Migraine with aura is a neurological condition where certain warning symptoms appear before or during an intense headache. These symptoms can include flashing lights, zigzag lines in your vision, numbness, or difficulty speaking. While uncomfortable and sometimes frightening, understanding this condition can help you manage it more effectively.

How Common Is Migraine with Aura?

Migraine is a widespread health condition affecting a significant portion of the population. Research shows that approximately 12% of people in the general population experience migraine headaches^[4]. Among those who suffer from migraines, about 25% to 30% experience aura symptoms as part of their attacks^[2][3]. This means that roughly one in three people with migraine will have attacks that include aura at some point.

The frequency of migraine with aura can vary greatly from person to person. Some individuals may experience these sensory disturbances with every migraine episode, while others might only have them occasionally. Interestingly, you can have both types of migraine attacks at different times throughout your life—some with aura and some without^[5]. Research has also found that migraine attacks with aura tend to increase with age and become more common among elderly patients^[23].

Women are more likely to experience migraine than men, which also means more women experience aura symptoms. Studies indicate that between 18% and 26% of women deal with migraines, compared to only 6% to 9% of men^[4]. This gender difference makes migraine with aura a particularly important health concern for women.

What Causes Migraine with Aura?

The exact mechanisms behind migraine with aura are not fully understood, but researchers have made significant progress in uncovering what happens in the brain during these episodes. Current scientific understanding points to a phenomenon called cortical spreading depression as the underlying cause. This is a self-propagating wave of neuronal and glial depolarization that spreads slowly across the cerebral cortex, which is the outer layer of the brain^[4].

This wave of altered brain activity leads to temporary changes in the chemicals, nerves, and blood flow in the brain. These changes affect how the brain functions and are believed to be connected to both the aura symptoms and the pain that follows^[5][14]. Research suggests that the cortical spreading depression may be caused by an electrical wave that moves across the visual cortex, which is the part of the brain responsible for processing visual information. This explains why visual symptoms are the most common type of aura^[2].

When this cortical depression occurs, it activates nerve fibers called trigeminal afferents. This activation causes an inflammatory cascade of molecular events in the membranes surrounding the brain, contributing to the headache pain that often follows the aura^[4]. Older theories suggested that migraine pain resulted from the dilation of cranial blood vessels and that auras were caused by subsequent constriction. However, current research indicates a genetic foundation combined with the cortical spreading depression as the fundamental cause^[4].

What Triggers Migraine with Aura?

Migraine with aura is typically triggered by the same factors that cause migraine without aura. Understanding your personal triggers can be an important step in preventing or reducing the frequency of attacks. Common triggers include bright lights, which can overstimulate the visual system and set off the chain of events leading to an aura and subsequent headache^[2][10].

Certain foods and beverages are well-known migraine triggers for many people. Chocolate, aged cheeses, and alcohol—especially red wine and port—are frequently reported culprits. Food additives such as monosodium glutamate (MSG) and aspartame can also trigger migraines in sensitive individuals. Pickled foods, hot dogs, bacon, and cold cuts containing preservatives may similarly provoke attacks^[13][20].

Lifestyle factors play a significant role as well. Stress is a major trigger, and migraines are most common during or immediately after stressful periods^[13]. Sleep disturbances, whether too little or too much sleep, can also trigger aura episodes^[2]. Women may notice that their migraine attacks occur in connection with their menstrual periods, suggesting hormonal fluctuations as a trigger^[10].

Environmental factors can also contribute to migraine onset. Strong odors, smoke, and changes in weather or barometric pressure have been reported as triggers. Even sudden changes in caffeine intake—either consuming too much or suddenly stopping caffeine consumption—can provoke a migraine attack^[13][20].

Symptoms of Migraine with Aura

The symptoms of migraine with aura can be varied and sometimes alarming, especially when you experience them for the first time. Aura symptoms are temporary sensory disturbances that typically occur before the headache begins, though they can also happen at the same time as the headache or, more rarely, without a headache following at all^[1]. These symptoms usually develop gradually over about five minutes and can last anywhere from five minutes up to an hour, though they generally resolve within 60 minutes^[1][5].

