To examine the unique role of migraine aura in predicting daily disability, independent of headache and psychological factors. 

Limited literature has retrospectively examined the impact of migraine aura on functional outcomes. Determining, at the attack level, whether aura is associated with disability independent of headache and psychological factors that also influence disability could help advance targeted treatment approaches and inform patient decision-making. 

This was an observational study of electronic daily diary data from the N1-Headache™ app. 554 participants with migraine were administered the Migraine Disability Assessment (MIDAS; Lipton et al., 2001) each day a headache was reported, and migraine criteria and psychological symptoms were queried daily. Multilevel generalized linear models were used to assess the predictive effects of aura on disability. Given the number of predictors, a conservative p < .01 was utilized.  

Aura occurred on 20% of the 4,469 first days of a migraine episode (11,156 total days). Aura on the first day significantly predicted greater odds of disability across all days of that episode (OR = 1.40, p < .001). This relationship remained unchanged after adjusting for patient-level variables (OR = 1.40, p < .001) and day-level psychological variables (OR = 1.39, p < .001). However, the relationship between aura and disability was no longer significant after controlling for day-level headache variables (OR = 1.19, p = .039). Nausea/vomiting, photophobia, phonophobia, and allodynia were most strongly associated with aura. 

This is the first study to evaluate the functional impact of aura at the attack level, showing attacks with aura are predictive of greater disability. This relationship was attributable to migraine-specific headache symptoms. These findings add to pathophysiological data from a recent fMRI study (Mehnert et. al, 2023) suggesting that aura is one of many symptoms of migraine rather than a unique initiating event.