Migraine is a major public health problem afflicting approximately 10% of the general population and is a leading cause of disability worldwide, yet our understanding of the basis mechanisms of migraine remains incomplete. About a third of migraine patients have attacks with aura, consisting of transient neurological symptoms that precede or accompany headache, or occur without headache. For patients, aura symptoms are alarming and may be transiently disabling. For clinicians and scientists, aura represents an intriguing neurophysiological event that may provide important insight into basic mechanisms of migraine. Several observations point toward important differences between migraine with and without aura. Compared with migraine without aura, migraine with aura has different heritability, greater association with different conditions including stroke, different alterations of brain structure and function as revealed by imaging studies. A number of studies also indicate that migraine with aura may respond differently to acute and preventive therapies as compared to migraine without aura. The purpose of this review is to provide an overview of these differences in treatment responses, and to discuss the possibility of different therapeutic strategies for migraine with vs. without aura.

中文翻译：

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有先兆偏头痛和无先兆偏头痛之间治疗反应的差异：临床实践和随机对照试验的经验教训

偏头痛是一个主要的公共卫生问题，困扰着大约 10% 的总人口，也是全世界残疾的主要原因，但我们对偏头痛的基本机制的了解仍然不完整。大约三分之一的偏头痛患者有先兆发作，包括先兆或伴随头痛或不伴头痛的短暂神经症状。对于患者来说，先兆症状是令人担忧的，并且可能会导致暂时性的失能。对于临床医生和科学家来说，先兆代表了一种有趣的神经生理学事件，可以为偏头痛的基本机制提供重要的见解。一些观察结果表明，有先兆偏头痛和无先兆偏头痛之间存在重要差异。与无先兆偏头痛相比，有先兆偏头痛具有不同的遗传性，与包括中风在内的不同疾病有更大的关联，影像学研究显示大脑结构和功能的不同改变。许多研究还表明，与无先兆偏头痛相比，有先兆偏头痛对急性和预防性治疗的反应可能不同。本综述的目的是概述治疗反应的这些差异，并讨论针对有先兆偏头痛和无先兆偏头痛采取不同治疗策略的可能性。