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Up to 30% of migraine patients may have attacks with aura.1 Aura symptoms nearly always (99%) include visual disturbances, such as an enlarging or moving scotoma, sometimes together with sensory, aphasic, or motor symptoms. Cortical spreading depression (a depolarization wave across the brain cortex) is believed to be the underlying mechanism for a migraine aura, and observed vascular changes are considered epiphenomena. It is likely that there is an individual threshold for spreading depression, influenced by genetic factors.1
In migraine aura status, patients experience a large number of consecutive (mostly) visual auras, very often without headache.2 Between the auras, the patient is without symptoms. Episodes can last for weeks, and within this period several migraine auras can occur on one day. An aura status generally resolves spontaneously, but during the episodes most patients are greatly bothered by it and cannot perform their daily activities. The treatment of migraine aura status is unknown. One patient failed to improve on daily doses of aspirin, and subsequently appeared to improve on cyproheptadine.2 Other reports of treatments for aura status are lacking.
In the last few years, seven patients with aura status visited our outpatient clinic. The history of the patients was stereotyped: a sudden and unexplained increase of the frequency of visual auras (with or …
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