▸ An aura is a transient subjective feeling of unusual visual symptoms, abnormal sensations (numbness or ‘pins and needles’) or speech disturbance that typically precedes onset of headache

▸ Aura symptoms are described in up to one-third of childhood migraine

▸ Onset is gradual over 5–20 min (as opposed to seizures) and lasts <60 min

▸ Abrupt onset of visual aura may indicate occipital lobe epilepsy

▸ Typical aura with non-migraine headache is also described

▸ Either familial or sporadic

▸ Typical presentation is with stroke-like hemiparesis with a migrainous-type headache

▸ Clinically evident weakness must be demonstrated

▸ May be confused with Todd's (postictal) paresis

▸ Attack is marked with abrupt onset of agitation, disorientation and behavioural changes

▸ Confusion lasts from minutes to hours

▸ There may be no recollection of the event and the associated headache

▸ A diagnosis of exclusion

▸ A form of migraine with atypical visual aura

▸ Abnormal visual illusions with spatial distortions

▸ The differential diagnosis includes occipital lobe epilepsies

▸ Episodic reversible monocular visual disturbance associated with ipsilateral retro-orbital pain

▸ Symptoms (and signs) of brainstem or posterior fossa involvement

▸ Attacks of dizziness, vertigo, ataxia, dysarthria and diplopia for minutes or up to an hour followed by the headache phase

▸ May be associated with decreased level of consciousness

▸ The combination of the above features may be confused with complex focal seizures