There are a number of rare complications of migraines, and persistent migraine aura without infarction (PMA) is one of them. In a persistent aura without infarction, your aura doesn’t go away, even after the onset of the migraine headache.
The most important feature of persistent migraine aura without infarction is the migraine aura itself. An aura is a reversible neurological disturbance that may precede or accompany a migraine headache. Typical auras last between five and 60 minutes, but in PMA, your aura can persist for a week or more.
Also, the persistent aura is not due to any problems with the brain, so a computerized tomography (CT) or magnetic resonance imaging (MRI) of the brain will show no evidence of stroke as it would in another migraine complication, called migrainous infarction (migraine-related stroke).
Many people experience visual disturbances during an aura. These symptoms are the same in persistent migraine aura without infarction, only they last longer. Visual changes can include:
- Seeing zigzag lines
- Seeing flashing lights
- Visual hallucinations
- Temporary blind spots (scotomas)
- Blurred vision
Even though most auras involve vision problems, neurological symptoms are possible as well, including a tingling sensation or numbness in a limb or on one side of the face, and/or speech and language difficulties.
Other symptoms that may signal the onset of a migraine of any type are called premonitory symptoms. They usually begin hours to days before the pain begins and should not be confused with an aura. Premonitory symptoms include:
- Loss of appetite or food craving
- Change in activity (more or less active)
- Low mood
- Frequent yawning
- Neck stiffness
The cause of migraines with aura and of PMA is unknown, though the aura may be owed to a type of electrical disturbance in the brain that creates the visual changes. The triggers are similar to that of migraines without aura: stress, hormonal changes, certain foods, bright light, and not getting enough sleep.
To confirm the diagnosis of persistent migraine aura without infarction, you must have visual symptoms consistent with migraine with aura that last one week or longer and no evidence of a stroke on a CT scan or MRI.
As such, your doctor will review your symptom history and conduct one or both of these imaging tests to reach this diagnosis. Keeping a diary of your symptoms can help paint a picture of what you’re experiencing for your physician.
In most cases, typical migraine medications, such as triptans and ergot alkaloids, are not effective for treating persistent migraine aura without infarction. There are some reports that treating PMA with Diamox (acetazolamide) or Depakote (valproic acid) may be helpful. A 2014 study in Headache found that the anti-seizure medication Lamictal (lamotrigine) may be the most effective medication for treating PMA.
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If you have a migraine aura that lasts longer than an hour, be sure to contact your healthcare provider so you can be evaluated. He or she will want to rule out other more serious medical issues, like a stroke or an injured retina, before determining that you have persistent migraine aura without infarction.