Migraine Headaches With Aura

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 migraine with auras.

Causes

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

According to the theory, a wave of nerve cell activity spreads across the brain and excites the trigeminal nerve. This excitation causes the release of a variety of neurotransmitters which caused a change in the size of the blood vessels releasing more neurotransmitters and ultimately causing an inflammatory process and pain. 

The aura which about 25% of migraine sufferers experience is believed to be due to this electrical wave moving across the part of your brain that processes signals from your senses.

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

Symptoms

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 urinate more often
  • Get constipated or have diarrhea

Auras often start about  an hour or so before 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)

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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:

Diagnosis

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.

Blood tests and imaging, such as X-ray, CT scan, or MRI, can help rule out other causes like an infection and bleeding.

Treatment: Relief

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

Over-the-counter 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. ( Do not use aspirin in anyone under the age of 19.)

The prescription medications are called triptans and include such medicines as almotriptan (Axert), eletriptan (Relpax), frovatriptan (Frova), naratriptan (Amerge), rizatriptan (Maxalt) and sumatriptan (Imitrex). Ergots (Migergot, Cafergot) may also be effective in treating migraine pain.

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

There are a couple of devices designed to short-circuit a migraine by turning on your brain in a particular way. A device called SpringTMS or eNeura sTMS uses a technique called a transcranial magnetic stimulation (TMS). Place it on the back of your head for about a minute for release of a pulse of magnetic energy. Similarly, Cefaly uses transcutaneous supraorbital nerve stimulation and is worn as a headband on the forehead and turned on daily for 20 minutes to prevent migraine from developing. There is also a noninvasive vagus nerve stimulator called gammaCore. When placed over the vagus nerve in the neck, it releases a mild electrical stimulation to the nerve's fibers to relieve pain. You'll need a prescription for any of these gadgets, too.

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Treatment: Prevention

If you don’t respond to other treatments and you have 4 or more migraine days a month, your doctor may suggest preventive medicines. You take these regularly to reduce the severity or frequency of the headaches. These include seizure medicines, blood pressure medicines (like beta blockers and calcium channel blockers), and some antidepressants. CGRP inhibitors are a new class of preventive medicine that your doctor may recommend if other medicines don’t help.

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 migraine headaches. You use it daily to prevent headaches.

Avoid your triggers. Common ones include:

  • Foods
  • Medications
  • Stress
  • 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 be setting off your headaches. Note the date and time of the migraine, any foods you ate, what you were doing, and any medication you took before the headache began. It may take several weeks to begin to see a pattern.

WebMD Medical Reference Reviewed by Melinda Ratini, DO, MS on May 27, 2018

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?"

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