Typical migraine auras are characterized by gradual development, duration no longer than one hour, a mix of positive and negative features, and complete reversibility [
95]. Positive symptoms indicate active discharge from central nervous system neurons. Typical positive symptoms can be visual (eg, bright lines, shapes, objects), auditory (eg, tinnitus, noises, music), somatosensory (eg, burning, pain, paresthesia), or motor (eg, jerking or repetitive rhythmic movements). Negative symptoms indicate an absence or loss of function, such as loss of vision, hearing, feeling, or ability to move a part of the body. Auras are most often visual but can also be sensory, verbal, or motor disturbances.
The aura of migraine usually develops gradually over more than five minutes. Less often, the aura develops more acutely (ie, in less than five minutes). The acute onset of aura makes confusion with a transient ischemic attack (TIA) or stroke more likely. In one case series, four patients (2 percent) had exclusively acute-onset visual aura [
96].