| IHS | Diagnosis | ICD-10 |
|---|---|---|
| 1.2.1 | Typical aura with migraine headache | G43.10 |
Description:
Typical aura consisting of visual and/or sensory and/or speech symptoms. Gradual development, duration no longer than one hour, a mix of positive and negative features and complete reversibility characterise the aura which is associated with a headache fulfilling criteria for 1.1 Migraine without aura.
Diagnostic criteria:
- At least 2 attacks fulfilling criteria B-D
- Aura consisting of at least one of the following, but no motor weakness:
- fully reversible visual symptoms including positive features (eg, flickering lights, spots or lines) and/or negative features (ie, loss of vision)
- fully reversible sensory symptoms including positive features (ie, pins and needles) and/or negative features (ie, numbness)
- fully reversible dysphasic speech disturbance
- At least two of the following:
- homonymous visual symptoms1 and/or unilateral sensory symptoms
- at least one aura symptom develops gradually over ≥5 minutes and/or different aura symptoms occur in succession over ≥5 minutes
- each symptom lasts ≥5 and ≤60 minutes
- Headache fulfilling criteria B-D for 1.1 Migraine without aura begins during the aura or follows aura within 60 minutes
- Not attributed to another disorder2
Notes:
- Additional loss or blurring of central vision may occur.
- History and physical and neurological examinations do not suggest any of the disorders listed in groups 5-12, or history and/or physical and/or neurological examinations do suggest such disorder but it is ruled out by appropriate investigations, or such disorder is present but attacks do not occur for the first time in close temporal relation to the disorder.
Comments:
This is the most common migraine syndrome associated with aura. The diagnosis is usually evident after a careful history alone though there are rare secondary mimics including carotid dissection, arteriovenous malformation and seizure.
Visual aura is the most common type of aura, often presenting as a fortification spectrum, ie, a zigzag figure near the point of fixation that may gradually spread right or left and assume a laterally convex shape with an angulated scintillating edge leaving variable degrees of absolute or relative scotoma in its wake. In other cases, scotoma without positive phenomena may occur; this is often perceived as being of acute onset but, on scrutiny, usually enlarges gradually. Next in frequency are sensory disturbances in the form of pins and needles moving slowly from the point of origin and affecting a greater or smaller part of one side of the body and face. Numbness may occur in its wake, but numbness may also be the only symptom. Less frequent are speech disturbances, usually dysphasic but often hard to categorise. If the aura includes motor weakness, code as 1.2.4 Familial hemiplegic migraine or 1.2.5 Sporadic hemiplegic migraine.
Symptoms usually follow one another in succession beginning with visual, then sensory symptoms and dysphasia, but the reverse and other orders have been noted. Patients often find it hard to describe their symptoms in which case they should be instructed in how to time and record them. After such prospective observation the clinical picture often becomes clearer. Common mistakes are incorrect reports of lateralisation of headache, of sudden onset when it is gradual and of monocular visual disturbances when they are homonymous, as well as incorrect duration of aura and mistaking sensory loss for weakness. After an initial consultation, use of an aura diary may clarify the diagnosis.
