes smells, nausea and vomiting, blurred vision, light headedness, sometimes followed by fainting. A migraine usually lasts from four to 72 hours. Attack of migraine is followed by feeling fatigued, weak and drained out.
Investigation
Medical history by the patient and Clinical examination by the doctor helps in diagnosis. Routine Blood tests are recommended. Imaging studies such as CT scan, MRI will help to rule out any tumours, infections, brain damage or bleeding in brain. Spinal tap [lumbar puncture] is advised. Electroencephalogram [EEG] to rule out seizures is done.
Treatment
There is no specific cure for migraine. Treatment is focused on relieving the pain and preventing the migraine attacks. Several medications are used for treating migraine. Medications are prescribed either to relieve the pain or symptoms, these are pain relieving medications or to reduce the severity or frequency of the migraines, these are preventive medications. Pain relieving medications include –analgesics, NSAIDs. Sometimes sedatives are also prescribed by doctors. Anti emetics are required in case of nausea and vomiting. Preventive medications include – Antidepressants, anti hypertensive medicines, anti epileptic i.e. Seizure medicines which contribute further to the treatment.
Other Modes of treatment
The other modes of treatment can also be effective in treating migraine with aura.
Homoeopathy is a science which deals with individualization considers a person in a holistic way. This science can be helpful in combating the symptoms. Similarly the ayurvedic system of medicine which uses herbal medicines and synthetic derivates are also found to be effective in treating migraine with aura.
