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If you’re one of the over one billion people worldwide who get migraines, you know that migraines are not like any other headache (Ashina, 2021). They often come with a range of symptoms besides the excruciating headache, like sensitivity to light or loud noises, nausea, vomiting, dizziness, or double vision. Around one in four people with migraine disorders experience something called an aura—a variety of sensory disturbances, like flashes of light or ringing in the ears, that either precede the migraine headache or kick in once the head pain starts (Shankar Kikkeri, 2021).
Aura can feel different for different people. It can last anywhere from five minutes to over an hour, and it may not happen with every migraine headache (Viana, 2016). This article will discuss different types of migraine with aura, along with causes, health concerns, and treatments.
What is a migraine aura?
Migraine aura describes the sensory symptoms that can accompany or immediately precede a migraine attack, such as changes to their sense of sight, hearing, or touch. People may see fuzzy blind spots in their vision, known as scotomas, or feel a tingling sensation on one side of their face.
An aura may begin up to one hour ahead of a migraine or start at the same time as the headache pain occurs. Symptoms usually set in gradually over several minutes. On average, an aura lasts around 20 to 30 minutes, although it can last over an hour (Viana, 2016).
Many people with migraines experience something called “prodrome,” even before the aura. A prodrome is an early warning sign and can occur up to 24 to 48 hours prior to the headache. Prodromal symptoms include yawning, euphoria, depression, irritability, and food cravings (Dodick, 2018).
Migraine with aura symptoms
Migraine aura can have different symptoms for different people. Some may experience exclusively one type of aura, such as visual aura, while others may experience multiple types of aura, such as visual and sensory symptoms (Viana, 2016). The most common type of aura is a visual aura, while auras affecting speech or movement are rare (Shakar Kikkeri, 2021).
Visual aura describes visual symptoms that affect a person’s field of vision, such as:
- Temporary, partial loss of vision, including blind spots that have a glittery geometric outline
- Seeing stars or flashing lights
- Seeing bright or flickering lines of light
- Seeing floating zigzagging lines
If a person only experiences vision changes in one eye, it is called a retinal migraine.
Auditory auradescribes symptoms that affect a person’s hearing, such as ringing in the ears (tinnitus) or hearing noise or music.
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Sensory aura describes symptoms that affect a person’s sense of touch, such as a feeling of numbness or tingling on one side of the face, arm, or leg that may spread slowly.
Language aura describes symptoms that affect a person’s ability to speak. They may have difficulty forming words, or mumble or slur their words.
Motor aura describes symptoms that affect a person’s ability to move. Also known as hemiplegic migraine, it is the rarest type of aura, affecting 0.01% of people. Typically, the person experiences muscle weakness on one side of the body or face, but the motor aura may affect both sides or switch sides. Symptoms start in one area, such as the hand, and spread gradually to other areas. Motor aura symptoms may look like a stroke at first and can last longer than other auras, for days or weeks at a time (Kumar, 2021).
Migraine aura without headache
Some people experience aura without a migraine attack. Known as silent migraine or acephalgic migraine, this type of migraine can still be a distressing experience, but it’s a well-known phenomenon among people who have migraines with aura (Shah, 2018).
Migraine with aura causes
Scientists don’t know for sure what causes migraine aura, although it may originate in the brain. Specifically, a wave of chemical or electrical activity may spread across your cortex, a part of the brain that controls speech, movement, and sight. Depending on the area of the cortex it moves across, you may experience different aura symptoms. For example, if electrical activity occurs in the visual cortex, you may experience a visual aura.
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Other elements involved in your central nervous system, such as serotonin or calcitonin gene-related peptide (CGRP), may also contribute to migraine (Shakar Kikkeri, 2021).
Risk factors for migraine (with or without aura) include having a family history of migraines or being assigned female at birth, either of which makes you three times more likely to have migraines. Your risk of experiencing migraine increases from adolescence through your late thirties (Pescador Ruschel, 2021).
Triggers for migraine with aura may include (Shankar Kikkeri, 2021):
- High stress levels
- Certain types of food, including aged cheese or those containing nitrates
- Too much caffeine or caffeine withdrawal
- Changes in weather or altitude
- Hormone changes during menstruation
- Exposure to bright lights, strong smells, or loud sounds
- Too much or too little sleep
Health precautions of migraine with aura
For the most part, while migraines with aura can be distressing to live with, they are not dangerous, but it’s important to know about potential health concerns associated with them.
Some research suggests that migraines (particularly migraines with aura) are linked to psychiatric conditions such as depression (Antonaci, 2011). Migraines may also increase your risk of experiencing a stroke (Adelborg, 2018).
Given the connection between aura migraines and stroke, women who have migraine with aura should avoid using estrogen-containing birth control. In women with certain risk factors, some birth control products can carry a risk of stroke, so combining these may further increase their risk of stroke. However, recent research suggests that the risk of stroke may not be all that much higher (Calhoun, 2017).
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Be sure to consult with a healthcare professional before taking birth control if you have migraines with aura. Let them know about your migraine symptoms and any other medications you are taking.
In some rare cases, a migraine with aura may trigger a seizure, which typically occurs an hour after the migraine. If this happens, consult a health professional immediately.
Treatment options for migraine with aura
When you feel a migraine coming on, go somewhere dark and quiet to rest. Close your eyes and put a cold compress on your forehead to relieve the pain. Over-the-counter and prescription medications can also relieve symptoms and reduce the intensity of the migraine once it has started. These include (Mayans, 2018):
- Over-the-counter pain relievers like ibuprofen and acetaminophen
- Prescription pain relievers that specifically target migraines and other types of headaches, like triptans, dihydroergotamine, ditans, and gepants
- Anti-nausea medications
Your health provider may also recommend medications to prevent and treat migraines, such as (Shankar Kikkeri, 2021):
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Finally, certain lifestyle changes can help with migraine prevention:
- Pay attention to what triggers your migraines, so you can take steps to avoid them.
- Avoid skipping meals. Instead, eat at regular times.
- Follow a regular sleep schedule every day of the week, including weekends.
- Exercise regularly. It can help relieve stress and improve your sleep.
The best treatment for your migraines depends on your symptoms, personal medical history, and frequency of migraines. Your health care provider can recommend a treatment plan for your migraines with aura.
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Felix Gussone is a physician, health journalist and a Manager, Medical Content & Education at Ro.