A Migraine attack can have up to four phases - prodrome, aura, headache, and postdrome. The aura is generally thought to be a separate phase that precedes the headache. During a clinical trial of transcranial magnetic stimulation (TMS) for Migraine, it was necessary to collect data that allowed researchers to evaluate the timing of the aura phase relative to headache and other Migraine symptoms. Researchers used this data for a prospective study¹  presented at the American Headache Society's annual scientific meeting in June.

Study objective:

"The objective of the study was to examine a large number of prospectively recorded attacks of Migraine with aura and determine the timing of aura relative to headache and other Migraine symptoms."¹

Study methods:

• 267 patients were enrolled from 16 centers and trained to use an electronic Migraine diary for a month.
• Participants were asked to record Migraine with aura and their symptoms and treat with the TMS device as soon as possible after the beginning of aura, always within one hour of aura beginning.
• A total of 456 Migraine attacks were reported in 320 participants during Phase I.
• 201 participants were included in Phase II, and a total of 405 Migraine attacks were reported in 164 participants.
• In total, researchers examined data on 861 attacks of Migraine with aura.

Study results:

• 72.9% of the participants reported headache already started during the aura phase.
• Other symptoms also frequently reported during the aura included:
  • nausea: 51%
  • photophobia: 88%
  • phonophobia: 83%
• In Phase I, during which 456 attacks were recorded, the headache was recorded in relation to the timing of the aura. 59% of participants reported headache fulfilling ICHD-II for Migraine during the first 0-15 minutes of aura.

Study conclusions:

"Our results indicate that headaches as well as associated Migraine symptoms are present early, during the aura phase in the majority of patients."¹

I asked two of the researchers from this study to give us a bit more perspective from their stand point. Dr. Peter. J. Goadsby of the University of San Francisco Headache Center told me:

"The work presented at the recent meeting of the American Headache Society showing that a substantial number of patients with aura have headache at the same time challenges received wisdom, and gives focus to the importance of carefully collected patient-centered data. Moreover, it provides new understanding of how pain and aura symptoms may be inter-related that will no doubt help thinking about new therapies."²

Dr. Stephen D. Silberstein of the Jefferson Headache Center commented:

"We used to simplistically believe that the migraine aura precedes and even causes the headache, good clinical observation often put bad theories to rest. The aura and headache of migraine are independent."³

Summary and comments:

If you're like me and have sometimes looked at the list of aura symptoms and the list of headache phase symptoms and wondered if your Migraines were strange because of the timing of the symptoms, this study shows us that we're actually in the majority.