Migraine with Aura Diagnosis and Characteristics

Core Aura Symptoms

The International Headache Society recommends that migraine with aura be diagnosed based on the presence of fully reversible neurological symptoms, most commonly visual disturbances that develop gradually over at least 5 minutes, last 5-60 minutes, and are typically followed by headache within 60 minutes 1
The aura phase consists of one or more of the following fully reversible symptoms, including sensory symptoms, such as hemisensory disturbances, pins and needles, and numbness, which occur in some patients with migraine with aura 1
Speech and/or language disturbances, such as aphasic symptoms, are also common in patients with migraine with aura 1
Motor symptoms, such as weakness, as in hemiplegic migraine, can occur in some patients with migraine with aura 1
Brainstem symptoms, such as dysarthria and vertigo, can also occur in patients with migraine with aura 1
Retinal symptoms, such as monocular visual disturbances, are another type of aura symptom that can occur in patients with migraine with aura 1

The American Academy of Neurology recommends that clinicians recognize the characteristic time course of migraine with aura, which includes a gradual onset of symptoms over at least 5 minutes, distinguishing it from stroke or TIA 1, 2
The aura symptoms typically last 5-60 minutes and are followed by headache within 60 minutes, according to the International Headache Society 1, 3
The symptoms often progress sequentially, with visual symptoms followed by sensory, aphasic, and other symptoms, as noted by the American Headache Society 1, 2

The International Headache Society recommends that at least two attacks must fulfill specific criteria for a formal diagnosis of migraine with aura, including at least three of six characteristics, such as gradual spread over ≥5 minutes, two or more symptoms in succession, and aura accompanied by or followed by headache within 60 minutes 1, 3

The American College of Emergency Physicians recommends that clinicians be aware of critical red flags that require urgent evaluation, including prolonged aura >60 minutes, which requires urgent neuroimaging with MRI to exclude stroke, AVM, or structural lesions 4, 5
Sudden, simultaneous onset of symptoms suggests TIA rather than migraine and requires urgent evaluation, according to the American Stroke Association 1, 2