There it is again. You know the headache is coming because you feel strange: You get dizzy, there's a ringing in your ears, you see zigzag lines, or light makes you cringe. And once it hits, the pain can put your day on hold.
Migraines with aura account for about a quarter of all migraines. Even if you get auras, you may not have one with every migraine. Some children and older adults may get an aura without later pain.
Though they can hurt a lot and make you feel "off," these headaches aren't life-threatening. There are things you can do as well as medications and devices that can help treat the symptoms and prevent migraines with auras.
Scientists aren't sure what causes migraines, but at least two brain chemicals, serotonin and dopamine, probably play a role.
According to the theory, something goes awry in the way these chemicals control how your brain works. Your brain and your body's immune system overreact, sending out a flood of cells. The blood vessels in your brain open wider to make room for them. Your body releases even more chemicals to help control the vessels' muscles. The vessels open and tighten. And you get a severe, often throbbing, headache.
The aura may come from a chemical or electrical wave moving across the part of your brain that processes signals from your senses.
Migraines often run in families. They frequently begin in childhood and get worse through adolescence. Although more boys than girls have migraines, more adult women than men have them. Over time, you'll get fewer, and they become less common after age 50.
About a third of people will get warning signs hours or days before a migraine. This is called the prodrome or pre-headache phase. You may:
- Have food cravings
- Get "hyper" or cranky
- Be fatigued and yawn more
- Feel stiff, especially your neck
- Need to pee more often
- Get constipated or have diarrhea
Auras often start within an hour or so of the headache. They aren't just distorted vision, though. They can affect any of your senses.
- Blind spots (scotomas)
- Vision loss in part of one or both eyes
- Seeing zigzag patterns (fortification spectra)
- Seeing flashing lights (scintilla)
- Seeing, hearing, or smelling things that aren't really there (hallucinations)
- Prickling, tingling, or numbness (paresthesia)
- Trouble finding words or speaking (aphasia)
The aura usually lasts less than an hour. Some symptoms might continue into the headache phase.
Migraine pain is steady or throbs. You usually feel it on the front or side of your head, around the eyes. Adults are more likely to hurt on just one side. The headache may last from an hour to 3 days.
Besides pain, other headache symptoms may include:
Your doctor will give you a physical exam and check your muscles, reflexes, speech, and senses to test the nerves in your head. He'll also ask about your health history.
- Do other family members have migraines or other kinds of headaches?
- Do you have any allergies?
- How much stress do you have in your life?
- What medications do you take, including birth control pills or blood pressure drugs?
- Do your headaches start after working hard, coughing, or sneezing?
When you're having a migraine with aura, stay in a quiet, dark room. Try cold compresses or pressure on the painful areas.
Pain-relievers like aspirin, acetaminophen, or a non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or naproxen, may help. Your doctor can prescribe larger doses of NSAIDs and ketorolac (Toradol).
A technique called a transcranial magnetic stimulation (TMS), uses a pulse of magnetic energy to stimulate part of your brain, which may stop or lessen the pain. You'll need a prescription to get this gadget, which you put on the back of your head when you feel a migraine starting.
Some drugs that treat other conditions can prevent migraines, too:
- Heart and blood pressure medications called beta-blockers, including atenolol (Tenormin), propranolol (Inderal), and timolol (Blocadren)
- Amitriptyline (Elavil) and nortriptyline (Pamelor), antidepressants
- Antihistamines such as cyproheptadine (Periactin)
- Valproic acid (Depakene, Depakote), an anticonvulsant for seizures and bipolar disorder
Your doctor may prescribe a headband-like device that creates electrical impulses on your skin. When it's on, you'll feel a tingling or massaging sensation on your forehead. This stimulates the nerve associated with migraines. You use it daily to prevent headaches.
Avoid your triggers. Common ones include:
- Being tired, sick, or hungry
- Hormone level changes
- Flickering or flashing light
- Air pressure or altitude changes
A headache diary can help you and your doctor figure out what might setting off your migraines. Note the date and time of the migraine, any foods you ate, what you were doing, and any medication you took just before the headache began. It may take several weeks to begin to see a pattern.