Migraine with aura
Migraine with aura (also called classic migraine) is a recurring headache that strikes after or at the same time as sensory disturbances called aura. These disturbances can include flashes of light, blind spots and other vision changes or tingling in your hand or face.
Treatments for migraine with aura and migraine without aura (also called common migraine) are usually the same. You can try to prevent migraine with aura with the same medications and self-care measures used to prevent migraine.
Migraine aura symptoms include temporary visual or other disturbances that usually strike before other 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
Most people who have migraine with aura develop temporary visual signs and symptoms. which tend to start in the center of the field of vision and spread outward. These might 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 or vision loss
- Flashes of light
Other temporary disturbances sometimes associated with migraine aura include:
- Numbness, typically felt as tingling in one hand or on one side of your face that may spread slowly along a limb
- Speech or language difficulty
- Muscle weakness
When to see a doctor
See your doctor immediately if you have the signs and symptoms of migraine with aura, such as temporary vision loss or floating spots or zigzag lines in your field of vision. Your doctor will need to rule out more-serious conditions, such as a stroke or retinal tear.
The cause of migraine with aura isn't entirely understood. There is evidence that the migraine with visual aura is like an electrical or chemical wave that moves across the part of your brain that processes visual signals (visual cortex) and causes these visual hallucinations.
Many of the same factors that trigger migraine can also trigger migraine with aura, including stress, bright lights, some foods and medications, too much or too little sleep, and menstruation.
Although no specific factors appear to increase the risk of migraine with 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 in men.
People who have migraine with aura are at a mildly increased risk of stroke.
Your doctor might diagnose the migraine with aura based on your signs and symptoms, your medical and family history, and a physical exam. If your aura isn't followed by head pain or if the visual disturbances affect only one eye, your doctor might recommend certain tests to rule out more-serious conditions, such as a retinal tear or a TIA.
Assessments might include:
- An eye examination. A thorough eye exam, done by an eye specialist (ophthalmologist), can help rule out eye problems that might be causing aura.
- Head CT scan. This X-ray technique produces detailed images of your brain.
- MRI. This diagnostic imaging procedure produces images of your internal organs, including your brain.
Your doctor might refer you to a doctor who specializes in nervous system disorders (neurologist) to rule out brain conditions that could be causing your symptoms.
For migraine with aura, just as with migraine alone, treatment is aimed at relieving migraine pain.
Medications for relief
Medications used to relieve migraine pain work best when taken at the first sign of an oncoming migraine — as soon as signs and symptoms of a migraine aura begin. Depending on how severe your migraine pain is, types of medications that can be used to treat it include:
Pain relievers. These over-the-counter or prescription pain relievers include aspirin or ibuprofen (Advil, Motrin IB, others). When taken too long, these might cause medication-overuse headaches, and possibly ulcers and bleeding in the gastrointestinal tract.
Migraine relief medications that combine caffeine, aspirin and acetaminophen (Excedrin Migraine) may be helpful, but usually only against mild migraine pain.
- Triptans. These are prescription drugs such as sumatriptan (Imitrex, Tosymra) and rizatriptan (Maxalt) are prescription drugs used for migraine because they block pain pathways in the brain. Taken as pills, shots or nasal sprays, they can relieve many symptoms of migraine. They might not be safe for those at risk of a stroke or heart attack.
Dihydroergotamines (D.H.E.45, Migranal). Available as a nasal spray or injection, these are most effective when taken shortly after the start of migraine symptoms for migraines that tend to last longer than 24 hours. Side effects can include worsening of migraine-related vomiting and nausea.
People with coronary artery disease, high blood pressure or kidney or liver disease should avoid dihydrogergotamines.
- Opioid medications. If you can't take triptans or ergots, narcotic opioid medications, especially those that contain codeine, might help. Because they can be highly addictive, these are usually used only if no other treatments are effective.
- Anti-nausea drugs. These can help if your migraine with aura is accompanied by nausea and vomiting. Anti-nausea drugs include chlorpromazine, metoclopramide (Reglan) or prochlorperazine (Compro). These are usually taken with pain medications.
Medications can help prevent frequent migraines, with or without aura. Your doctor might recommend preventive medications if you have frequent, long-lasting or severe headaches that don't respond well to treatment.
Preventive medication is aimed at reducing how often you get a migraine headache with or without aura, how severe the attacks are, and how long they last. Options include:
- Blood pressure lowering medications. These include beta blockers such as propranolol (Inderal, Innopran XL, others), metoprolol tartrate (Lopressor) and timolol (Betimol). Calcium channel blockers such as verapamil (Calan, Verelan, others) can be helpful in preventing migraines with aura.
- Antidepressants. Amitriptyline, a tricyclic antidepressant, can prevent migraines. Because of the side effects of amitriptyline, such as sleepiness and weight gain, other antidepressants might be prescribed.
- Anti-seizure drugs. Valproate (Depacon) and topiramate (Topamax) might help you have less frequent migraines, but can cause side effects such as dizziness, weight changes, nausea and more.
- Botox injections. Injections of onabotulinumtoxinA (Botox) about every 12 weeks help prevent migraines in some adults.
- Calcitonin gene-related peptide (CGRP)) monoclonal antibodies. Erenumab (Aimovig), fremanezumab (Ajovy) and galcanezumab (Emgality) are newer drugs approved by the FDA to treat migraines. They're given monthly by injection. The most common side effect is a reaction at the injection site.
Stress management and lifestyle
When symptoms of migraine with aura start, try heading to a quiet, darkened room. Close your eyes and rest or take a nap. Place a cool cloth or an ice pack wrapped in a towel or cloth on your forehead or at the back of your neck.
Other practices that might soothe migraine with aura pain include:
- Relaxation techniques. Biofeedback and other forms of relaxation training teach you ways to deal with stressful situations, which might help reduce the number of migraines you have.
- Develop a sleeping and eating routine. Don't sleep too much or too little. Set and follow a consistent sleep and wake schedule daily. Try to eat meals at the same time every day.
- Drink plenty of fluids. Staying hydrated, particularly with water, might help.
Preparing for an appointment
If you're having temporary visual or sensory disturbances, see your family doctor. In some cases, you'll be referred to a doctor who specializes in nervous system disorders (neurologist).
Here's information to help you get ready for your appointment.
What you can do
- Keep track of your symptoms. Keep a headache diary by writing a description of each incident of visual disturbances or unusual sensations, including when they occurred, how long they lasted and what triggered them. A headache diary can help your doctor diagnose your condition.
- Write down key personal information, including major stresses or recent life changes.
For migraine with aura, some 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?
- I have other health conditions. How can I best manage them together?
- Are there dietary restrictions I need to follow?
- 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 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?