Migraine with aura

Migraine with aura is a recurring headache disorder where sensory disturbances called auras occur before or during the headache. These temporary symptoms, most commonly visual, can include seeing flashing lights, blind spots, or zigzag patterns, and typically last less than an hour.

Table of contents

• What is migraine with aura?
• Symptoms and warning signs
• Types of aura
• Specific subtypes of migraine with aura
• What causes migraine with aura?
• Common triggers
• How is it diagnosed?
• Treatment options
• Prevention strategies
• Important health risks

What is migraine with aura?

Migraine with aura is a type of recurring headache where you experience certain nervous system symptoms called an aura before or at the same time as the headache pain. An aura is a set of temporary sensory disturbances related to your nervous system^[1][5].

Approximately 25% to 30% of people who have migraines experience aura with their attacks. This means that up to a third of people with migraine get attacks with aura, though you may not have an aura with every migraine episode^[2][4]. Some people experience only migraine with aura, while others have both types of attacks at different times^[5].

Aura symptoms usually occur within an hour of when headache pain begins and generally last less than 60 minutes. However, the aura can happen at the same time as the headache. In rare cases, some people experience aura without any headache following it, particularly those over age 50^[1].

Symptoms and warning signs

Aura symptoms typically start gradually over about five minutes and usually last from five minutes up to an hour. These symptoms are temporary and will wear off after this time^[5][7].

Most people who have migraine with aura develop temporary visual symptoms. These visual disturbances tend to start in the center of your field of vision and spread outward^[1]. Common visual symptoms include:

• Blind spots, sometimes outlined by simple shapes such as circles
• Zigzag lines that gradually float across your vision
• Flashing or flickering lights
• Seeing brightly colored spots or lines
• Blurred vision
• Foggy vision
• The sensation that you’re looking at objects through water or heat waves

Beyond visual symptoms, auras can also include^[2][5]:

• Numbness or tingling sensations like pins and needles in parts of your body
• Problems with speech, such as mumbling or slurred speech
• Feeling dizzy
• Ringing in your ears (tinnitus)
• Muscle weakness

For most people who get migraine with aura, the aura usually happens just before the main attack stage when you typically get a headache and other migraine symptoms like nausea and sensitivity to light or sounds. Some people experience aura symptoms throughout a migraine attack or after a headache has begun^[5].

Types of aura

There are three main types of migraine auras^[2]:

Visual aura is the most common type. It is characterized by temporary changes in your vision, such as flashing lights or zigzag patterns. Approximately 90% to 99% of people who develop aura experience visual symptoms^[2].

Sensorimotor aura involves sensory or motor disturbances. These may include tingling, numbness, or weakness, which may or may not be accompanied by visual aura. About 36% of people with aura develop sensory symptoms^[2].

Dysphasic aura is the least common type of migraine aura. It includes verbal and language symptoms like mumbling or slurred speech. Only about 10% of people with aura experience these language-related symptoms^[2].

Specific subtypes of migraine with aura

Retinal (ocular) migraine

This is a rare type of migraine that causes disturbances with your vision in one eye only. These can include flashes or sparkles, blind spots, or even temporary vision loss. You usually get a headache at the same time or within 60 minutes of the eye symptoms^[5][6].

Retinal migraine symptoms are usually temporary and don’t cause long-term damage. However, it’s important to rule out other more serious causes of eye symptoms and vision loss. If you experience visual disturbances for the first time, seek urgent medical attention. You should go to emergency services or call for emergency help if you experience sudden vision loss^[5].

Migraine with brainstem aura

This type of migraine occurs when the aura starts in the base of your brain (called the brainstem) or on both sides of your brain. This type includes symptoms like slurred speech, dizziness, ringing in the ears, and double vision^[6].

Hemiplegic migraine

This is a rare type where the aura causes weakness on one side of your body (hemiplegia means weakness on one side of the body)^[6].

Silent migraine (migraine aura without headache)

Some people have aura symptoms but don’t get a headache. This is sometimes referred to as a silent migraine or as migraine aura without headache. Silent migraine is more common in older people. You may be more likely to get it if you develop migraine later in life. If you had typical migraine with aura (with headache) when you were younger, you may also progress to silent migraine as you get older^[5][6].

What causes migraine with aura?

The exact causes of migraine aura are not fully understood. However, research indicates that the condition may be due to an electrical wave that moves across the part of the brain responsible for vision (the visual cortex), resulting in visual changes^[2].

Scientists have found that aura may be caused by a slow wave of altered brain activity called cortical spreading depression. This leads to temporary changes in the chemicals, nerves, and blood flow in the brain that affect how it works. This process underlies both the headache and aura associated with migraine^[4][5].

