title: Variability of clinical features in attacks of migraine with aura.
abstract: BACKGROUND
  There is significant variability in the clinical presentation of migraine, both among patients, and between attacks in an individual patient. We examined clinical features of migraine with aura in a large group of patients enrolled in a clinical trial, and compared retrospective migraine attack characteristics reported upon enrollment in the trial with those recorded prospectively in the trial.
  
  
  METHODS
  Patients with migraine (n = 267) with typical visual aura in more than 30% of their attacks were enrolled from 16 centers for a clinical trial. Upon enrollment, patients provided a detailed retrospective description of the clinical features of their attacks of migraine. During the trial, clinical symptoms in migraine attacks starting with aura were recorded prospectively in 861 attacks.
  
  
  RESULTS
  Retrospectively reported visual aura symptoms were variable and often overlapping; the most common symptoms were dots or flashing lights, wavy or jagged lines, blind spots, and tunnel vision. Multiple patients reported more than one visual phenomenon. Approximately half of the patients reported nonvisual aura symptoms, the most common were numbness and tingling, followed by difficulty in recalling or speaking words. A significant percentage of patients also reported a change in olfaction. There were several inconsistencies between the features of prospectively recorded and retrospectively reported attacks. Headache, nausea, photophobia, and phonophobia were all less common in prospectively recorded attacks as compared with retrospective reporting. Nausea was prospectively recorded in only 51% of attacks and mostly with mild intensity. The occurrence and severity of nausea was reduced with advancing patient age. Phonophobia was not consistently recorded in conjunction with photophobia.
  
  
  CONCLUSIONS
  These findings are consistent with variable involvement of different brain regions during a migraine attack. The variable occurrence of nausea, and phonophobia in conjunction with photophobia, both defining features of migraine, may be an important consideration in designing clinical studies of migraine in which prospectively recorded attacks are diagnosed based on these clinical features.
authors.affiliation: Headache Research and Treatment Program, Department of Neurology, University of California Los Angeles, USA jmh@dadlnet.dk.
authors.forename: Jakob M
authors.initials: JM
authors.lastname: Hansen
authors.affiliation: Headache Group, Clinical Neurosciences and NIHR-Wellcome Trust Clinical Research Facility, King's College London, UK.
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Goadsby
authors.affiliation: Headache Research and Treatment Program, Department of Neurology, University of California Los Angeles, USA.
authors.forename: Andrew C
authors.initials: AC
authors.lastname: Charles
mesh_terms: D000328:Adult; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D020325:Migraine with Aura / Q000628:therapy; D050781:Transcranial Magnetic Stimulation; D055815:Young Adult
keywords: Migraine aura; RCT; clinical characteristics; cohort study; cortical spreading depression; prospective recordings