title: Migraine: Does aura require investigation?
abstract: OBJECTIVE
  Migraine is a debilitating condition that affects approximately 15% of the general population. It represents a huge proportion of presentations to the emergency department and a significant number of neurology admissions. Patients are often investigated with imaging. This is particularly the case with migraine with aura (MA). The yield of imaging is however low. There is limited information on Australian hospital presentations and utility of imaging. We aimed to analyse the demographics of migraine presentations to our hospital and the yield of imaging in our centre to help guide future approaches to these patients.
  
  
  METHODS
  We retrospectively looked at medical records of patients presenting to the western health from January 2012 to June 2013. Patients were classified as either having migraine with aura or without. Baseline demographics, cardiovascular risk factors and imaging studies (CT brain, MRI brain and carotid Doppler studies) in each group were evaluated. Patients found to have white matter hyperintensities on MRI were further evaluated.
  
  
  RESULTS
  We found patients with aura were more likely to have hypercholesterolemia (12% vs 7%, p=0.05). Patients with aura were more likely to be evaluated with imaging (CT brain (70% vs 41% p<0.0001) and MRI brain (44% vs 17% p<0.0001)). The patients investigated with imaging had no clinically significant findings. 21% of patients with aura were investigated with carotid Doppler studies. Only 1 patient had an abnormal result. Patients with white matter hyperintensities were older (51 vs 39 years; p<0.0001) and were more likely to have Hypertension (29% vs 14% p=0.019), Hypercholesterolemia (29% vs 11% p=0.003) and T2DM (16% vs 4% p=0.011).
  
  
  CONCLUSIONS
  We found patients with MA and without aura to be largely similar. We also found imaging in either group to be of almost no clinical value.
authors.affiliation: Department of Neurology, Western Health, Gordon Street Footscray, 3011 Victoria, Australia; Department of Neurology, Alfred Health, Commercial Road, Melbourne 3004, Victoria, Australia. Electronic address: nirosenv@gmail.com.
authors.forename: Nirosen
authors.initials: N
authors.lastname: Vijiaratnam
authors.affiliation: Department of Neurology, Western Health, Gordon Street Footscray, 3011 Victoria, Australia.
authors.forename: Daniel
authors.initials: D
authors.lastname: Barber
authors.affiliation: Department of Neurology, Western Health, Gordon Street Footscray, 3011 Victoria, Australia.
authors.forename: Kai Zheong
authors.initials: KZ
authors.lastname: Lim
authors.affiliation: Department of Clinical Haematology, Alfred Health, Commercial Road, Melbourne 3004, Victoria, Australia; Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, The Alfred Centre, 99 Commercial Road, Melbourne 3004, Victoria, Australia.
authors.forename: Eldho
authors.initials: E
authors.lastname: Paul
authors.affiliation: Department of Neurology, Western Health, Gordon Street Footscray, 3011 Victoria, Australia.
authors.forename: Matthew
authors.initials: M
authors.lastname: Jiang
authors.affiliation: Faculty of Medicine Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Chosich
authors.affiliation: Department of Neurology, Western Health, Gordon Street Footscray, 3011 Victoria, Australia.
authors.forename: Tissa
authors.initials: T
authors.lastname: Wijeratne
mesh_terms: D000328:Adult; D015897:Comorbidity; D005260:Female; D006801:Humans; D006937:Hypercholesterolemia / Q000097:blood* / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D020325:Migraine with Aura / Q000097:blood / Q000000981:diagnostic imaging / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors; D066127:White Matter / Q000000981:diagnostic imaging*
keywords: Aura; Imaging; Migraine; Risk factors