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Aura symptoms or not?

Are there more people than me who have a hard time figuring out what are aura symptoms and what are not? Is vertigo an aura symptom or not? What about extreme sensitivity? Is it even a meaningful question? It might be. Some research has shown that “traditional” migraine treatment does not work well on persistent visual auras. A few other drugs have been suggested. If for example vertigo is an aura symptom then this might indicate the possibility of better results from treatment with other drugs than the “normal” ones. Farfetched? Yes. A possibility? The future will tell.

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A question that’s been half formed in my mind for ages but which I’ve never had tge chance to ask a neurologist. As a person who didn’t experience migraine headaches and/or auras it’s not surprising my only thought at the word ‘aura’ had always been the visual effects people I knew experienced as a warning of impeding migraine. According to the UK National Migraine Centre fact sheets there are in fact three types of aura: Visual, Sensory (feeling of numbness) and Motor a genuine weakness on one side of the body.. Over the last few years I’ve experienced the first two but as yet never the third.

My question would be where does the constant 24/7 symptoms of dizziness, imbalance, unsteadiness or for that matter maybe photophobia that can all be part of MAV fit in to all this. Could these symptoms exist as part of the Aura? Are they linked to ‘Postdrome’? Or are they something entirely different? At first glance one could think it doesn’t really matter. I’ve put it out of my mind many times as being not relevant but having just recently read, in the Medical Journal of Australia, certain drugs (Sodium Valproate, Verapamil, Lamotrigine and Levetiractem are better in cases of Prominent Aura and certain other drugs (example given Propranolol) have relative contra indications, and the above post, I’m beginning to think an answer to the question could prove useful, to me at least. So I will put it on the list for the neurologist, Helen

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Helen
I was struck down with the worst " ever" right sideed migraine in 2014 so bad i was injected with triptans and left on oxygen until i could take oral medication. I have NEVER been right since which makes me think brain trauma or stuck in a constant state of postdrome…i would love to know what you can find out at your neuro visit…i too think a lot about the answer to this question
Jo💖

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No, not all of the symptoms are due to neurological activity imho.

Vertigo is not an aura, imho.

Proof of that for me is the fact you can sometimes turn it on and off like a tap with position. That’s not a migraine aura switching on and off at your beckon call!

The times you cannot do that it feels very similar but you have no choice in the matter.

That tells me it’s something physiological to do with the ear.

Of course there could be a relationship with migraine, but it’s not the migraine.

E.g. migraine could swell the middle ear lining or even something in the inner ear and this causes changes in the way the apparatus responds to position. If this was unilateral (ie affecting one ear only) the brain might interpret that as a spin.

One really disappointing realisation is that no medic seems to be able to explain this. They say this is BPPV, but then how come I’ve got BPPV and MAV?! What are the chances I was so unlucky to have got both complaints at the same time, even though I’ve never suffered from either for my entire life! How about all these other people reporting the same comorbidity? Surely it’s the same illness? Of course it is! This is why the migraine explanation is incomplete.

This doesnt apply to me James…i have no control over my symptoms and i deffo canniot switch it off at my back and call…wish i could tho😞
Jo

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The positional aspect of VM is POTS(Postural orthostatic tachycardia syndrome) and not BPPV. POTS is a common migraine comorbidity and has been even before the classification of VM. I have had POTS all my life.

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Oh, so everyone who experiences positional vertigo with MAV has POTS?

Have they all been told?!

Yes many here have a POTS diagnosis as well

if everyone has the same underlying mechanism causing migraine. Why does the same med not work for everyone ?

I wouldn’t claim that at all. The difference in effectiveness of the drugs does indeed suggest different situations.

Which suggests there is a proportion who do have positional symptoms who’ve not received that diagnosis?

@Onandon03 have you considered POTS?

Same here Jo, I can’t switch off my symptoms either and head positioning makes no difference. Just constant distortion in my vision and light sensitivity, foggy vision which may be caused by light very sensitive to glare. All with a wooly unhappy head. Ami has helped some, but I’ve had a set back this week, probably due to hormones

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Positional vertigo is very common with MAV though.

It appears as if the majority experience it POLL: Does your position in bed seem to affect your level of comfort and symptoms?