Visual symptoms are by far the most common type of aura, affecting 90% to 99% of people who experience aura^[2]. People often describe seeing blind spots, also called scotomas, which sometimes appear outlined by simple shapes. Zigzag lines that gradually float across your field of vision are another classic symptom. Many people report seeing flashing or flickering lights, brightly colored spots, or geometric patterns. Some describe the sensation of looking at objects through water or heat waves, while others experience foggy or blurred vision^[2][5].

A common visual pattern is described as a fortification pattern—zigzag lines that are scintillating or shimmering, often with a crescent or “C” shape. These typically start smaller in the center of vision and then progress toward the edges. They may simultaneously expand in size before eventually fading away^[8]. The visual symptoms affect both eyes, though they tend to be more noticeable in the eye that has outer visual field involvement^[8].

Sensory symptoms are another category of aura, affecting about 36% of people with aura^[2]. These can include numbness or tingling sensations, often described as pins and needles, that may affect parts of your body such as your hands, arms, or face^[1][5]. Some people experience tinnitus, which is ringing in the ears, or feelings of dizziness^[2].

Speech and language problems represent another type of aura, called dysphasic aura, though this is the least common type, affecting only about 10% of those who experience aura^[2]. Symptoms can include mumbling, slurred speech, or difficulty finding the right words to express yourself^[2].

Muscle weakness is a less common but more concerning symptom of aura. If you experience muscle weakness for the first time, it’s important to seek medical advice to rule out other conditions^[5][14]. After the aura episode ends, your vision and other affected senses should return to the way they were before the episode. If they do not, medical evaluation is recommended^[8].

It’s important to understand that migraine aura doesn’t happen during every migraine episode, even in people who regularly experience aura^[2]. For most people who get migraine with aura, the aura usually happens just before the main headache phase. During the headache phase, you typically experience a pulsating, throbbing pain, often on one side of the head, along with nausea, sensitivity to light, and sensitivity to sound^[5][9].

Special Types of Migraine with Aura

There are several subtypes of migraine with aura, each with distinctive characteristics. Understanding these variations can help you and your healthcare provider identify your specific condition and determine the most appropriate treatment approach.

Migraine with brainstem aura, formerly called basilar-type migraine, is a subtype where the aura originates in the base of the brain, called the brainstem, or affects both sides of the brain. This type includes neurological symptoms such as vertigo, difficulty with coordination (ataxia), slurred speech, ringing in the ears, double vision, impaired hearing, and pain in the back of the head. This is an uncommon form of migraine with aura^[5][6].

Hemiplegic migraine is a rare type of migraine where the aura causes temporary weakness on one side of your body, a condition called hemiplegia. This weakness occurs along with other aura symptoms such as visual distortions, blurry vision, or nausea. Because the symptoms can mimic those of a stroke, seizure, or other complex neurological conditions, it’s vital to seek immediate medical help if you experience these symptoms for the first time^[5][6].

Retinal migraine, also called ocular migraine, is another rare form where visual disturbances occur in only one eye rather than both. You may experience flashes or sparkles, blind spots, or even temporary vision loss in one eye. The headache usually occurs at the same time as these eye symptoms or within 60 minutes after they begin. While retinal migraine symptoms are usually temporary and don’t cause long-term damage, it’s crucial to rule out other more serious causes of sudden vision loss^[5][6].

Silent migraine, or migraine aura without headache, occurs when you experience aura symptoms but no headache follows. This is sometimes more common in older people, particularly those who may have experienced typical migraine with headache when they were younger but progress to having only aura symptoms as they age^[5][13][20].

How to Prevent Migraine with Aura

Prevention strategies for migraine with aura focus on identifying and avoiding triggers, making lifestyle modifications, and in some cases, taking preventive medications. A comprehensive approach to prevention can significantly reduce the frequency and severity of attacks.

Maintaining regular sleep patterns is one of the most important preventive measures. Getting plenty of sleep and sticking to a consistent sleep schedule helps stabilize your body’s internal rhythms. However, it’s important not to oversleep, as too much sleep can also trigger a headache^[13][20].

Eating regular meals at consistent times throughout the day helps prevent migraine attacks. Skipping meals or going too long without eating can lower your blood sugar and trigger an episode. At the same time, avoiding known food triggers is essential. This includes limiting or eliminating chocolate, aged cheeses, alcohol (especially red wine), and foods containing MSG, aspartame, or certain preservatives^[13][20].

