Persistent Migraine Aura - The Basics

Patient Expert
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The migraine aura is the second potential phase of a migraine attack. Aura symptoms usually last from five to 60 minutes. Of course, each of us is different, so they could last longer.

When aura symptoms persist for a week or more, however, it's a different matter, and we need to see our doctors. If aura symptoms last this long, it could be a rare form of migraine aura called persistent aura without infarction (an area of tissue death due to obstruction of the local circulation, aka stroke).

For consistency in diagnosing and classifying head pain disorders, the _International Headache Society’_s International Classification of Headache Disorders, 3rd Edition (ICHD-3), is generally accepted as the “gold standard.” This provides standardization of diagnoses, providing guidance and reducing confusion.

The ICHD-3 on Persistent Aura Without Infarction:

1.4.2 Persistent aura without infarction

Description:
Aura symptoms persisting for 1 week or more without evidence of infarction on neuroimaging.

Diagnostic criteria:

  1. Aura fulfilling criterion B
  2. Occurring in a patient with 1.2 Migraine with aura and typical of previous auras except that one or more aura symptoms persists for 1 week or longer
  3. Neuroimaging shows no evidence of infarction
  4. Not better accounted for by another ICHD-3 diagnosis.

Comments:

Persistent aura symptoms are rare but well documented. They are often bilateral and may last for months or years. The 1-week minimum in criterion B is based on the opinion of experts and should be formally studied.

Diagnostic work-up must distinguish 1.4.2 Persistent aura without infarction from 1.4.3 Migrainous infarction, and exclude symptomatic aura as a result of cerebral infarction of other causes. Attacks lasting more than 1 hour and less than 1 week and not fulfilling criteria for 1.2.1 Migraine with typical aura are coded 1.5.2 Probable migraine with aura.

What This Means for Migraine Patients:

Whenever we have new, strange, or frightening symptoms, we need to check in with our doctors. In the case of migraine aura symptoms that last longer than they should, this can be especially important. Many of these same symptoms can be symptoms of infarction or stroke, and it's important to determine which is causing the symptoms. An imaging study may be necessary.

More Helpful Information:

Migraine with Aura and Migrainous Infarction

Migraine with Aura - The Basics

Migraine Aura Can Have Many Variations

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