An Overview of Migraine With Aura

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As a migraine headache symptom, an aura is a neurologic disturbance characterized by strange sensations that typically come on before actual pain sets in. At least 30 percent of people who get migraine headaches experience auras, according to the American Migraine Foundation (AMF). That estimate may be conservative based on a 2018 study published in Brain and Behavior that found that more than 51 percent of migraine sufferers have auras.

There are several types of aura, some of which may mimic symptoms of neurological events or conditions such as stroke or a brain tumor, so it's important to get an official diagnosis of migraine with aura to rule out these concerning possibilities. There are no medications or therapies targeted specifically to preventing or treating auras, so in most cases, migraine with aura is treated the same way as migraine without aura.

migraine with aura
Verywell / Emily Roberts

Symptoms

Migraine with aura can have several symptoms, many of which are common to migraine without aura as well.

The primary symptom of migraine is head pain that can be described as a throbbing or pulsing sensation that usually affects only one side of the head. Migraine pain can be so severe that the person experiencing it isn't able to go about daily activities.

Other symptoms of migraine include nausea/vomiting, sensitivity to light or sound, dizziness, neck pain, and more.

A migraine with aura comes along with additional symptoms that are unique to the type of aura experienced. Sometimes a person will experience more than one type at a time, with a visual aura almost always present in that case.

Auras can last for as few as five minutes. Most clear up within 60 minutes, often disappearing before head pain sets in, although sometimes there's overlap.

2:05

Visual Aura

Examples of disturbances in vision that can herald the onset of a migraine headache are blind spots called scotomas that sometimes are outlined by simple geometric shapes, zigzag or wavy lines, shimmery spots or stars, sparkles or flashes of light that move or get larger, or changes in vision or vision loss. Often visual auras start in the center of the field of vision and spread outward.

The visual distortions caused by migraines have inspired certain works of art and may even have been the impetus for Lewis Carroll's Alice in Wonderland.

Sensory Aura

A sensory aura might be tingling or pins-and-needles in an arm or leg, for instance, numbness in the face or on one side of the body. These sensations sometimes travel up one arm to one side of the face.

Auditory Aura

A person may hear noises or music, or experience ringing in the ears.

Language Aura

Broadly speaking, this refers to difficulty talking. The most common language aura is having trouble coming up with a specific word or producing a word you know you want to say. For some people, it may mean being unable to understand what others are saying.

Motor Aura

This type of aura is rare but may be characterized by an inability to move a part of the body.

An aura typically occurs within an hour of when head pain begins and so for many people, it serves as a warning that a migraine headache is likely to happen.

In some instances, though, a headache may not follow an aura—what's known as an acephalgic or silent migraine.

Causes

Why some people have auras with their migraines and others do not isn't fully understood. It is known that the same sorts of triggers can set off both types of migraine, among them stress, hormonal fluctuations (such as those that occur during menstruation), caffeine, alcohol, nitrates, and other foods and food additives.

A wave of depressed nerve activity called cortical spreading depression or CSD is believed to be the mechanism responsible for the migraine aura. This wave sweeps across the cerebral cortex, the outer layer of the brain often referred to as gray matter.

Diagnosis

The symptoms of migraine headache—with and without aura—are so distinct and straightforward that most neurologists are able to rely on them, along with a medical history and physical exam, to make a definitive diagnosis.

However, more extensive testing may be needed to rule out other possible causes of head pain—for example, a blood test or spinal tap (lumbar puncture) to check for an infection of the brain or spinal cord, or an imaging test to look for tumors, strokes, or brain damage. According to the Mayo Clinic, women who have migraine with aura have a slightly increased risk of stroke, especially if they smoke or take birth control pills.

Important to Know

If you have severe head pain along with visual or other types of symptoms that you suspect is migraine with aura, it's important to have your doctor assess your condition since aura can mimic other conditions such as transient ischemic attack, stroke, or seizures.

Getting an official diagnosis of migraine with aura also is important for distinguishing this type of migraine from another type called retinal migraine (sometimes called one-eye migraine). As the nickname suggests, any visual symptoms that accompany a retinal migraine affect only one eye and are caused by a spasm of blood vessels in the retina. 

Prevention

Managing migraine with aura is a two-pronged undertaking that involves measures and medications for preventing them and drugs and other approaches to relieving acute pain and symptoms.

There are no medications that target auras specifically. Successful measures for preventing migraine headaches in general obviously will keep auras at bay. But once an aura is in progress, nothing can be done to stop it beyond waiting it out.

In May 2018, the U.S. Food and Drug Administration (FDA) approved the first medication developed specifically to prevent migraine headaches, a biologic drug called Aimovig (erenumab).

Aimovig, a once-monthly subcutaneous injection, blocks the transmission of pain signals by targeting a protein in the brain and nervous system called calcitonin gene-related peptide (CGRP). It also dilates blood vessels outside and inside of the skull.

All other medications used to prevent migraines originally were developed for other purposes but have since been found to help stave off headaches. Collectively they're often referred to as oral migraine preventive medications (OMPMs).

Those approved by the FDA for this purpose include:

Acupuncture may also be helpful. In a 2016 review of studies looking at the effectiveness of this ancient Chinese medical practice for preventing migraine, acupuncture was found to "be at least similarly effective as treatment with prophylactic drugs."

Treatment

When preventive measures fail and you experience the onset of an aura, what you do from there will depend on the nature of your symptoms and how long they last.

Medications

There are several medications that can help to relieve headache and other general migraine symptoms. Once these take effect, a lingering aura should subside along with pain.

Pain relievers: These can be over-the-counter or prescription analgesics, including Tylenol (acetaminophen) and non-steroidal anti-inflammatory drugs (NSAIDs) such as aspirin and ibuprofen, which is sold under the brand names Advil, Motrin, and others.

Triptans: Triptans are prescription drugs that work by blocking the pathways of pain in the brain. The triptans used for migraine include Amerge (naratriptan), Imitrex (sumatriptan), Relpax (eletriptan), Treximet (sumatriptan and naproxen), and others.

Dihydroergotamine: Available as D.H.E. 45 or Migranal, this medication is in a class of drugs known as ergot alkaloids. It helps head off migraines by tightening blood vessels in the brain and preventing the release of substances that cause swelling. It can be injected subcutaneously, usually in the thigh well above the knee, or taken as a nasal spray.

Antiemetics (anti-nausea medications): Drugs called dopamine-receptor antagonists may be used to relieve nausea and vomiting that often accompany migraine headaches, especially as part of emergency treatment, in which case they're given intravenously or by injection. Examples include Chlorpromazine, Compro, Procomp (prochlorperazine), and Haldol (haloperidol).

Modifications

If an aura is prolonged or continues even after head pain sets in, do all you can to cope with any sensations you're having:

  • If you find light exacerbates a visual aura, lying down in a dark room or putting on sunglasses may be helpful.
  • Seek quiet if noise bothers you.
  • Get away from cooking smells or other aromas that are unpleasant.
  • If you experience an aura that affects your balance or ability to move, ask someone to help you get somewhere you can sit or lie comfortably.

A Word From Verywell

Migraine with aura can be debilitating enough to have a negative effect on your quality of life. You may feel isolated because the unpredictability of your migraine attacks makes it difficult to plan social events. Frequent migraine attacks may also impact your work and relationships.

It is important that you seek the help of a professional. Some neurologists are specialists in migraines and headaches. Besides professional treatment, migraine support groups also exist to help with information and guidance.

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