Visual Aura in Non-Migraine Headaches: A Population Study

Abstract

Background Visual aura (VA) occurs mostly in migraine with aura (MA), but some case studies have reported aura in non-migraine headaches. Thus, information of VA in non-migraine headaches is scarce. Aim of this study was to investigate the prevalence and impact of VA in non-migraine headache and compare it with that of migraine headache. Methods This study was a nationwide population-based study. We used an internet-based headache diagnosis questionnaire to diagnose headache, and various modules to evaluate clinical features and comorbidities of participants with headache. We defined migraine headache as migraine and probable migraine (PM), whereas non-migraine headache was defined as a headache but not migraine or PM. VA was defined as a self-reporting VA rating scale score ≥ 3. Results Of the 3,030 participants, 1,431 (47.2%) and 507 (16.7%) had non-migraine headache and migraine headache, respectively. VA prevalence was much lower in the non-migraine headache group than in the migraine headache group (14.5% [207/1,431] vs. 26.0% [132/507], P < 0.001). In subjects with non-migraine headache, those with VA had a markedly higher number of headache days per 30 days (median [25 th –75 th percentiles]: 2.0 [1.0–5.0] vs. 2.0 [1.0–3.0], P < 0.001), and headache-related disability (6.0 [3.0–16.0] vs. 2.0 [0.0–7.0], P < 0.001) than those without VA. VA prevalence did not differ significantly according to age and sex. Conclusion Non-migraine headache with VA patients had more severe symptoms than those without VA. These findings may improve the understanding of VA and the management of individuals with non-migraine headache.

Letter to the Editor: Frequency of Visual Aura in Non-Migraine Headache Strongly Depends on the Underlying Pathophysiology

“… 1 Among those with non-migraine headaches, those with visual aura reported more headache days and higher headache-related disability than those without aura. 1 The study is excellent but has limitations that should be discussed.…”

“…Headaches were diagnosed using an internet-based headache diagnosis questionnaire. 1 A visual aura was reported in 26% of patients with migraine compared to only 14.5% of non-migraine headaches. 1 Among those with non-migraine headaches, those with visual aura reported more headache days and higher headache-related disability than those without aura.…”

“… 1 A visual aura was reported in 26% of patients with migraine compared to only 14.5% of non-migraine headaches. 1 Among those with non-migraine headaches, those with visual aura reported more headache days and higher headache-related disability than those without aura. 1 The study is excellent but has limitations that should be discussed.…”

“…We read with interest the article by Kim et al 1 on a population-based study of 1,431 patients with non-migraine headaches and 507 patients with migraines for the presence of visual aura. Headaches were diagnosed using an internet-based headache diagnosis questionnaire.…”

“…The main limitation of the study is that headaches were diagnosed over the internet and not in person. 1 Patients with headaches require a detailed individual and family history as well as a thorough clinical neurological examination. In order to distinguish primary from secondary headache types, it is imperative that all patients with headaches undergo cerebral imaging and angiography of cerebral arteries and veins.…”