Migraine With Aura: Symptoms, Causes, Treatment, and Essential Facts
Recognizing early warning signals can help prevent or ease headache pain.
Migraine With Aura: What You Need to Know
Migraine with aura is a neurological condition that affects millions of people worldwide. Characterized by recurrent headaches and distinct sensory disturbances, it remains one of the most misunderstood types of migraines. This article offers a comprehensive overview of migraine with aura, including its symptoms, causes, types, treatment, prevention strategies, and answers to common questions.
What Is Migraine With Aura?
Migraine with aura is defined as a recurring headache disorder that includes distinct neurological symptoms called an aura. The aura often precedes or accompanies the headache and reflects temporary changes in brain function due to a phenomenon involving the nervous system.
About one-third of individuals with migraine experience aura at least once, but not everyone with migraine will have this symptom. Migraine with aura was previously known as “classic migraine.”
Understanding the Aura
The word “aura” refers to a group of sensory and neurological disturbances that usually develop gradually over five minutes and last for up to an hour. These symptoms are reversible and typically disappear as the headache phase of the migraine begins.
- Visual changes: flashes of light, zigzag patterns, blind spots (scotomas), shimmering spots, flickering lights, blurred vision, or colored spots.
- Sensory changes: tingling, numbness (commonly on the face or one hand, spreading slowly), or a pins-and-needles sensation.
- Speech and language disturbances: difficulty forming words, slurred, or jumbled speech.
- Other neurological symptoms: dizziness, muscle weakness (rare), problems with coordination, or hearing changes such as ringing in the ears.
| Symptom Type | Common Descriptions |
|---|---|
| Visual | Flashing lights, zigzag lines, blind spots, shimmering or flickering patterns |
| Sensory | Tingling, numbness, pins-and-needles sensation (often one side) |
| Speech/Language | Difficulty speaking, slurred speech, trouble finding words |
| Motor | Weakness on one side of the body (hemiplegia; rare) |
| Auditory | Ringing in the ears, hearing disturbances |
How Long Do Aura Symptoms Last?
Aura symptoms generally last 5–60 minutes. For most people, they resolve before or as the headache phase of the migraine starts. In some cases, the aura and headache overlap or, rarely, the aura continues after the pain begins.
Types of Migraine With Aura
There are several types of migraine aura presentations. Some individuals may experience only one type, while others may alternate between types:
- Migraine aura with headache: The classic presentation, where the aura occurs shortly before or during a migraine headache.
- Migraine with brainstem aura: Symptoms originate at the base of the brain and include dizziness, ringing in the ears, slurred speech, double vision, and sometimes loss of consciousness.
- Hemiplegic migraine: Characterized by temporary weakness or paralysis on one side of the body, often with other aura symptoms. This type is rare.
- Retinal migraine: Involves temporary visual disturbances or vision loss in one eye, often preceding the headache.
- Silent migraine (migraine aura without headache): Effects of aura symptoms alone with no subsequent headache. This is more common in older adults and may occur in individuals who previously experienced migraine headaches with aura.
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Migraine With Aura Vs. Migraine Without Aura
| Feature | Migraine With Aura | Migraine Without Aura |
|---|---|---|
| Neurological symptoms (aura) | Present before/during attack (visual, sensory, speech, etc.) | Absent |
| Headache | Usually follows or overlaps aura, may have typical migraine pain & symptoms | Main symptom; no preceding aura |
| Prevalence | About 1/3 of migraine cases | About 2/3 of migraine cases |
| Treatment approach | Similar to migraine without aura | Similar to migraine with aura |
What Causes Migraine With Aura?
The exact mechanism behind migraine with aura is not fully understood, but research indicates that a phenomenon known as cortical spreading depression might be involved. This is a slow-moving wave of altered electrical activity that spreads across the cortex of the brain, temporarily affecting nerves, chemicals, and blood flow.
Both genetic factors and environmental triggers contribute to the onset and recurrence of migraine with aura. Some individuals inherit a predisposition to migraines, but triggers play a significant role in bringing on attacks.
Common Triggers of Migraine With Aura
- Stress—emotional and physical
- Changes in sleep patterns (lack of sleep, oversleeping)
- Hormonal fluctuations (such as those associated with menstrual cycle or menopause)
- Certain foods or additives (chocolate, aged cheese, processed meats, artificial sweeteners, alcohol, especially red wine)
- Bright or flickering lights
- Strong smells
- Skipping meals
- Dehydration
- Weather changes or barometric pressure shifts
Symptoms and Phases of Migraine With Aura
Migraine with aura typically unfolds in phases:
- Premonitory (Prodrome) Phase: Subtle symptoms such as irritability, food cravings, fatigue, difficulty concentrating, or neck stiffness may occur hours or days before the aura or headache.
- Aura Phase: Neurological symptoms develop over minutes and last less than an hour, as described previously.
- Headache Phase: Intense, throbbing headache—often on one side of the head—usually sets in during or after the aura. Other possible symptoms include nausea, vomiting, and increased sensitivity to light (photophobia) and sound (phonophobia).
- Postdrome (Recovery) Phase: Feelings of exhaustion, confusion, dizziness, or difficulty concentrating can last up to 24 hours after the headache resolves.
Diagnosis: How Migraine With Aura Is Identified
Diagnosis of migraine with aura is primarily based on history and clinical symptoms. There is no specific test for migraine with aura, so your healthcare provider will take a detailed account of your symptoms and possible triggers. They may perform a physical and neurological examination to rule out other health issues.
In some cases, brain imaging (such as MRI or CT scans) or other tests may be recommended to exclude alternative diagnoses, especially if your symptoms are atypical or occur for the first time after age 50.
