Do you treat migraine with aura if there is not an associated headache/pain?

It is officially called migraine aura without headache, but I like to refer to it as isolated migraine aura. Although a migraine aura can be visual, somatosensory, or involve speech, the presentation in practice, in my experience, is always visual.

The best way to diagnose it is by having the patient draw whatever obscures his or her vision. A typical response is for the patient to draw a zigzag line, which, in my opinion, settles the diagnosis. There is no other neurological disorder that manif...

I do if it interferes with quality of life.

I do not recommend abortive medications for aura. There is no evidence that migraine abortive treatments shorten the duration of aura. I do not think that they do. Anecdotally, I have had some patients report that taking NSAIDs or a triptan at the aura onset somewhat shortens aura duration.

If aura is frequent, prolonged, and is interfering with quality of life, then I do recommend migraine prevention. While good quality evidence in terms of a preventa...

In an older patient over 50 years of age who has never had a migraine attack, if they start having typical auras without pain, I usually do not treat. If they are frequent and/or always unilateral on the same side, and might do a workup, and if normal, consider putting them on Vitamin B6, 200 mg bid. I have seen that stop auras without headache, although I do not think it has been properly studied.

Alan M. Rapoport, M.D.