An Overview of Migraine With Aura

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Migraine with aura (also called a "common migraine") is a migraine with sensory disturbances. These disturbances can occur just before or at the same time as the migraine itself.

Experiencing auras with migraine is relatively common. Estimates from the American Migraine Foundation (AMF) say at least 30 percent of people with migraines have symptoms of aura, while other evidence has placed that number at more than 50 percent.

Symptoms of aura can range in severity and may be similar to symptoms that accompany more serious neurological events, such as stroke or brain tumor. Because of this, it is important to speak with your doctor about your symptoms in order to rule out other causes and get an official migraine with aura diagnosis.

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 and without aura share many of the same symptoms - the primary symptom of both is a throbbing or pulsing head pain that typically affects just one side of the head. Other symptoms of migraine include nausea and vomiting, sensitivity to light or sound, dizziness, neck pain, and more.

Migraine pain can be so severe that the person experiencing it isn't able to go about daily activities.

Visual symptoms are by far the most common among migraine with aura symptoms. Between 98 and 99 percent of aura symptoms experienced migraine with aura are visual, while symptoms affecting sensation and speaking occur in 36 and ten percent of aura, respectively.

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

Visual auras can look like 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 (scotomas). Often visual auras start in the center of the field of vision and spread outward.

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.

When Do Auras Happen?

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

While migraine with aura is caused by electric- or chemical-like waves (cortical spreading depression) that affect different parts of the cortex, there is no certain explanation at this time for why the actual visual symptoms appear to be the same across people.

Many of the same causes that trigger migraine without aura are triggers for migraine with aura. These known triggers include stress, hormonal fluctuations (such as those that occur during menstruation), and intake of caffeine, alcohol, nitrates, and other foods and food additives.

Diagnosis

Neurologists are normally able to diagnose migraine with or without aura based on a review of symptoms, medical history and physical exam.

A neurologist may, however, order additional testing to rule out other causes depending on the severity and type of symptoms. A blood test or spinal tap (lumbar puncture) can be used to check for an infection of the brain or spinal cord, while an imaging test can help look for tumors, strokes, or brain damage.

According to the AMF, 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

Preventing migraine involves a balance of taking measures to avoid known migraine triggers and medications to manage headache pain and other symptoms.

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."

What About Treating Aura Specifically?

Evidence suggests magnesium can help control pain symptoms in migraine with aura. Some health professionals recommend taking magnesium to help with migraine prevention as well, but you should speak with your doctor about your medical history before starting any supplements.

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.

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.

Calcitonin gene-related peptide inhibitors (CGRPs): This class of medications works by blocking CGRP, a protein occurring in higher levels among those with migraine, from attaching to a brain receptor. Medications approved in this class for migraine with aura include Aimovig (erenumab), Ubrelvy (ubrogepant), Nurtec ODT (rimegepant), and Reyvow (lasmiditan).

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).

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:

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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