Abstract
Background: Migraine with and without aura may have distinct etiologies. Aura can vary in complexity (simple to complex), possibly reflecting differences in cortical involvement and influencing acute treatment response.
Objective: To compare acute treatment responses between migraine patients with and without aura, and across aura complexity levels in Thailand.
Methods: A retrospective cohort study was conducted from January 3, 2007, to June 30, 2022, at the Chulalongkorn Comprehensive Headache Center, King Chulalongkorn Memorial Hospital, Thai Red Cross Society. Baseline data were retrieved from baseline case-record forms, while clinical data were obtained from paper headache diaries and follow-up case-record form. The primary outcome was 2-hour pain-free response; secondary outcomes included pain scores and associated symptoms.
Results: Among 358 patients (110 with aura, 248 without), baseline characteristics were largely similar, except for differences in associated symptoms (photophobia and phonophobia) and the use of antiepileptic drugs for migraine prevention. No significant differences in acute treatment response were found between groups. However, patients with complex aura showed a trend toward better outcomes, with higher 2-hour pain-free rates (44.5% vs. 23.9%) and greater pain duration improvement (33.3% vs. 22.8%) compared to simple aura.
Conclusion: Acute treatment responses did not significantly differ across migraine types, though patients with complex aura may respond better.
DOI
10.56808/2673-060X.5573
First Page
Migraine is a common neurological disorder that consists of four phases: the premonitory, aura, headaches, and postdrome phases; however, not all patients experience all four phases. (1, 2) During the aura phase, cortical spreading depression involving different parts of the cerebral cortex contributes to different aura symptoms, known as aura subtypes. Stimulation of the visual or occipital cortex contributes to visual symptoms, referred to as visual aura; (1 - 3) stimulation of the sensory cortex may contribute to somatosensory symptoms, referred to as sensory aura, (4) and stimulation of the parietal cortex may contribute to language or speech disturbances, referred to as language/speech aura. (5) These three common subtypes are collectively known as typical aura. (6) Other aura subtypes are less common and include motor, brainstem, and retinal aura. (6) Because migraine aura has heterogeneous manifestations, a scale for assessing the complexity of migraine aura has been proposed and developed. (7) The scale categorizes aura into three groups: simple aura, moderately complex aura, and complex aura, which may reflect differences in cortical thickness. (8) However, in clinical practice, migraine with aura can be divided into two subtypes – simple aura and complex aura – according to the classification proposed by Petrušić I, et al. (7) Simple visual aura includes flashing light, flickering lights, stars, zigzags, visual snow, or blind spots, whereas complex visual aura includes perception of disfigurement in the size or shape of objects, discoloration perception, or cracked vision. Simple sensory aura includes
Last Page
Conclusion Specific drugs for the acute treatment of migraine in patients with aura cannot be recommended. In clinical practice, empirical observation of the response to acute treatment may be the best course for migraine with simple or complex aura. More research is needed to understand why those with aura benefit from an acute treatment.
Recommended Citation
Asawavichienjinda, Thanin
(2026)
"Acute treatment response among patients with migraine subtypes: A real-world study in Thailand,"
Chulalongkorn Medical Journal: Vol. 70:
Iss.
6, Article 1.
DOI: https://doi.org/10.56808/2673-060X.5573
Available at:
https://digital.car.chula.ac.th/clmjournal/vol70/iss6/1