Persistent Migraine Aura: New Cases, a Literature Review, and Ideas About Pathophysiology

Sam Thissen, MD; Iris G. Vos, MD; Tobien H. Schreuder, MD; Wendy M.J. Schreurs, MD; Linda A. Postma, PhD; Peter J. Koehler, PhD


Headache. 2014;54(8):1290-1309. 

In This Article


Despite the fact that 47 cases of PMA have been reviewed in this paper, many questions remain. The cases that have been described so far show inconsistent data with respect to the results of functional studies and treatment. The pathophysiology of PMA is still largely a matter of conjecture. As we suppose that PMA is more frequent than reported up to the present, it would be useful to report more series including results of functional studies that may lead to more insight into the pathophysiology of the condition. Although the data on physiological studies were inconsistent, there may be a preponderance with respect to hypoperfusion SPECT studies.

PMA should be considered in patients who complain of persistent visual phenomena even without a history of migraine. Diagnostic studies, at least a neurologic and neuro-ophthalmologic examination, as well as a high-resolution MR scan with thin slices, should be considered to exclude other pathology. The variability of the data is too large to provide a prognosis for individual patients. Symptoms may persist for up to 28 years. Lamotrigine may be the most effective treatment. Further studies are needed to identify the underlying pathophysiology.