Headache Medicine 2020, 11(1):10-13 ISSN 2178-7468, e-ISSN 2763-6178

ASAA

DOI: 10.48208/HeadacheMed.2020.4

Headache Medicine

Original

Migraine aura: results from an art contest

Aura da enxaqueca: resultados de um concurso de arte

Bruna de Freitas Dias

Arao Belitardo de Oliveira

Juliane Prieto Peres Mercante

Michele Viana

6,7

Luiz Paulo de Queiroz

Mario Fernando Prieto Peres

2,3,4

Faculdade Israelita de Ciências e Saúde Albert Einstein (FICSAE) .

Associação Brasileira de Cefaleia em Salvas e Enxaqueca (ABRACES).

Instituto

de Psiquiatria do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (IPQ-HCFMUSP).

Instituto Israelita de Pesquisa

Albert Einstein Hospital Israelita Albert Einstein (HIAE).

Universidade Federal de Santa Catarina

Headache Group, Department of Basic and Clini-

cal Neurosciences, King’s College London, London, UK.

Headache Center, Neurocenter of Southern Switzerland (NSI), Regional Hospital Lugano.

Abstract

Introduction

Migraine is a common primary headache and a major cause of disability. In at least a third of migraine attacks, the hea-

dache is preceded or accompanied by aura, and the visual manifestation is the most frequent phenotype. Migraine with

aura is underdiagnosed and undertreated. So, a detailed aura iconography is important for better recognition, prevention,

and treatment of migraine with aura.

Objective

A visual aura art contest was performed by ABRACES (Brazilian Association of Cluster Headaches and Migraines) in order

to provide new images for raising awareness among the population and professionals and decreasing the gap between

diagnosis and treatment.

Methods

The contest involved a free subscription of drawings, paintings, and digital art that expressed realistic results of a visual aura

of migraine and answering a questionnaire. The awards were separated into two categories (painting/drawing and digital

art/photography) and amounted up to R$5,000.

Results

There were 139 participants (76% women). The most common visual aura’s characteristic was colorful points, and the

less frequently was golden. The duration of visual aura was 110.6±450.5 min (1- 3,600 min). 36.7% of the subscribers

have only one kind of visual aura, and 33.8% answered that have more than one kind. 46.5% said that their visual aura

almost never occurs without pain after or while aura, and 19% reported that their visual aura always occurs without a

headache.

Conclusion

Art contests are useful tools for disease awareness. Further actions in disseminating aura images may help migraine aura

underdiagnosis and undertreatment.

Resumo

Introdução

A enxaqueca é uma cefaleia primária comum e uma das principais causas de incapacidade. Em pelo menos um terço dos ata-

ques de enxaqueca, a cefaleia é precedida e/ou acompanhada por aura e a manifestação visual é o fenótipo mais frequente.

Enxaqueca com aura, um subtipo de enxaqueca, é subdiagnosticada e subtratada. Portanto, uma iconograa detalhada

da aura é importante para um melhor reconhecimento, prevenção e tratamento da enxaqueca com aura.

Objetivo

Um concurso de arte de aura visuais foi realizado pela ABRACES (Associação Brasileira de Dores de Cabeça e Enxaqueca),

para que mais imagens possam ser usadas para aumentar a conscientização da população e dos prossionais, otimizando

o diagnóstico e o tratamento.

Métodos

O concurso envolveu inscrição gratuita de desenhos, pinturas, e arte digital e fotograa que expressavam resultados realistas

de uma aura visual de enxaqueca e preenchimento de um questionário. Os prêmios foram separados em duas categorias

(pintura/desenho e arte digital/fotograa), numa quantia até R$ 5.000.

Resultados

Foram 139 participantes, 24% homens e 76% mulheres. A mais prevalente característica da aura visual foi a presença de

pontos coloridos e menos frequentemente dourados. A duração média foi de 110,6 minutos (450,5 de desvio padrão),

mediana de 20 minutos, mínimo de 1 minuto e máximo de 3600 minutos. 36,7% dos participantes possuem apenas um tipo

de aura visual e 33,8% responderam que possuem mais de um tipo. 46,5% disseram que sua aura visual quase nunca ocorre

sem dor após ou durante a aura e 19% relataram que sua aura visual sempre ocorre sem dor de cabeça.

Conclusão

Concursos de arte são ferramentas úteis para a conscientização de doenças. Outras ações na disseminação de imagens

da aura podem ajudar no subdiagnóstico e subtratamento da aura da enxaqueca.

Mario F P Peres

mariop3r3s@gmail.com

Received: January 15, 2020.

Accepted: January 22, 2020.

Edited by

Marcelo M. Valença

Keywords:

Migraine

Aura

Contest

Palavras-chave:

Enxaqueca

Aura

Concurso

Dias BF, et al.

Migraine aura: results from an art contest

Introduction

igraine is a common primary headache and a major cause

of disability

. It is characterized by recurrent episodes of

headache often associated with nausea, vomiting, photophobia

and phonophobia. The annual prevalence in general population

is an average of 12%, and it is more frequent in 25 to 55 years old

individuals and women population

. Patients have episodic attacks

separated by interictal phases. The attack is an interplay between

genetic

and environmental factors, possibly resulting in a dysfunc-

tional state and structure alteration of the brain

4,5

In at least a third of migraine attacks, the headache is preceded

and/or accompanied by reversible neurologic symptoms, named

aura. This condition is classied as migraine with aura, a subtype of

migraine disorder. In early descriptions, aura is linked to migraine

since 1870, when Elliott showed the idea of migraine as a disorder

characterized by aura, and associated with creativity, intellect, and

visual disturbance.

