6, 7 In the general population included in the Framingham cohort, the prevalence of MwvA, and visual aura without headache were reported to be approximately 1.23% (1.33% in women and 1.08% in men), and 0.71% (0.70% in women and 0.72% in men) respectively. Epidemiological studies have shown that the prevalence of typical visual aura without headache in the outpatient ophthalmology clinic was approximately 3.2 to 6.5%. 6 Patients with visual aura without headache are likely to present to ophthalmologists or optometrists first for their visual disturbances. 5Īlthough the prevalence of MwvA in the ophthalmology clinic is yet to be determined, this is a common encounter for eye care providers. Typical aura without headache is defined as attacks fulfilling ICHD-3 criteria for migraine with typical aura, but no headache accompanies or follows the aura within 60 min. The International Classification of Headache Disorders-3 (ICHD-3) 5 defines typical aura as one or more of the following fully reversible aura symptoms: visual, sensory, speech and/or language, motor, brainstem, retinal with at least three of the following six characteristics: at least one aura symptom spreads gradually over ≥ 5 min, two or more aura symptoms occur in succession, each individual aura symptom lasts 5–60 min, at least one aura symptom is unilateral, at least one aura symptom is positive, the aura is accompanied, or followed within 60 min, by headache. 3, 4 Given a high number of migraine patients that present with visual phenomena, the visual aura rating scale (VARS) was created to help with diagnosing MwvA 3, 4 Clinically, visual aura can precede migraine headache attacks, but can also occur on its own without associated headache. 1, 2 Migraine with visual aura (MwvA) is the most studied visual syndrome associated with migraine and occurs in approximately 30% of patients with migraine. Migraine can be associated with various visual disturbances, including blurry vision, visual aura, and visual snow. More data is needed to determine the absolute risk of stroke when evaluating MwvA in situations including smoking and low dose estrogen use, new or late onset (>50 years) MwvA, to facilitate the development of practice guidelines for stroke prevention in specific clinical scenarios. The risks of stroke associated with other types of migraine aura or aura without headache, as well as such association in men require further investigation. Most studies that assessed the migraine-stroke association were based on patients with MwvA. MwvA is associated with an increased risk of cardioembolic stroke and a higher incidence of atrial fibrillation compared to migraine without aura.

Studies reported that increased frequency of aura is associated with an increased risk of IS in women. Age of onset of MwvA 50 years or greater is associated with IS that occurs in late life. For women younger than 50 years, MwvA is associated with an increased risk of IS, and the risk further increases in patients who also smoke and use oral contraceptives.

Aural migraine stroke