Migraine with aura is a prevalent neurological disorder that affects up to 30% of individuals experiencing migraines. It presents as temporary neurological disturbances, primarily visual, but also includes sensory, speech, motor, and brainstem symptoms. The underlying pathophysiology is closely tied to cortical spreading depression, which initiates neurovascular and inflammatory changes. Epidemiological studies show significant variations in the prevalence of migraine with aura across different demographics, with a more pronounced effect observed among women. Genetic research has identified both common and rare variants that influence susceptibility to migraine with aura, with genome-wide association studies revealing distinct risk loci. Neuroimaging studies indicate structural and functional alterations in cortical and subcortical areas, reinforcing the role of altered brain connectivity in migraine with aura. Additional studies, including various neurophysiological techniques (such as EEG, VEP, or TMS), are needed to potentially identify specific patterns within MA that would help better characterise clinical and electrophysiological phenotypes. Differential diagnosis is essential, as migraine aura symptoms may overlap with a wide range of primarily neurological paroxysmal disorders. While the treatment of migraine traditionally prioritises the headache, there is limited evidence for targeted therapies addressing aura symptoms; further research is warranted. This systematic review offers a comprehensive synthesis of aura types, epidemiology, genetics, pathophysiology, diagnosis, and management of migraine with aura, emphasising areas for future exploration.

Birmingham Neuro Ophthalmology University Hospitals Birmingham NHS Foundation Trust Birmingham UK

Clinical Neuroscience and Mental Health Department Faculty of Medicine University of Porto Porto Portugal

Department of Neurology and Experimental Neurology Charité Universitätsmedizin Berlin Berlin Germany

Department of Neurology Koventhospital Barmherzige Brüder Linz Austria

Division of Vascular Medicine and Pharmacology Department of Internal Medicine Erasmus MC University Medical Center Rotterdam the Netherlands

Faculty of Medicine Masaryk University Brno Czech Republic

Headache Medical Center Linz Seilerstätte 2 Linz Austria

Neurology Department Health Nation Rehabilitation Center Astana Kazakhstan

Neurology Department Hospital Universitário de São João Porto Portugal

Neurology Department Military University Hospital Prague Czech Republic

Neurology Department of Neurosciences and Mental Health Hospital de Santa Maria Unidade Local de Saúde Santa Maria Lisbon Portugal

Neurology Department University Hospital Brno Brno Czech Republic

School of Medicine Nazarbayev University Astana Kazakhstan

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