The Difference Between Epileptic Auras and Migrainous Auras in the 19th Century

Abstract

In the International Headache Society classification of headaches, the concept of aura is given a key role. It serves as a boundary between 'migraine without aura' and 'migraine with aura'. Historically, the concept of an aura was borrowed from the epilepsy vocabulary; a borrowing that took place in English medicine at the beginning of the 19th century and in French medicine in the mid-19th century. It would therefore be interesting to see which features of the epileptic aura are used to explain the migraine aura. Based on the French and English medical literature of the 19th century, two processes have been reviewed: (i) the emergence of the concept of aura, and (ii) the modifications of this concept throughout the 19th century. It appears that the original medical use of the term 'aura' as a set of rising tactile sensations was in use from the 2nd century until late in the 19th century, but then various other symptoms were recognized and the aura gradually became accepted as an early part of the seizure. By the end of the 19th century the aura that preceded a migraine was seen as a similar process, and thought of as part of the migraine sequence.

The hermeneutics of symptoms

“…It is through identifying experiences such as these that Galen’s writings create a model of that which was to be explained by medicine. The idea of aura – “not, originally, a scholarly or theoretical idea but one that was brought into medicine by way of the patients’ complaints”(Lardreau 2007 ) – permitted the construction of a pathophysiological model of epileptic seizures as resulting from a rising substance that, when it reached the head, would result in loss of consciousness. This in turn guided mooted treatments, such as applying ligatures to limbs affected by focal seizures to arrest the spread of this substance (Temkin 1994 , p. 38).…”

From “Transient Hemiopsia” to Migraine Aura

“…Airy did not use the term “aura” for the phenomenon that he described. As the historian and biographer of migraine Esther Lardreau has demonstrated, “aura” was a term that had predominantly been applied to sensory symptoms that preceded an epileptic seizure; this usage continues to the present day [ 2 ]. Airy instead coined two terms for the phenomenon, the first of which was contained in the title of his paper, “On a distinct form of Transient Hemiopsia”.…”

“…“Just as all operas have an overture getting the spectator ready, and a book has its foreword to inform the reader of the situation, so each migraine has its foreword, or overture… This aura … may show endless variations… it is mandatory… and free of charge” [ 1 ], as quoted in [ 2 ].…”

Preictal Symptomatology in Migraines: Diagnostic and Therapeutic Significance

“…The type of aura and its temporal relationship with the next evolving symptom during attack differentiate between subgroups of migraine [21]. Aura in migraine serves as a boundary between "migraine without aura" and "migraine with aura" [22] and "migraine-related condition. "…”