According to Headache Classication Committee of the Interna-

tional Headache Society (IHS)

, aura is described as one or more

of visual, sensitive, speech, motor, brainstem or retinal symptoms.

Positive and/or negative visual manifestation is the most frequent

phenotype, present in 98% of the patients

. Prevalent symptoms are

ashes of bright light, foggy/blurred vision, zigzag or jagged lines,

scotoma and phosphenes; and less frequent are more complex

perception, such as misperception of distance, fractured vision,

dysmorphopsias, tunnel vision, hemianopsia, curved or circular

lines, among others

. Since visual auras varies in form, severity

and duration both among patients and within each patient

, the

anatomical location, extent and probably nature of the underlying

occipital dysfunction must vary.

Migraine with aura are underdiagnosed and undertreated, partially

because of misdiagnosis

. The consequences are chronic migraine,

decreased quality of life and work productivity

11–13

. A detailed aura

iconography is important for better recognition, prevention and

treatment of migraine with aura.

An aura art contest was performed by ABRACES (Brazilian Asso-

ciation of Cluster Headaches and Migraines), so more images can

be used for raising awareness of population and professionals,

decreasing the gap between diagnosis and treatment.

Methods

The Art Contest Migraine Visual Aura by ABRACES involved free

subscription of drawings, paintings, digital art and photography

that expressed realistic results of a visual aura of migraine. The

applications were open to September 22

until October 6

, 2019.

The awards were separated in two categories (painting/drawing

and digital art/photography) and were equivalent to up to R$ 5.000.

The participants were people that have migraine with visual aura or

people with artistic skills that asked somebody who has.

Visual aura was characterized as a disturbance of visual perception

that occurs before the start of a migraine (or during), in a gradual

way, lasting ve minutes to one hour and completely reversible.

Some questions were ascertained, such as: “how did you hear about

the contest?”, “are you submitting this work to someone else?”, “how

long does your aura take on average (in minutes)?”, “do you have

more than one type of aura?”, “does your visual aura occur without a

headache?” and “what are the characteristics of your visual aura?”.

Double data and data not properly lled were excluded to analy-

zing the results.

Statistical analysis

Categorical variables are presented as percentages and absolute

number and continuous variables are presented as means with

standard deviation, median, maximum and minimum data.

Results

There were 139 participants in the contest. It was composed by

24% men and 76% women.

Most of participants heard about the contest by social medias:

Instagram (38%) and Facebook (38%), 9% from google, 9% from

ABRACES website, 5% from other vehicle of information and

1% from interview. The great majority submitted their own art

expressing their visual aura.

Figure 1 detailed the prevalence of the characteristics of the visual

aura. The most common was presence of points and colorful and

the less common was golden. 20% of the participants answered

that their visual aura has others features not mentioned.

Figure 1. Percentage of visual disturbances reported by contest participants

Type of color

The mean duration of visual aura was 110.6 minutes (450.5 of standard

Dias BF, et al.

Migraine aura: results from an art contest

deviation), median of 20 minutes, minimum of 1 minute and maximum of

3600 minutes.

About the predominance of the pattern of visual aura, 36.7% of the sub-

scribers have only one kind of visual aura and 33.8% answered that have

more than one kind. Besides visual aura, 6% of the participants also present

loss of strength in one half of the body, 9% have difculty of speaking and

14.4% show tingling of in a half of face or body (Figures 2 and 3).

About the relation with headache, 8 participants did not ll the eld. From

131 of the participants that answered, 46.5% said that their visual aura

almost never occurs without pain after or while aura and 19% reported that

their visual aura always occurs without a headache (Figures 4, 5 and 6).

Figure 2. Percentage of visual aura types.

Figure 3. Percentage of visual auras, non-visual auras, with one type of

visual auras or more than one visual aura.

Figure 4. Visual aura occurring with or without headache.

Figure 5. Winners of the contest for the category digital art

Figure 6. Winners of the contest for the category painting

Discussion

The visual aura contest attracted a signicant number of participants who

contributed with representations of migraine auras. This helped us in gen-

erating new iconography of migraine aura and therefore will be of help in

increasing awareness of this underdiagnosed condition. Art contests are

a useful tool for awareness campaigns. The images uploaded were from

a great variety of visual auras.

Aura features reported by the participants were like the ones described

in previous papers

8,14

Further spread of the images is planned, a book with aura images is under

development and hopefully will published soon. The same images could be

uploaded and disseminated via social media and website / search engine

such as Google. Indeed Health information is one of the most frequently

searched topics on the Internet

Availability of aura images to the general public may increase aura diagno-

sis, improving the access to migraine or other headache sufferers because

recognition of visual patterns by patients is likely to occur.

Conclusion

Art contests are useful tools for disease awareness. Further actions in

disseminating aura images may help migraine aura underdiagnosis and

undertreatment.

Dias BF, et al.

Migraine aura: results from an art contest

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