Migraine With Aura

What Is a Migraine With Aura?

A migraine with aura is a severe headache that happens along with things like dizziness, a ringing in your ears, zigzag lines in your vision, or sensitivity to light.

About a quarter of all migraines happen with auras. But you may not have one with every migraine. Some children and older adults may get an aura but no 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 treat the symptoms and prevent migraine with aura.

What is aura?

"Aura" is the term for any of the sensory changes that happen before a migraine headache. They can affect your vision, hearing, or ability to speak. You could also have muscle weakness or tingling.

Types of Migraine With Aura

Aura can happen in four types of migraine:

  • Migraine with aura (with or without a headache). This is also called a classic migraine.
  • Migraine with brainstem aura. This is when the aura starts in the base of your brain (brainstem) or both sides of your brain.
  • Hemiplegic migraine. In this rare type, aura causes weakness on one side of your body (hemiplegia).
  • Retinal migraine. You have vision changes in one eye before the migraine begins.

Migraine With Aura Symptoms

Prodrome symptoms

About a third of people will have warning signs 24 to 48 hours before a migraine. This is called the prodrome or pre-headache phase. You may:

  • Crave certain foods
  • Feel hyper or cranky
  • Be tired and yawn more
  • Feel stiff, especially in your neck
  • Need to pee more often
  • Get constipated or have diarrhea

Sensory symptoms

The aura usually begins over a period of 5 to 20 minutes and lasts less than an hour. It can affect any of your senses. Symptoms include:

  • 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)

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Some symptoms might continue into the headache phase.

Other symptoms

Migraine pain can be steady or throb. You usually feel it on the front or side of your head, around your eyes. Adults are more likely to have pain on just one side. The headache may last an hour to 3 days.

Besides pain, your symptoms may include:

Migraine With Aura Causes

Scientists aren't sure what causes migraine, but several brain chemicals probably play a role.

According to this theory, a wave of nerve cell activity spreads across your brain and triggers your trigeminal nerve. This causes the release of a variety of neurotransmitters, changing the size of blood vessels, releasing more neurotransmitters, and ultimately causing an inflammatory process and pain. 

Experts think the aura happens because of this electrical wave moving across the part of your brain that processes signals from your senses.

Migraine often runs in families. It often begins in childhood and gets worse through adolescence. Although more boys than girls have migraine, more adult women than men have them. Over time, you'll have fewer, and they become less common after age 50.

Migraine With Aura Diagnosis

Your doctor will give you a physical exam and check your muscles, reflexes, speech, and senses to test the nerves in your head. They’ll also ask about your health history, such as:

Blood tests and imaging, such as X-rays, CT scans, or MRIs, can help rule out other causes like an infection and bleeding.

Migraine With Aura Treatment

When you're having a migraine with aura, stay in a quiet, dark room. Try putting cold compresses or pressure on the painful areas.

Over-the-counter pain relievers like acetaminophen or nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin, ibuprofen, or naproxen may help. Your doctor can prescribe larger doses of NSAIDs. (No one under the age of 19 should take aspirin.)

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Prescription medications called triptans or ditans -- such as almotriptan (Axert), eletriptan (Relpax), frovatriptan (Frova), lasmiditan (Reyvow), naratriptan (Amerge), rizatriptan (Maxalt), and sumatriptan (Imitrex) -- can help. Ergots (CafergotMigergot) may also treat migraine pain.

Other medications can ease related symptoms such as nausea and vomiting.

Some devices are designed to short-circuit a migraine by turning on your brain in a particular way.

SpringTMS and eNeura sTMS use a technique called transcranial magnetic stimulation (TMS). Place the device on the back of your head for about a minute to release a pulse of magnetic energy.

A vagus nerve stimulator called gammaCore, when placed over the vagus nerve in your neck, releases mild electrical stimulation to relieve pain. 

You'll need a prescription for any of these devices.

Migraine With Aura Prevention

If other treatments don’t work and you have 4 or more migraine days a month, your doctor may suggest preventive medicines. You take these regularly to make migraines less strong or happen less often. These include seizure medicines, blood pressure medicines (like beta-blockers and calcium channel blockers), and some antidepressants. A new class of preventive medicine called CGRP inhibitors may also help.

Your doctor can also prescribe a device, Cefaly, that uses a method called transcutaneous supraorbital nerve stimulation. You wear it as a headband on your forehead and turn it on daily for 20 minutes to prevent migraines. 

Avoid your triggers. Common ones include:

  • Certain foods
  • Medications
  • Stress
  • Being tired, sick, or hungry
  • Hormone changes
  • Flickering or flashing light
  • Air pressure or altitude changes

A headache diary can help you and your doctor figure out what might be setting off your headaches. Note the date and time of the migraine, any foods you had eaten, what you were doing, and any medication you took before the headache began. It may take several weeks before you notice a pattern.

WebMD Medical Reference Reviewed by Hansa D. Bhargava, MD on August 18, 2020

Sources

SOURCES:

American Migraine Foundation: "Migraine and Aura."

Mayo Clinic: "Migraine with aura."

eMedicine.com: "Headache, Migraine," "Migraine Headache: Pediatric Perspective."

International Headache Society: "International Classification of Headache Disorders, edition 2."

eMedicineHealth.com: "Alternative and Complementary Approaches to Migraines and Headaches."

American Headache Society: "Cefaly for Migraine Prevention?"

American Migraine Foundation: “Understanding Migraine with Aura,” “Migraine with Brainstem Aura (Basilar Type Migraine),” “Hemiplegic Migraine,” “Retinal Migraine.”

StatPearls: “Migraine with Aura.”

The Migraine Trust: “Migraine with aura.”

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