Managing caffeine intake carefully is another important strategy. While too much caffeine can trigger migraines, suddenly stopping caffeine consumption can also provoke an attack. If you regularly consume caffeine, maintain a consistent daily amount rather than varying your intake significantly^[13][20].

Stress management techniques can be particularly helpful since migraines are most common during or right after stressful periods. Finding healthy ways to deal with stress—such as practicing mindfulness, deep breathing exercises, or other relaxation techniques—can reduce the frequency of attacks^[13][20]. Relaxation techniques such as massage may also help prevent migraine with aura^[1].

Regular exercise is beneficial for preventing migraines, but it’s important to be careful not to push yourself too hard. Vigorous or intense exercise may trigger a headache in some people, so finding the right balance is key^[13][20].

Avoiding smoking and secondhand smoke is crucial. If you smoke and need help quitting, talk to your doctor about stop-smoking programs and medications that can increase your chances of success^[13][20].

For women taking birth control pills or hormone therapy, it’s important to discuss these medications with your healthcare provider. Hormonal fluctuations can trigger migraines, and adjusting hormone-based medications may help reduce attacks^[13][20]. Research has shown that women with migraine with aura who use estrogen-containing contraceptives may have an increased risk of stroke, making this conversation with a healthcare provider especially important^[3][12].

When lifestyle modifications alone aren’t sufficient to control migraine frequency, preventive medications may be recommended. These include beta-blockers, tricyclic antidepressants, and anti-epileptic medications. These medications are taken regularly, even when you don’t have a headache, to reduce the frequency and severity of future attacks^[5][14].

How the Body Changes During Migraine with Aura

Understanding what happens in your body during a migraine with aura can help explain why you experience the symptoms you do. The changes occur primarily in the brain and involve complex interactions between nerve cells, blood vessels, and chemical messengers.

Migraine attacks progress through four distinct phases, though not everyone experiences all four phases with every attack. These phases are the prodrome, aura, headache, and postdrome^[4][23].

The prodrome phase can last from several hours to a few days before the headache begins. During this phase, you might experience subtle warning signs such as neck stiffness, fatigue, sensitivity to light or sound, irritability, or mood changes. These symptoms indicate that changes are already beginning in your nervous system^[23].

The aura phase involves the cortical spreading depression mentioned earlier—a wave of electrical activity that moves slowly across the surface of the brain at a rate of about 3 to 5 millimeters per minute. As this wave spreads, it temporarily disrupts normal brain function in the affected areas. When it crosses the visual cortex, you experience visual disturbances. When it affects sensory areas, you may feel numbness or tingling. If it reaches language centers, you might have difficulty speaking^[4][7].

This spreading depression causes a cascade of chemical changes in the brain. It leads to the release of various substances that can activate pain pathways and cause inflammation in the membranes covering the brain. These chemical changes also affect blood flow in the brain, though current understanding suggests that blood flow changes are a consequence rather than the primary cause of migraine^[4].

During the headache phase, the trigeminal nerve system becomes activated. This complex network of nerves serves the face and head, and when activated, it releases substances that cause inflammation and sensitize pain receptors. The result is the characteristic throbbing, pulsating pain typically felt on one side of the head. The pain-processing centers in the brain become hypersensitive, which explains why normal sensations like light and sound become painful during a migraine attack^[4].

The postdrome phase occurs after the headache resolves. During this “migraine hangover,” you might feel exhausted, confused, or generally unwell. Your brain is recovering from the intense neurological event it has just experienced, and it takes time for all systems to return to their normal baseline function^[23].

Throughout these phases, your body’s normal biochemical and physical processes are disrupted. The balance of neurotransmitters—chemical messengers that allow nerve cells to communicate—is altered. Inflammation occurs in structures around the brain. Blood vessels may constrict and then dilate. Energy metabolism in brain cells is disrupted. All of these changes contribute to the symptoms you experience during a migraine with aura^[4].

One important aspect of migraine pathophysiology is that it involves genetic factors. Migraine tends to run in families, suggesting that inherited variations in genes that control brain excitability, chemical signaling, or blood vessel function may make some people more susceptible to developing migraines^[4]. This genetic component explains why some people are more prone to migraine with aura while others never experience these symptoms.