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Aura

An aura is a sensory or motor phenomenon, idea, or emotion that marks the initial stage of a seizure or the approach of a classic migraine headache. Auras may be classified as cognitive, affective, psychosensory, or psychomotor. (See Recognizing types of auras.)

When associated with a seizure, an aura stems from an irritable focus in the brain that spreads throughout the cortex. Although an aura was once considered a sign of impending seizure, it’s now considered the first stage of a seizure. Typically, it occurs seconds to minutes before the ictal phase. Its intensity, duration, and type depend on the origin of the irritable focus. Unfortunately, an aura is difficult to describe because the postictal phase of a seizure temporarily alters the patient’s level of consciousness, impairing his memory of the event.

The aura associated with a classic migraine headache results from cranial vasoconstriction. Diagnostically important, it helps distinguish a classic migraine from other types of headaches.

Emergency Actions

When an aura rapidly progresses to the ictal phase of a seizure, quickly evaluate the seizure and be alert for life-threatening complications such as apnea. When an aura heralds a classic migraine, make the patient as comfortable as possible. Place him in a dark, quiet room and administer drugs to prevent the headache, if necessary.

History

Obtain a thorough history of the patient’s headaches or seizure history, asking him to describe any sensory or motor phenomena that precede each headache or seizure. Find out how long each headache or seizure typically lasts. Does anything make it worse, such as bright lights, noise, or caffeine? Does anything make it better? Ask the patient about drugs he takes for pain relief.

Physical assessment

First, perform a full neurologic examination. Then proceed to a complete physical examination to detect systemic disorders. Be aware that the physical assessment may not reveal abnormalities.

Medical causes

Classic migraine headache

A migraine headache is preceded by a vague premonition and then, usually, a visual aura involving flashes of light. The aura lasts 10 to 30 minutes and may intensify until it completely obscures the patient’s vision. A classic migraine may cause numbness or tingling of lips, face, or hands; slight confusion; and dizziness before the characteristic unilateral, throbbing headache appears. It slowly intensifies; when it peaks, it may cause photophobia, nausea, and vomiting.

Seizure, generalized tonic-clonic

A generalized tonic-clonic seizure may begin with or without an aura. The patient loses consciousness and falls to the ground. His body stiffens (tonic phase); then he experiences rapid, synchronous muscle jerking and hyperventilation (clonic phase). The seizure usually lasts 2 to 5 minutes.

Special considerations

Advise the patient to keep a diary of factors that precipitate each headache or seizure as well as their associated symptoms to help you evaluate the effectiveness of drug therapy. Recommend lifestyle changes such as stress-reduction measures, which may help reduce the frequency of headaches.

Pediatric pointers

Watch for nonverbal clues possibly associated with aura, such as rubbing the eyes, coughing, and spitting. When taking the seizure history, recognize that children — like adults — tend to forget the aura. Ask simple, direct questions, such as “Do you see anything funny before the seizure?” and “Do you get a bad taste in your mouth?” Give the child ample time to respond because he may have difficulty describing the aura.

Patient counseling

If the patient recognizes the aura as a warning sign, tell him to prevent the headache by taking appropriate drugs. If the patient has a seizure disorder, emphasize the importance of taking anticonvulsants as directed. Stress the importance of regular follow-up appointments for blood studies.

Pictures

Book Source Details

• Book Title: Signs & Symptoms: A 2-in-1 Reference for Nurses
• Author(s): Springhouse
• Year of Publication: 2007
• Copyright Details: Signs & Symptoms: A 2-in-1 Reference for Nurses, Copyright © 2007 Lippincott Williams & Wilkins.

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Copyright Details: Signs & Symptoms: A 2-in-1 Reference for Nurses, Copyright © 2008 Williams & Wilkins.

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• Back to symptom: Dizziness: Introduction (review 1275 causes)
• Next Book Extract About Dizziness: Level of consciousness, decreased (Signs & Symptoms: A 2-in-1 Reference for Nurses)
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More About This Book: Title: Signs & Symptoms: A 2-in-1 Reference for Nurses Authors: Springhouse Publisher: Lippincott Williams & Wilkins Copyright: 2007 ISBN: 1-58255-318-1

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