Migraine: Does aura require investigation?

• Migraine with aura patients are more likely to have hypercholesterolemia.
• Migraine with aura patients are more likely to be investigated with imaging.
• CT brain, MRI brain and carotid Doppler studies are of no yield in migraine.
• White matter hyperintensity appear to be age related and associated with cardiovascular risk factors.

ObjectivesMigraine is a debilitating condition that affects approximately 15% of the general population. It represents a huge proportion of presentations to the emergency department and a significant number of neurology admissions. Patients are often investigated with imaging. This is particularly the case with migraine with aura (MA). The yield of imaging is however low. There is limited information on Australian hospital presentations and utility of imaging. We aimed to analyse the demographics of migraine presentations to our hospital and the yield of imaging in our centre to help guide future approaches to these patients.Patients and methodsWe retrospectively looked at medical records of patients presenting to the western health from January 2012 to June 2013. Patients were classified as either having migraine with aura or without. Baseline demographics, cardiovascular risk factors and imaging studies (CT brain, MRI brain and carotid Doppler studies) in each group were evaluated. Patients found to have white matter hyperintensities on MRI were further evaluated.ResultsWe found patients with aura were more likely to have hypercholesterolemia (12% vs 7%, p = 0.05). Patients with aura were more likely to be evaluated with imaging (CT brain (70% vs 41% p < 0.0001) and MRI brain (44% vs 17% p < 0.0001)). The patients investigated with imaging had no clinically significant findings. 21% of patients with aura were investigated with carotid Doppler studies. Only 1 patient had an abnormal result. Patients with white matter hyperintensities were older (51 vs 39 years; p < 0.0001) and were more likely to have Hypertension (29% vs 14% p = 0.019), Hypercholesterolemia (29% vs 11% p = 0.003) and T2DM (16% vs 4% p = 0.011).ConclusionWe found patients with MA and without aura to be largely similar. We also found imaging in either group to be of almost no clinical value.