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Aura has long been a favorite aspect of migraine among neurologists, with luminaries such as Gowers1 providing some very clear clinical descriptions of attacks. In practice most physicians will see migraine aura manifesting as visual symptoms, although sensory and motor symptoms are well described.2 The report of missense mutations in voltage-gated P/Q type calcium channels in approximately 50% of patients with familial hemiplegic migraine (FHM)3 threw considerable light specifically on FHM and more generally on migraine with aura. The wonderfully careful clinical characterization of patients with sporadic hemiplegic migraine by Thomsen et al. in this issue of Neurology draws attention to their clinical phenotype, introduces the second edition of the International Headache Society (IHS) classification, and offers some insights into aura more generally.4
The patients described by Thomsen et al. 4 …
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