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The visual aura rating scale (VARS) for migraine aura diagnosis

Authors

  • MK Eriksen,

    Corresponding author
    1. Danish Headache Center, University of Copenhagen, Department of Neurology, Glostrup Hospital, Copenhagen, Denmark
      Dr Malene Kirchmann Eriksen, Danish Headache Center, University of Copenhagen, Department of Neurology, Glostrup Hospital, Nordre Ringvej 57, DK-2600 Glostrup, Denmark. Tel. +45 43 23 27 14, fax +45 43 23 39 60, e-mail kirchmann@dadlnet.dk
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  • LL Thomsen,

    1. Danish Headache Center, University of Copenhagen, Department of Neurology, Glostrup Hospital, Copenhagen, Denmark
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  • J Olesen

    1. Danish Headache Center, University of Copenhagen, Department of Neurology, Glostrup Hospital, Copenhagen, Denmark
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Dr Malene Kirchmann Eriksen, Danish Headache Center, University of Copenhagen, Department of Neurology, Glostrup Hospital, Nordre Ringvej 57, DK-2600 Glostrup, Denmark. Tel. +45 43 23 27 14, fax +45 43 23 39 60, e-mail kirchmann@dadlnet.dk

Abstract

To supplement the traditional ICHD-2 diagnosis for migraine with aura (MA) we developed a diagnostic scale for migraine aura that quantifies the importance of the cardinal characteristics of MA. Since more than 99% of MA patients have visual aura, we developed for simplicity a Visual Aura Rating Scale (VARS). In total 427 patients with MA (ICHD-2) or nonaura visual disturbances were diagnosed in a validated semistructured interview by a trained physician. The patients were separated into a derivation sample and a validation sample. By regression analysis we identified the visual aura characteristics associated with MA in the derivation sample. Based on the identified characteristics we developed VARS and derived a predictive VARS score which was tested in the validation sample. The VARS score is the weighted sum of the presence of five visual symptom characteristics: duration 5–60 min (3 points), develops gradually ≥ 5 min (2 points), scotoma (2 points), zig-zag lines (2 points), and unilateral (1 point). The maximum score is 10 points. A VARS score of 5 or more diagnosed MA with a sensitivity of 96% (95% CI 92–99%) and a specificity of 98%(95% CI 95–100%) in the derivation sample, and a sensitivity of 91% (95% CI 86–95%) and a specificity of 96% (95% CI 91–100%) in the validation sample. VARS adds evidence based weights to a number of clearly specified characteristics; it is easy to learn, apply and teach and may therefore be a valuable addition to traditional ICHD-2 diagnosis.

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