Migraine with aura is a migraine that's preceded or accompanied by sensory warning signs or symptoms, such as flashes of light, blind spots, or tingling in your hand or face.
Migraine with aura is generally treated in the same way as migraine without aura. And the same medications and self-care measures that help to prevent a migraine can also be used to prevent migraine with aura.
Migraine aura symptoms include temporary visual or sensory disturbances that typically precede the usual migraine symptoms — such as intense head pain, nausea, and sensitivity to light and sound. Migraine aura usually occurs within an hour before head pain begins and generally lasts less than 60 minutes. Sometimes migraine aura occurs with little or no headache, especially in people age 50 and older.
Visual signs and symptoms
The majority of people who experience migraine aura develop visual signs and symptoms. These may include:
- Blind spots (scotomas), which are sometimes outlined by simple geometric designs
- Zigzag lines that gradually float across your field of vision
- Shimmering spots or stars
- Changes in vision
- Flashes of light
These types of visual disturbances tend to start in the center of your visual field and move outward, or spread.
Other sensory disturbances
Other temporary sensations sometimes associated with aura include:
- Feelings of numbness, typically felt as tingling in one hand or in your face
- Difficulty with speech or language
- Muscle weakness
When to see a doctor
If you experience the signs and symptoms of migraine with aura, such as temporary vision loss or floating spots or zigzag lines in your field of vision, see your doctor immediately to rule out more serious conditions, such as stroke or retinal tear. Once these conditions are ruled out, future migraines with aura won't require a visit to your doctor, unless your symptoms change.
The cause of migraine with aura isn't clearly understood. It's believed that the visual aura that may accompany migraine is like an electrical or chemical wave that moves across the part of your brain that processes visual signals (visual cortex). As the wave spreads, it may cause these visual hallucinations.
Many of the same factors that trigger migraine can also trigger migraine with aura, including stress, bright lights, too much or too little sleep, and menstruation.
Although no specific factors appear to put you at risk for migraine aura, migraines in general seem to be more common in people with a family history of migraine. Migraines are also more common in women than men.
People who have migraine with aura are at a slightly higher risk of stroke. Women who have migraine with aura appear to have an even higher risk of stroke if they smoke or take birth control pills.
Preparing for your appointment
If you're experiencing temporary visual or sensory disturbances, see your family doctor or a general practitioner. In some cases, you may be referred to a doctor who specializes in nervous system disorders (neurologist).
Here's information to help you get ready for your appointment and to know what to expect from your doctor.
What you can do
- Keep track of your symptoms. One of the most helpful things you can do is keep a headache diary. Write a description of each incident of visual disturbances or unusual sensations. What are they? When did they happen? How long did they last? What followed them? Did something seem to trigger them? A headache diary may help your doctor diagnose your condition.
- Write down key personal information, including any major stresses or recent life changes.
- Write down questions to ask your doctor.
For migraine with aura, some basic questions to ask your doctor include:
- What's the likely cause of my symptoms?
- What tests, if any, do I need?
- Is my condition likely temporary or chronic?
- What treatments are available? Which do you recommend?
- What are the alternatives to the primary approach you're suggesting?
- I have other health conditions. How can I best manage them together?
- Are there dietary restrictions I need to follow?
- Is there a generic alternative to the medicine you're prescribing?
- Are there written materials I can take with me or websites you recommend?
Don't hesitate to ask other questions you have.
What to expect from your doctor
Your doctor is likely to ask you a number of questions, including:
- When did you begin having symptoms?
- What types of visual symptoms or other sensations do you have?
- How long do they last?
- Are they followed by a headache?
- If you have headaches, how often do you get them and how long do they last?
- How severe are your symptoms?
- What, if anything, seems to improve your symptoms?
- What, if anything, appears to worsen your symptoms?
Tests and diagnosis
If you experience signs and symptoms of aura followed by typical signs and symptoms of migraine, it's likely you have migraine with aura. Your doctor may diagnose the condition on the basis of your medical history and a physical exam.
But if your aura isn't followed by head pain, or the visual disturbances affect only one eye, your doctor may recommend certain tests to rule out more serious conditions, such as a retinal tear or a transient ischemic attack — a temporary decrease in blood supply to part of your brain — that could be causing your symptoms.
Your doctor may recommend:
- An eye examination. During this exam, your doctor will use an instrument the size of a small flashlight (ophthalmoscope) to project a beam of light into your eye to examine the back of your eyeball (fundoscopy).
- Computerized tomography (CT). This X-ray technique produces detailed images of your internal organs, including your brain.
- Magnetic resonance imaging (MRI). This diagnostic imaging procedure produces images of your internal organs, including your brain.
Your doctor may also refer you to a doctor who specializes in nervous system disorders (neurologist) to rule out brain conditions that could be causing your symptoms.
Treatments and drugs
There is no specific treatment for the signs and symptoms of aura. Treatment for migraine with aura is similar to treatment for migraine without aura.
Medications used to relieve migraine pain work best when taken at the first sign of an oncoming migraine; for example, as soon as you notice signs and symptoms of a migraine aura beginning.
Types of medications that can be used to treat migraine pain include:
- Over-the-counter or prescription pain relievers
- Triptans, prescription drugs used specifically for migraine
- Ergots, another family of drugs used for migraine
- Dopamine antagonists, drugs that block dopamine receptors
- Anti-nausea drugs, to help with nausea and vomiting
Medications can help prevent frequent migraines, with or without aura. Your doctor may recommend preventive medications if you're having frequent or severe headaches. Preventive medication options include:
- Blood pressure-lowering medications
- Anti-seizure drugs
- Botox injections
Cognitive behavioral therapy, a technique that teaches you more appropriate ways to deal with stressful situations, may help reduce the number of migraines you have.