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Distinctive anatomical and physiological features of migraine aura revealed by 18 years of recording

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Hansen, Jakob Møller ; Baca, Serapio Michael ; Vanvalkenburgh, Paul ; Charles, Andrew. / Distinctive anatomical and physiological features of migraine aura revealed by 18 years of recording. In: Brain. 2013 ; Vol. 136, No. Pt 12. pp. 3589-95.

Bibtex

@article{6595c2302f3d436cb8addd1cc8f51216,
title = "Distinctive anatomical and physiological features of migraine aura revealed by 18 years of recording",
abstract = "The mechanisms underlying the initiation and propagation of the migraine aura, and the visual percept that is produces, remain uncertain. The objective of this study was to characterize and quantify a large number of visual auras recorded by a single individual over nearly two decades to gain insight into basic aura mechanisms. An individual made detailed drawings of his visual percept of migraine aura in real time during more than 1000 attacks of migraine aura without headache over 18 years. Drawings were made in a consistent fashion documenting the shape and location of the aura wavefront or scotoma in the visual field at one minute intervals. These drawings were digitized and the spatial and temporal features of auras were quantified and analysed. Consistent patterns of aura initiation, propagation and termination were observed in both right and left visual fields. Most aura attacks originated centrally (within 10° eccentricity), but there were also other distinct sites of initiation in the visual field. Auras beginning centrally preferentially propagated first through lower nasal field (69-77% of all auras) before travelling to upper and temporal fields, on both sides. Some auras propagated from peripheral to central regions of the visual field-these typically followed the reverse path of those travelling in the opposite direction. The mean velocity of the perceived visual phenomenon did not differ between attacks starting peripherally and centrally. The estimated speed of the underlying cortical event (2-3 mm/min) was in the same range as has been previously reported by others. Some auras had limited propagation and spontaneously 'aborted' after a few minutes, despite being initiated in similar locations to those that spread throughout the entire visual field. The visual percept of the aura changed corresponding with the presumed propagation from the V1 to the V2 region of the occipital cortex. In some cases the visual percept disappeared for several minutes before reappearing in a distant location, providing direct evidence that the aura can be clinically 'silent'. These results indicate that there can be multiple distinct sites of aura initiation in a given individual and suggest that the spatial pattern of propagation in the occipital cortex is non-concentric with a variable extent of propagation. The visual percept of migraine aura changes depending on the region of the occipital cortex that is involved.",
keywords = "Aged, Caffeine, Drug Combinations, Ergotamine, Humans, Longitudinal Studies, Male, Migraine with Aura, Time Factors, Visual Cortex, Visual Fields, Visual Perception",
author = "Hansen, {Jakob M{\o}ller} and Baca, {Serapio Michael} and Paul Vanvalkenburgh and Andrew Charles",
year = "2013",
month = dec,
doi = "10.1093/brain/awt309",
language = "English",
volume = "136",
pages = "3589--95",
journal = "Brain",
issn = "0006-8950",
publisher = "Oxford University Press",
number = "Pt 12",

}

RIS

TY - JOUR

T1 - Distinctive anatomical and physiological features of migraine aura revealed by 18 years of recording

AU - Hansen, Jakob Møller

AU - Baca, Serapio Michael

AU - Vanvalkenburgh, Paul

AU - Charles, Andrew

PY - 2013/12

Y1 - 2013/12

N2 - The mechanisms underlying the initiation and propagation of the migraine aura, and the visual percept that is produces, remain uncertain. The objective of this study was to characterize and quantify a large number of visual auras recorded by a single individual over nearly two decades to gain insight into basic aura mechanisms. An individual made detailed drawings of his visual percept of migraine aura in real time during more than 1000 attacks of migraine aura without headache over 18 years. Drawings were made in a consistent fashion documenting the shape and location of the aura wavefront or scotoma in the visual field at one minute intervals. These drawings were digitized and the spatial and temporal features of auras were quantified and analysed. Consistent patterns of aura initiation, propagation and termination were observed in both right and left visual fields. Most aura attacks originated centrally (within 10° eccentricity), but there were also other distinct sites of initiation in the visual field. Auras beginning centrally preferentially propagated first through lower nasal field (69-77% of all auras) before travelling to upper and temporal fields, on both sides. Some auras propagated from peripheral to central regions of the visual field-these typically followed the reverse path of those travelling in the opposite direction. The mean velocity of the perceived visual phenomenon did not differ between attacks starting peripherally and centrally. The estimated speed of the underlying cortical event (2-3 mm/min) was in the same range as has been previously reported by others. Some auras had limited propagation and spontaneously 'aborted' after a few minutes, despite being initiated in similar locations to those that spread throughout the entire visual field. The visual percept of the aura changed corresponding with the presumed propagation from the V1 to the V2 region of the occipital cortex. In some cases the visual percept disappeared for several minutes before reappearing in a distant location, providing direct evidence that the aura can be clinically 'silent'. These results indicate that there can be multiple distinct sites of aura initiation in a given individual and suggest that the spatial pattern of propagation in the occipital cortex is non-concentric with a variable extent of propagation. The visual percept of migraine aura changes depending on the region of the occipital cortex that is involved.

AB - The mechanisms underlying the initiation and propagation of the migraine aura, and the visual percept that is produces, remain uncertain. The objective of this study was to characterize and quantify a large number of visual auras recorded by a single individual over nearly two decades to gain insight into basic aura mechanisms. An individual made detailed drawings of his visual percept of migraine aura in real time during more than 1000 attacks of migraine aura without headache over 18 years. Drawings were made in a consistent fashion documenting the shape and location of the aura wavefront or scotoma in the visual field at one minute intervals. These drawings were digitized and the spatial and temporal features of auras were quantified and analysed. Consistent patterns of aura initiation, propagation and termination were observed in both right and left visual fields. Most aura attacks originated centrally (within 10° eccentricity), but there were also other distinct sites of initiation in the visual field. Auras beginning centrally preferentially propagated first through lower nasal field (69-77% of all auras) before travelling to upper and temporal fields, on both sides. Some auras propagated from peripheral to central regions of the visual field-these typically followed the reverse path of those travelling in the opposite direction. The mean velocity of the perceived visual phenomenon did not differ between attacks starting peripherally and centrally. The estimated speed of the underlying cortical event (2-3 mm/min) was in the same range as has been previously reported by others. Some auras had limited propagation and spontaneously 'aborted' after a few minutes, despite being initiated in similar locations to those that spread throughout the entire visual field. The visual percept of the aura changed corresponding with the presumed propagation from the V1 to the V2 region of the occipital cortex. In some cases the visual percept disappeared for several minutes before reappearing in a distant location, providing direct evidence that the aura can be clinically 'silent'. These results indicate that there can be multiple distinct sites of aura initiation in a given individual and suggest that the spatial pattern of propagation in the occipital cortex is non-concentric with a variable extent of propagation. The visual percept of migraine aura changes depending on the region of the occipital cortex that is involved.

KW - Aged

KW - Caffeine

KW - Drug Combinations

KW - Ergotamine

KW - Humans

KW - Longitudinal Studies

KW - Male

KW - Migraine with Aura

KW - Time Factors

KW - Visual Cortex

KW - Visual Fields

KW - Visual Perception

U2 - 10.1093/brain/awt309

DO - 10.1093/brain/awt309

M3 - Journal article

C2 - 24264937

VL - 136

SP - 3589

EP - 3595

JO - Brain

JF - Brain

SN - 0006-8950

IS - Pt 12

ER -

ID: 45515155