What Is a Migraine With Aura?
A migraine with aura is a severe headache that can happen along with things like dizziness, a ringing in your ears, zigzag lines in your vision, or sensitivity to light.
About a quarter of 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 dietary things you can do as well as medications and devices that can treat the symptoms and prevent migraine with 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
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 stiffness, especially in your neck
- Need to pee more often
- Get constipated or have diarrhea
Visual symptoms of migraine
Light may sparkle across your eyes. It may seem like a bulb is flickering. You may notice jagged lines that look like a horseshoe that get bigger. That’s called a fortification spectrum. You may get something called Alice in Wonderland syndrome. When this happens, your body parts may seem distorted, or you may feel like a big person in a small room.
Common visual aura symptoms include:
- Flashes of bright lights
- Foggy or blurry vision
- Zigzag lines
- Blind spots (scotoma)
- Partial loss of vision
- Small bright dots
- A field of vision that looks like a heat wave or water
- Colored spots
Sometimes, you may have:
- An inability to judge distances
- Fractured vision, like looking through broken glass
- Visions of things that aren’t there (hallucinations)
- Tunnel vision
- Short-term blindness
Sensory symptoms of migraine
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:
- Seeing, hearing, or smelling things that aren't really there (hallucinations)
- Prickling, tingling, or numbness (paresthesia)
Speech symptoms of migraine
Less commonly, you may have trouble talking. You may not be able to say the right words. Or your sentences may not make sense. You may not be able to understand what people say.
Symptoms may include:
- Trouble finding words or speaking (aphasia)
- Slurred speech
Any of these symptoms could also be signs of a stroke. If you have new symptoms that are different for you, call 911 and get help right away.
Some symptoms might continue into the headache phase.
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. It is a long-lasting headache, and may last a few hours up to 3 days.
Besides pain, your symptoms may include:
- Upset stomach or vomiting
- Hot flashes and chills
- Stuffy or runny nose
- Dizziness or spinning (vertigo)
- Sore neck or jaw
- Sensitivity to light, sounds, smells, touch, or motion
- Muscle weakness
Migraine With Aura Causes
Scientists aren't sure what causes migraine, but several brain chemicals probably play a role.
According to this theory, a primary wave of nerve cell activity leads to changes 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 take a history of your headaches, 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:
- Do other family members have migraine or other kinds of headaches?
- What medications do you take, including birth control pills or blood pressure drugs?
- Do your headaches start after working hard, coughing, or sneezing?
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.)
Prescription medications called triptans or ditans, also known as abortive medications because they work quickly -- such as almotriptan (Axert), eletriptan (Relpax), frovatriptan (Frova), lasmiditan (Reyvow), naratriptan (Amerge), rizatriptan (Maxalt), and sumatriptan (Imitrex) -- can help. Ergots (Cafergot, Migergot) 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 four 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
- 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.
Migraine With Aura vs. Ocular Migraine
Ocular migraine, like migraine with aura, may also involve changes in your vision, but the important difference is that it happens only in one eye.
Also known as retinal migraine, ocular migraine is less common than migraine with aura. But it can be more serious. If you don't get treatment, there's a small chance that the vision loss in one eye could become permanent.
In an ocular migraine, a change in vision can happen in one eye before, during, or after a headache. The symptoms include:
- Seeing twinkling or sparkling lights
- Having blind spots
- Temporary blindness
One way to tell if the vision changes are only happening in one eye is to close each of your eyes and check if you only see the changes in one of them.
Other Causes of Aura
An epilepsy aura is sometimes called a focal aware seizure (FAS). Symptoms may only last a few seconds to several minutes. But it can be a sign that a more serious seizure is about to happen. You may get it before you faint. If you know what to look out for, you may be able to get somewhere safe before your seizure starts.
Symptoms of epilepsy aura include:
- A feeling of déjà vu
- An uneasy feeling in your stomach
- A weird taste or smell
- A strong sense of joy or fear
- Numbness or pain in your head or limbs
You’ll need to prevent your seizures to stop the auras. Your doctor can help you find the right treatment. They may give you medicine. In some cases, you may need nerve stimulation or surgery. If other treatments fail, your doctor may suggest a special diet.
Migraine with aura can come before a stroke. But it happens in less than 1% of all strokes. Experts aren’t sure why this happens. They do know that you’re more likely to have a stroke if you have a history of migraine with aura. It’s also more common in women 45 and younger. That may be because of hormonal changes. Hormonal birth control also increases the chances you’ll get blood clots.
You should look for signs of aura mixed with stroke symptoms, including:
- Numbness or weakness on one side of your body
- Trouble talking, seeing, or walking
- Dizziness or loss of balance
- A really bad headache
You may be able to lower your chances of having a stroke if you:
- Treat your high blood pressure
- Manage your diabetes
- Lower your high cholesterol
- Exercise on a regular basis
- Don’t smoke
Always call 911 if you think a loved one is having a stroke. They need medical attention right away.