Which feature is most characteristic of migraine with aura?

• A. Unilateral throbbing with N/V
• B. Photophobia
• C. Visual changes preceding headache
• D. Numbness and weakness

Answer: (C)

Visual changes preceding headache reflect the aura phase of migraine. In migraine with aura, transient focal neurologic symptoms precede the pain, most commonly visual disturbances such as scintillating scotomas, zigzag lines, or fortification spectra that develop gradually and typically last only a few minutes to an hour before the headache begins. This premonitory visual phenomenon is what distinguishes migraine with aura, and after the aura, the headache often starts as a unilateral, throbbing pain with nausea and sensitivity to light or sound. Numbness or weakness can occur in some aura variants, but the classic experience is the visual disturbance that heralds the migraine attack.