Whether migraine with aura represents a distinct disorder or is simply a part of the spectrum of migraine remains an open question. During attacks, cerebral blood flow changes may differ between migraine with and without aura. Imaging studies suggest that structural brain changes are more prevalent in those with migraine than in controls, and some of these changes are most pronounced in migraine with aura. A number of other disorders are also associated with migraine with aura, but not with migraine without aura. Migraine with aura is associated with an increased risk of ischemic stroke, whereas no increased risk is associated with migraine without aura. Migraine with and without aura show distinct familial occurrence and mode of inheritance, suggesting different etiology. Several observations point toward important differences between migraine with and without aura. Still today, migraine aura is both an alarming symptom to patients and an intriguing phenomenon to clinicians and scientists. Migraine has been vividly depicted since the dawn of medicine with the first accounts of attacks of migraine with aura dating back more than two millennia. Migraine is the most prevalent neurological disease afflicting a large part of the population across the world and ranks the 2nd leading cause of years lived with disability especially in the young and middle-aged. The purpose of this review is to provide an overview of these differences in treatment responses, and to discuss the possibility of different therapeutic strategies for migraine with vs. A number of studies also indicate that migraine with aura may respond differently to acute and preventive therapies as compared to migraine without aura. Compared with migraine without aura, migraine with aura has different heritability, greater association with different conditions including stroke, different alterations of brain structure and function as revealed by imaging studies. For clinicians and scientists, aura represents an intriguing neurophysiological event that may provide important insight into basic mechanisms of migraine. For patients, aura symptoms are alarming and may be transiently disabling. About a third of migraine patients have attacks with aura, consisting of transient neurological symptoms that precede or accompany headache, or occur without headache. Migraine is a major public health problem afflicting approximately 10% of the general population and is a leading cause of disability worldwide, yet our understanding of the basis mechanisms of migraine remains incomplete.
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