Migraine with aura

Recognising and treating migraine with aura

What is the aura?

Migraine is so much more than just a headache. Many of those affected will experience one or more of the other symptoms that can occur at any point during the attack.

One common symptom that can be alarming is the ‘aura’, which affects around a quarter of people with migraine. Aura symptoms typically occur before the headache phase begins, although a small number of people will experience aura without a headache occurring at all (acephalgic migraine).

Aura symptoms can be sensory, commonly involving visual disturbances, or may even affect your strength. They can also be sequential, such as starting with visual disturbances, followed by a tingling sensation in the limbs and face, before causing speech difficulties.

While you are experiencing aura, always avoid any activities that you feel may be dangerous.

Visual aura

This is the most common and well-studied type of aura.

The symptoms can be quite alarming, with patients often and understandably feeling worried when they experience them for the first time.

Visual aura can take many forms but, typically, patients see a zig-zag line starting on one side which moves across the field of vision before fading away. Patients may also see sparkling, flashing or diamond-shaped lights, which some people liken to looking into a kaleidoscope. Some people notice a blurring or a dark spot in the centre of their vision.

The symptoms usually change in shape, size and location. If the symptoms are stationary, for example flashing spots or zigzags which do not move or grow in size, they are less likely to represent migraine aura.
Visual aura generally lasts between five and 60 minutes in a typical patient, although some patients may have persistent visual symptoms. Sometimes after these symptoms go away, there may be temporary dark holes in the vision where patients are not able to see (scotoma).

An ocular migraine, more commonly now referred to as a retinal migraine, is not the same as migraine with aura and refers to short periods (between around five and 20 minutes) of visual disturbances or blindness that affects one eye only. Migraine with aura generally affects both eyes. While retinal migraine is not usually a sign of anything serious, it’s important to speak to a GP or optometrist.

Sensory aura

This can be in the form of tingling (‘pins and needles’) or numbness (a dead feeling in part of a limb).
Usually, patients can note the progression of symptoms as they start in one part of the body and move up or down. For example, if the feeling starts in the hand, it may move up the arm and not involve the entire limb all at the same time.

Speech and language can also be affected, making it difficult to find the right words or leading to slurred speech.
Another form of sensory aura is found in vestibular migraine, where a feeling of dizziness or vertigo is experienced. You can find out more about this type of migraine in our factsheet.

Motor aura

Motor aura, linked to hemiplegic migraine, is a much rarer form of aura and consists of weakness in parts of the body. Many patients with this type of aura have other members in the family who experience similar symptoms, although it can also occur without a family history. You can read more about motor aura in our factsheet on hemiplegic migraine.

How do you treat migraine aura?

Fortunately, most aura symptoms last for a short period of time. Triptan medications are not usually effective during the aura phase, but some people find that aspirin can be helpful.

If the aura symptoms are frequent and disturb your life significantly, preventive medications can be used to reduce the frequency and duration of the aura attacks – speak to your GP or book a consultation with an expert at the National Migraine Centre.

Migraine aura and stroke

It has been shown that patients with migraine aura have a slightly increased risk of having a stroke. This is a very small risk but can increase further if other risk factors are present, such as smoking, high blood pressure, high cholesterol or being overweight. Those affected should speak to their GP about stopping smoking, getting their blood pressure, cholesterol and glucose levels checked regularly, and maintaining a healthy lifestyle and body weight.

Another factor that can increase the chances of stroke is the use of the combined contraceptive pill (‘the Pill’): this should be avoided by female patients with migraine aura. There are other hormonal options available for contraception that are at least as effective. Find out more in our factsheet on migraine and contraception.

For information on oestrogen-containing HRT for those who suffer with migraine and aura, check out our factsheet on menopause and HRT.

Book an appointment with the experts: review the best treatment options for you with a leading headache specialist. Beat the misery of migraine and get back to living. Book your consultation through the National Migraine Centre now.