Atypical aura and referral criteria

With respect to typical aura (1):

Suspect aura in people who present with or without headache and with neurological symptoms that:

• are fully reversible and
• develop gradually, either alone or in succession, over at least 5 minutes
• and last for 5-60 minutes

Diagnose migraine with aura in people who present with or without headache and with one or more of the following typical aura symptoms that meet the criteria above:

• visual symptoms that may be positive (for example, flickering lights, spots or lines) and/or negative (for example, partial loss of vision)
• sensory symptoms that may be positive (for example, pins and needles) and/or negative (for example, numbness)
• speech disturbance

However consider further investigations and/or referral for people who present with or without migraine headache and with any of the following atypical aura symptoms that meet the criteria in recommendation:

• motor weakness or
• double vision or
• visual symptoms affecting only one eye or
• poor balance or
• decreased level of consciousness

Reference:

• NICE (September 2012). Headaches - Diagnosis and management of headaches in young people and adults