Aura without headache (acephalgic migraine)

The differential diagnosis must exclude aura mimics, especially transient ischaemic attack or epilepsy. Concerning signs include a first episode of aura after the age of 40 years, exclusively negative symptoms (eg hemianopia) or prolonged aura (more than 60 minutes). The presence of other migraine features (eg photophobia, phonophobia, nausea) may support the diagnosis, but maintain a high index of suspicion for other diagnoses. Refer for expert advice.

Acute treatment of isolated aura is not usually helpful, because the attacks are so brief. Consider migraine prophylaxis for frequent attacks.