Treatment for Migraine With Aura
The goal of treatment is to relieve symptoms, reduce the frequency and severity of attacks, and improve quality of life. Migraine management generally involves a combination of medication and lifestyle modification.
Acute Treatments
- Over-the-counter painkillers: Aspirin, ibuprofen, or acetaminophen may help relieve headache pain if taken early in the attack.
- Triptans: Prescription medications that target serotonin receptors and are specifically designed for migraines. They help by narrowing blood vessels and reducing inflammation around nerves. Should be taken as soon as headache starts.
- Anti-nausea medications: For those experiencing significant nausea or vomiting.
- Ergots: Sometimes used as alternatives to triptans. More effective when taken early but less commonly prescribed due to side effects.
Preventive Treatments
- Beta-blockers: Commonly used to help reduce the frequency and severity of attacks.
- Tricyclic antidepressants: Medications that help change how pain signals are processed in the brain.
- Anti-epileptic (anticonvulsant) medications: These can stabilize nerve activity and make migraine attacks less likely.
- Calcium channel blockers: Sometimes prescribed for migraine with aura, especially if other preventive treatments do not work.
If attacks are infrequent or mild, medication may not be necessary, but some people require daily preventive therapy, especially if attacks are disabling or occur frequently.
For migraine aura without headache, traditional acute treatments are generally ineffective, and management is individualized. Always discuss your treatment plan with your healthcare provider.
Important Note About Medication Overuse
Taking acute migraine treatments (like painkillers or triptans) too often can lead to “medication overuse headache”—a condition where frequent use of acute medications makes headaches more frequent or chronic.
Lifestyle Strategies and Self-Care
In addition to medication, several lifestyle tactics can help prevent or minimize migraine attacks:
- Keep a consistent routine: Wake up and go to bed at the same time every day, including weekends.
- Eat regular meals: Don’t skip meals, and maintain a healthy, balanced diet.
- Stay hydrated: Drink plenty of water throughout the day.
- Identify and avoid triggers: Keep a migraine diary to track symptoms and possible triggers, then work to minimize exposure.
- Exercise regularly: Aerobic exercise can help prevent migraines, although overexertion may trigger an attack in some individuals.
- Manage stress: Practice stress-reduction techniques, such as meditation, deep breathing, yoga, or progressive muscle relaxation.
- Prioritize sleep: Good sleep hygiene is crucial—aim for consistent, sufficient, and restful sleep.
When to See a Doctor
Most migraine auras are harmless, but certain symptoms require immediate medical evaluation to rule out other conditions, such as stroke:
- New or unusual aura symptoms (especially after age 50)
- Muscle weakness
- Loss of vision (sudden or persistent)
- Trouble speaking or understanding speech
- Severe, sudden-onset headache (“the worst headache ever”)
Complications and Risks
- People with migraine with aura may have a slightly increased risk of stroke, especially in women under age 45, those who smoke, or those who use estrogen-containing contraceptives.
- Chronic migraine (headaches on more than 15 days per month) can develop, especially with medication overuse.
- Migraine may contribute to other health issues, such as anxiety and depression, due to its impact on quality of life.
Frequently Asked Questions (FAQs)
Is migraine with aura dangerous?
For most people, migraine with aura is not dangerous, but the symptoms can mimic more serious problems like stroke. Immediate medical attention is needed if you have new or unusual aura symptoms, especially if you have muscle weakness, trouble speaking, or vision loss.
Can migraine aura cause permanent brain damage?
No, migraine aura does not cause permanent brain damage. The neurological symptoms are temporary and reversible, though frequent or severe migraines can impact daily functioning over time.
Are there specific foods that trigger migraine with aura?
Triggers can vary, but common offenders include processed meats, aged cheeses, chocolate, caffeine, alcohol (especially red wine), and artificial sweeteners. Keeping a food diary can help identify personal triggers.
Can I prevent migraine with aura naturally?
Lifestyle modifications—such as avoiding known triggers, getting enough sleep, regular exercise, and managing stress—can reduce the frequency and severity of attacks. However, some individuals will also require medication.
Does migraine with aura get worse with age?
For many people, migraine symptoms—including aura—may decrease with age, especially after menopause in women. In some people, headaches may stop but aura symptoms persist as “silent migraine.” Always discuss significant changes in symptoms with a healthcare provider.
Key Takeaways
- Migraine with aura is a neurological condition involving temporary sensory and neurological disturbances followed by headache.
- Aura symptoms are commonly visual but can include sensory, language, or motor disturbances.
- Triggers include stress, certain foods, hormonal changes, and environmental factors.
- Treatment involves medication (both acute and preventive), lifestyle changes, and trigger management.
- If you experience unusual or severe symptoms, seek immediate medical evaluation.
Living well with migraine with aura means understanding your unique triggers, working with your healthcare provider to develop a treatment plan, and implementing practical strategies for prevention and relief.
References
- https://migrainetrust.org/understand-migraine/types-of-migraine/migraine-with-aura/
- https://www.mayoclinic.org/diseases-conditions/migraine-with-aura/symptoms-causes/syc-20352072
- https://www.webmd.com/migraines-headaches/what-is-a-migraine-with-aura
- https://my.clevelandclinic.org/health/diseases/22131-migraine-aura
- https://www.mayoclinic.org/diseases-conditions/migraine-with-aura/diagnosis-treatment/drc-20352077
- https://www.ncbi.nlm.nih.gov/books/NBK554611/
- https://my.clevelandclinic.org/health/diseases/5005-migraine-headaches
- https://americanmigrainefoundation.org/resource-library/retinal-migraine/
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