I’ve been through phases where I could control it (eg don’t lie down!) and periods when I could not. Sometimes it just depended on the ‘attack’. The sensation for me was very similar in either case.

No, never. Very different symptoms I thought, Don’t know much about POTS but I thought it was vertigo on standing up, sitting up and involved fast heart beats, fainting, etc? Not really my symptoms. My very first experience of vertigo which lasted a couple of minutes may have been positional and was diagnosed as BPPV but the vertigo in my episodic attacks wasn’t positional. It was just constant for the duration of the attack. I couldn’t switch it off. Movement would make it worse. If I kept my eyes closed I couldn’t see the room spinning obviously. I spent days with my eyes shut. I had no control over it at all.

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I’ve been mulling this one for a long time, too. I would, and have, argued that nearly all MAV symptoms are migraine related, though some folks have come by these same sets of symptoms via other routes. Kind of a many roads into the same disease state sort of thing. Though I agree with @andy that the word ‘migraine’ is a bit of a red herring. For example, I have Polycystic Ovarian Syndrome. I’ve had it long enough to watch the condition change names (from Stein-Leventhol disorder to a proposed but never adopted Pan-Endocrine Disorder) and go from obscurity to common. Are my ovaries covered in cysts? Yep. Was infertility an issue? Yep. But that’s nothing compared to the carnage PCOS wreaks on my insulin/glucose metabolism, or on my heart, kidneys, pancreas and the disaster area that is my hormonal balance and every single associated organ (pituitary, hypothalamus, adrenal glands, my now missing reproductive system, etc.). By identifying PCOS as an infertility disorder we marginalize the long term damage (ridiculously high risks for heart disease, stroke, diabetes, cancer). No research dollars go into finding the mechanism that’s causing all this collateral damage. All the treatment options are imperfect, treat only the symptoms and were designed to treat something else. Sound familiar? Is VM migraine? Unquestionably, absolutely, obviously. Is it also a bunch of other things? How can it not be?

Personally, my money’s on science finding it’s a genetically influenced inflammatory autoimmune disorder affecting the brain including the CNS, autonomic functions and the metabolism in very fundamental ways. The someday to be developed blood test for VM specific pro-inflammatory neural cytokines will eventually be diagnostic for VM vs. other, similar but different issues.

What’s that got to do with aura? What’s stroke got to do with PCOS? As an endocrine disorder PCOS is the expression of profound, fundamental dysfunction in the primary chemistry upon which healthy function depends. It creates a foundation of shifting sands. A hyper excitable migraine brain runs out of its basic chemical building blocks. But misfires there can be expressed anywhere and everywhere in the body. That doesn’t require a headache. And if, like most of us, you’re living in status migraine, you’re always expressing some migraine effects. Could a status migraine manifest as 24/7 dizziness or nausea or photophobia or a thousand other things? I think so.

My worst aura, by far, are relatively discreet events (that might still be a week or more). These are unmistakable brain stem auras with loss of each sense in succession, then language, then consciousness. It takes days to get back to a semblance of functional normalcy where conversation is possible, higher level thinking returns and the X/Y axis finds a stable, if skewed position in space. These are relatively discreet events though sometimes the leftover aura elements linger, occasionally for months.

I think VM has more in common with fibromyalgia or MS than it does classical, episodic migraine. Aura as a term doesn’t seem helpful here.

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I absolutely agree there…ive suffered classic migraines when younger and MAV has much more in common symptom wise with the above…agree 100%
Jo x

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Yes, I’d almost forgot about ‘status migraine’. That is the other option.

I know nothing about fibromyalgia, in fact I’ve only just managed to learn how to spell it! And only a very slightest acquaintance with MS though surely if you’ve had MRI and bern pronounced clear should be OK.

I don’t really experience the true migraine headache so cannot compare. All I understand is my ‘vertigo attacks’ have bern described by a friend who does as being ‘exactly like my (diagnosed) migraine without the headache’! I could easily be convinced my MAV symptoms are just a vertigo attack that started (in December 2014) and forgot to stop, ie ‘status migraine’.

When it comes to comparisons with MS and fibromyalgia maybe Dr Silver has the answer. Helen

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That’s a really great article. Good reading for another sleepless night.

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