Clinical neurophysiology of migraine with aura


Andriana is thirty-one years old living in New York. She is four months pregnant with a medical diagnosis of migraine aura. In the past, Andriana has received physical therapy from an injury she sustained while jogging around the city. Adriana has not received treatment for the present medical symptoms that she is experiencing. Andriana was taken to physical therapy after she viciously complained of general upper cervical and thoracic pain. When Andriana went for physical therapy, she had not experienced any falls or trauma before.

The patient identified that the pregnancy caused additional weight, which was pulling her upper thoracic spine and shoulders into a rounded position. The patient also said that during the third month of her pregnancy, she started to experience sore pain while sitting during meetings at work. According to Andriana, the various activities that she performs at work do not contribute to the pain, but when she sits at home and rests, it offers her a sense of relief. The patient is unwilling to use painkillers due to the adverse effects they may have on her unborn child and, therefore, uses a heating pack to decrease the symptoms. The patient has no medication allergies.

Upon taking physical therapy, the vital signs of Andriana were: heartrate 84, blood pressure 124/82, and her respiratory rate was 13. The neck disability score was 8, indicating moderate disability while the dizziness handicap disability was 74. Sensation and reflexes were intact, while the cervical extension test was 5/5. The Shoulder flexion test result was 5/5. The thoracic rotation test was 75 degrees right and 70 degrees left.

Description of the disease.

In the past few weeks, the patient has been complaining of throbbing headaches on the right side of the forehead. The patient has also been experiencing dizziness and nausea after the headaches begin. However, the patient believes that the pregnancy causes the nausea. Whenever she takes a nap for two hours, the pain subsides. Additionally, the patient says that she experiences stronger headaches when exposed to sunlight rays from the window or when she stares at the screen for an extended period.

Migraine aura is among the classic migraines that are associated with a recurring headache that is caused by sensory disturbances that are referred to as an aura (Fraser et al., 2019, December). These disturbances include flashes of light or blind spots. The symptoms of migraine aura include intense headache, nausea, sensitivity to light (Charles,2018).Most patients who experience migraine aura complain of temporal visual sins such as loss of vision, blind spots, and bright spots. The patient may also experience fatigue and food cravings.

Patients are suffering from migraine aura experience a socioeconomic barrier that emanates from the functional impairment of headaches (Coppola et al., 2019). These patients have to be in constant bed rest, which may cause absenteeism from work as a consequence. These patients also experience a reduction in the effectiveness of performing specific roles and activities within their jurisdiction. Hence they are not able to effectively and efficiently participate in family affairs or social events. Goadsby& Holland(2019) opine that the best mechanism to increase the effectiveness of the individual in performing various responsibilities, the patient should break down the work into small achievable goals or schedules, and making room in between for sessions of relaxation to break the monotony of work.

Medication Management

In managing the disease, it is crucial to determine the pains and symptoms that originate from musculoskeletal organs (Hadjikhani& Vincent,2019). The thoracic pain can be relived through position since it may have originated from her posture at work. The complaints of dizziness should be further investigated due to the lack of positional changes in the symptoms of the patient. The diagnosis of this ailment can be headache-related vertigo, which can be confirmed using a Dix Hallpike test (Munro, 2020). The intervention mechanisms of dealing with thoracic pain involve vestibular exercises, habituation exercises, and a multidisciplinary approach involving visiting neurologist and ENT services. The patient should also undergo balance exercises such as head turns on a wobble board, head turns while walking and standing on a wobble board.

The medical prescriptions to treat migraine aura are pain relievers such as Aspirin, for example, ibuprofen and Advil. These painkillers should only be taken once per day since their overuse may cause ulcers. The adverse effect of using painkillers is addiction. Painkillers are brought together with nausea drugs such as chlorpromazine (Schoenen et al., 2020).The patient should also take triptans, which are drugs that are used to block pathways of pain in the brain. They include sumatriptan (Imitrex) and rizatriptan (Maxalt). They are ideal for treating migraines and can be taken in the form of pills or nasal sprays. The drugs should be taken only when the patient experiences migraines. The adverse effect of taking this drug is that the patient may be at risk of heart attack or stroke and extreme migraine (Viana et al., 2016). The patient can substitute this drug with opioids. Dihydroergotamines(Migranal) is an injection that should be taken immediately after the onset of the symptoms of migraine. The dose is most ideal when the migraine lasts for more than 24 hours — the adverse effects of using this drug in extreme cases of nausea and vomiting. 

An alternative therapy that can be used to treat the disease is medical devices such as single-pulse transcranial magnetic stimulation (Schilling, 2019). The method makes use of magnetic energy, and hence the patient should place the device on top of her head for a few moments. Also, the patient can undertake lifestyle changes such as practicing stress reduction techniques, taking a nap when the symptoms occur. The patient should even eat balanced diets that have low amounts of processed foods. 

Since Andriana is four months pregnant, the goal should be to treat the migraine without medical interventions but making use of physical therapy. The physical therapy sessions involve vestibular rehab programs and pharmacological treatment (Bisht et al., 2019). The patient is expected to go for a follow checkup every two weeks. The checkup will involve administering an MRI on the patient that will help to examine the migraine further. It is recommended that the patient undertakes physical therapy as opposed to medical interventions, which may put the unborn child under risk.




Bisht, K., Kotwal, S., Vidyarthi, V., Singh, D. S., &Pahwa, P. (2019). An Ayurvedic approach in the management of Migraine: A Review Study. Journal of Ayurveda and Integrated Medical Sciences (ISSN 2456-3110)4(4), 241-246.

Charles, A. (2018). The migraine aura. Continuum: Lifelong Learning in Neurology24(4), 1009-1022.

Coppola, G., Di Lorenzo, C., Parisi, V., Lisicki, M., Serrao, M., &Pierelli, F. (2019). Clinical neurophysiology of migraine with aura. The journal of headache and pain20(1), 42.

Fraser, C. L., Hepschke, J. L., Jenkins, B., & Prasad, S. (2019, December). Migraine Aura: Pathophysiology, Mimics, and Treatment Options. In Seminars in Neurology (Vol. 39, No. 06, pp. 739-748). Thieme Medical Publishers.

Goadsby, P. J., & Holland, P. R. (2019). Pathophysiology of Migraine. Neurologic Clinics37(4), 651-671.

Hadjikhani, N., & Vincent, M. (2019). Neuroimaging clues of migraine aura. The journal of headache and pain20(1), 32.

Munro, K. (2020). Migraine in primary care: myths, management, and medication overuse. Primary Health Care30(1).

Schilling, R. (2019). Non-Drug Treatment for Migraines in Women.

Schoenen, J., Charles, A., Burstein, R., &Goadsby, P. (2020). Pathophysiology of Headache Progression. The Medical Roundtable General Medicine Edition.

Viana, M., Linde, M., Sances, G., Ghiotto, N., Guaschino, E., Allena, M., … &Tassorelli, C. (2016). Migraine aura symptoms: duration, succession, and temporal relationship to headache. Cephalalgia36(5), 413-421.

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