title: Persistent and Repetitive Visual Disturbances in Migraine: A Review.
abstract: Visual disturbances in migraineurs, such as visual aura, are typically episodic, that is, associated with the headache attack, and overlaid by head pain and other symptoms that impact the patient. In some patients, however, visual symptoms are dominant due to frequency (migraine aura status), duration (persistent migraine aura and other persistent positive visual phenomena), or complexity (visual snow syndrome). These syndromes are more rare and challenging to classify in clinical practice resulting in a lack of systematic studies on pathophysiology and treatment. We aim at describing clinical features and pathophysiological concepts of typical migraine aura with a focus on cortical spreading depression and differentiation from non-typical migraine aura. Additionally, we discuss nomenclature and the specifics of migraine aura status, persistent migraine aura, persistent positive visual phenomena, visual snow, and other migrainous visual disturbances. The term migraine with prolonged aura might be a useful bridge between typical aura and persistent aura. Further studies would be necessary to assess whether a return of the classification category eventually helps diagnosing or treating patients more effectively. A practical approach is presented to help the treating physician to assign the correct diagnosis and to choose a medication for treatment that has been successful in case reports of these rare but disabling conditions.
authors.affiliation: Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.|Department of Neurology, Grosshadern, University Hospital Munich, University of Munich, Munich, Germany.
authors.forename: Christoph J
authors.initials: CJ
authors.lastname: Schankin
authors.affiliation: Headache Science Center, C. Mondino National Neurological Institute, Pavia, Italy.
authors.forename: Michele
authors.initials: M
authors.lastname: Viana
authors.affiliation: Headache Group, NIHR-Wellcome Trust King's Clinical Research Facility, King's College London, London, United Kingdom.
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Goadsby
mesh_terms: D000818:Animals; D001921:Brain / Q000187:drug effects / Q000503:physiopathology; D006801:Humans; D008881:Migraine Disorders / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy / Q000503:physiopathology*; D010468:Perceptual Disorders / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology / Q000503:physiopathology*; D014796:Visual Perception / Q000187:drug effects / Q000502:physiology*
keywords: cortical spreading depression; migraine aura; migraine aura status; persistent migraine aura; prolonged migraine aura; visual snow