The newly developed Migraine Aura Complexity Score (MACS) is effective for stratifying patients with migraine with aura (MwA) into distinct migraine severity categories and identifying patients’ phenotypes. This is according to a study in Frontiers in Neurology.

Adult patients between 21 and 60 years of age who had an episodic MwA were recruited for the study. After each MwA attack, participants completed a questionnaire about the quality and characteristics of aura symptoms. The MACS, a 0- to 9-point scoring system, was used to categorize patients into 3 groups describing the complexity of their auras. These groups included MwA-simple (MwA-S), MwA-moderately complex aura (MwA-MC), and MwA-complex aura (MwA-C). Groups were compared in regard to patient characteristics and estimated cortical thickness of regions of interest.

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A total of 39 patients with 338 MwA attacks (estimated average aura duration, 47.82 ± 36.1 min) were included in the study; 7 patients who experienced less than 6 MwA attacks were excluded from data analysis. Using the MACS, patients were categorized into MwA-S (n=14), MwA-MC (n=9), and MwA-C (n=9). The most frequently reported symptom in all groups was scotoma. This symptom was closely followed by somatosensory aura in patients in the MwA-C group and zig-zag lines in patients categorized to the MwA-S and MwA-MC groups.

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Compared with the MwA-S group, increased cortical thickness was observed in the left primary visual cortex in the MwA-C (P =.006) and MwA-MC (P =.010) groups. Compared with the MwA-S group, patients in the MwA-C group had significantly increased cortical thickness in the left secondary visual cortex (P =.001), right secondary visual cortex (P =.002), left visual area V5 (P =.011), right visual area V5 (P =.013), right somatosensory BA3a cortex (P =.009), and left somatosensory BA3b cortex (P =.017).

Limitations of the study were the small sample size and the use of a questionnaire to assess aura symptoms.

The researchers concluded that the MACS may be used “for the stratification of MwA patients and identifying their phenotypes, herewith allowing the better investigation of changes in migraineurs’ brains.”


Petrusic I, Viana M, Dakovic M, Zidverc-Trajkovic J. Application of the Migraine Aura Complexity Score (MACS): clinical and neuroimaging study. Front Neurol. 2019;10:1112.