Arterial Spin Labelling Perfusion Changes in Persistent Migrainous Aura Without Infarction

Migraine is a common disorder characterized by recurrent, usually unilateral, pulsatile headaches often accompanied by nausea, vomiting, photophobia, phonophobia, and fatigue. Visual aura is the most common of all aura symptoms in migraine patients. The aura and headache phases of migraine are caused by intracranial vasoconstriction and extracranial vasodilation, respectively. Migrainous aura without infarction refers to migraine aura symptoms that persist for an extended period of one week or longer without any evidence of infarction on imaging. Arterial spin labelling (ASL) is a non-invasive magnetic resonance imaging technique used to quantitatively assess cerebral blood flow. It can be used to track perfusion changes over the migraine cycle. This case report highlights the utility of ASL as a non-invasive tool to detect reversible perfusion changes in persistent migrainous aura, aiding in differentiating it from ischemic events, offering insights into underlying pathophysiology, such as cortical spreading depression, and informing more accurate clinical management.