Current research indicates a genetic foundation for migraine with aura. Earlier theories linked the pain of migraine headaches to blood vessel changes in the head, but current understanding points to primary brain dysfunction as the fundamental cause^[4].

Common triggers

Migraine aura is typically triggered by the same factors that cause migraine without aura. Common triggers include^[2]:

• Bright lights
• Certain foods or medications
• Stress
• Sleep disturbances
• Periods (menstruation)

Additional triggers can include specific foods such as chocolate, cheese, and wine, as well as odors, smoke, lack of sleep, and chemicals used in food such as aspartame and monosodium glutamate (MSG). Food additives found in hot dogs, bacon, cold cuts, aged cheeses, and pickled foods can also trigger migraines^[13].

How is it diagnosed?

Your healthcare provider might diagnose migraine with aura based on your symptoms, your medical and family history, and a physical examination. To diagnose you with migraine with aura, your healthcare provider will look for a history of repeated headaches that include^[9]:

• Pain on one side of the head
• Pain that pulses and throbs
• Temporary visual disturbances or vision loss
• Temporary hearing loss
• Nausea
• Sensitivity to light and sound

There is no specific test to diagnose migraine with aura^[9].

To rule out more serious conditions, such as a transient ischemic attack (TIA) or mini stroke, your healthcare provider will perform a physical examination. They may also run certain tests to confirm your diagnosis. These tests may include^[2][9]:

• An eye exam to help rule out any eye conditions that could be causing aura symptoms
• A CT (computed tomography) scan of your head, which takes detailed images of your brain
• Magnetic resonance imaging (MRI), which uses magnets and radio waves to capture images of your tissues, organs, and structures inside of your body

Your healthcare provider might refer you to a doctor who specializes in nervous system conditions, called a neurologist, who can rule out brain conditions that could cause your symptoms^[9].

Treatment options

Although uncomfortable, migraine aura itself is not dangerous. Treatment for migraine with aura is focused on easing symptoms and preventing attacks^[2].

Your treatment options depend on how often you have attacks and how severe they are. It will also depend on other factors such as other illnesses you may have or medication that you take^[5].

Acute treatment

Acute treatment includes medicines you take when an attack comes on. Your healthcare provider may recommend a number of medications, including^[2][5][9]:

• Pain relievers: Prescription or over-the-counter pain medications such as acetaminophen, ibuprofen, or aspirin can alleviate migraine aura and associated pain
• Triptans: Medications like sumatriptan and rizatriptan block pain pathways in the brain. These medications may be prescribed as pills, injections, or nasal sprays
• Anti-sickness medication to help with nausea

For migraine with aura, you should take these treatments as soon as a headache starts. If you only get aura and no head pain, talk to your doctor, as acute pain treatments won’t work for you. There are no treatments specifically to help with the aura alone^[5].

Be careful not to take certain acute treatments on too many days a month as this can cause medication overuse headache^[5].

Preventive treatment

If your migraine episodes are frequent, daily preventive medications can be used to decrease the frequency and prevent the episodes from happening. Although these preventive medications are not directed at the migraine visual aura itself, better control of the migraine attacks can also reduce the number of times the visual aura happens^[8].

Prevention strategies

You can try to prevent migraine with aura using self-care steps^[1][13]:

• Keep a diary to figure out what triggers your auras or headaches. Record when each aura or headache began, how long it lasted, and what the symptoms were like. Note if the aura or headache occurred near your period. List anything that might have triggered the aura
• Follow a regular sleep and meal schedule
• Get plenty of sleep and exercise, but be careful not to push yourself too hard during exercise as vigorous exercise may trigger a headache
• Find healthy ways to deal with stress, such as practicing mindfulness or deep breathing exercises
• Eat regular meals and avoid foods and drinks that often trigger migraines, including chocolate and alcohol, especially red wine
• Limit caffeine by not drinking too much coffee, tea, or soda. But don’t quit caffeine suddenly, because that can also give you migraines
• Do not smoke or allow others to smoke around you

When patients only experience visual aura and do not have headaches, typically no medication is recommended, although some patients find benefit from supplementation with vitamin B2 (riboflavin) and magnesium^[8].

Important health risks

It’s important to correctly identify aura because those who have migraine with aura can potentially develop chronic migraine and have a higher risk of stroke^[3][12].

Migraine with aura carries an increased risk of cerebrovascular accidents (strokes), prompting the need for timely diagnosis and appropriate treatment^[4]. Women who experience migraine with aura are at greater risk of all types of stroke, including ischemic and hemorrhagic stroke^[12].

If you experience muscle weakness as an aura symptom for the first time, seek medical advice. Although migraine aura isn’t dangerous, it can mimic symptoms of other serious conditions, such as stroke. Therefore, it’s important to seek medical care if you think something suspicious is going on^[2][5].