6 Common Migraine Aura Symptoms

Migraine aura is a complex neurological phenomenon that affects millions of people worldwide. This often misunderstood condition can cause a range of sensory disturbances, typically occurring before or during a migraine headache. While many are familiar with the intense pain of migraines, the aura phase remains a source of confusion and concern for those who experience it.

Understanding migraine aura is crucial to managing its symptoms effectively. This article delves into the nature of migraine aura, exploring its common symptoms, potential triggers, and available treatment options. We’ll also examine the differences between various types of migraine aura, including ocular and brainstem auras, and discuss whether these experiences pose any long-term risks. By shedding light on this aspect of migraines, we aim to help sufferers better navigate their condition and find relief.

What is Migraine Aura?

Definition

Migraine aura is a complex neurological phenomenon that occurs before or during a migraine headache. It is characterised by fully reversible symptoms that can affect vision, sensation, speech, language, and motor function. Migraine aura is typically a warning sign that a migraine attack is imminent, though it can sometimes occur without an associated headache.

The aura phase is a distinct part of the migraine experience, usually lasting between 5 to 60 minutes. It is believed to be caused by a wave of electrical or chemical activity that spreads across the brain, particularly affecting the visual cortex in the case of visual auras. This neurological event can lead to various sensory disturbances, making it a unique and often confusing aspect of migraine for those who experience it.

Types of Migraine Aura

There are several types of migraine aura, with visual aura being the most common. Visual auras can manifest as blind spots, zigzag lines, flashing lights, or other visual disturbances. These symptoms often start in the centre of the visual field and gradually spread outward, creating what is known as a fortification spectrum due to its resemblance to the walls of a mediaeval fort.

Sensory auras are also common, typically presenting as tingling or numbness that travels up an arm and may spread to one side of the face and tongue. Some individuals experience dysphasic auras, which cause temporary speech or language problems. In rare cases, people may experience hemiplegic migraine, where weakness occurs in the limbs and possibly the face on one side of the body.

Other types of migraine aura include brainstem aura and retinal migraine. These subtypes can cause additional symptoms such as dizziness, double vision, or temporary vision loss in one eye.

Prevalence

Migraine aura affects a significant portion of those who suffer from migraines. Approximately one-third of people with migraine experience aura. In a study comparing migraine and probable migraine (PM), which is a subtype that fulfils all but one criterion of migraine, the prevalence of visual aura was found to be similar between the two groups. Among participants with migraine, 29.4% experienced visual aura, while 24.3% of those with PM reported visual aura symptoms.

The frequency of aura occurrence varies among individuals. Most commonly, aura symptoms appear in 10% to 24% of headache attacks for both migraine and PM sufferers. Interestingly, only a small percentage of people experience aura in all of their migraine attacks, with 4.0% of migraine sufferers and 1.2% of PM sufferers reporting this frequency.

Understanding the prevalence and types of migraine aura is crucial for proper diagnosis and management of the condition. By recognising the various manifestations of aura, individuals can better prepare for and cope with their migraine attacks, potentially improving their quality of life and reducing the impact of this neurological disorder.

Common Symptoms of Migraine Aura

Migraine aura is a complex neurological phenomenon that can manifest in various ways. Understanding these symptoms is crucial for proper diagnosis and management of migraine attacks. The most common types of aura symptoms are visual, sensory, and speech-related disturbances.

Visual Symptoms

Visual aura is the most prevalent type, affecting approximately 90% to 99% of people who experience migraine with aura. These symptoms typically develop gradually over  to 20 minutes and last for less than 0 minutes . Common visual disturbances include:

• Flashing lights or bright spots
• Zigzag lines or geometric patterns
• Blind spots (scotomas)
• Blurry or foggy vision
• Partial vision loss
• Tunnel vision

Some individuals may also experience more complex visual phenomena, such as fractured vision (as if looking through broken glass) or the sensation of viewing objects through water or heat waves .

Sensory Symptoms

Sensory aura is the second most common type, affecting about 3% of people who experience migraine with aura. These symptoms often follow or accompany visual disturbances and can include:

• Tingling or numbness, typically starting in one limb
• A prickling sensation that gradually travels up an arm or leg
• Numbness that spreads to one side of the face and tongue

Sensory symptoms usually build in intensity before receding and resolving completely. In rare cases, some individuals may experience weakness in the limbs or face on one side of the body, a condition known as hemiplegic migraine.

Speech and Language Symptoms

Speech and language disturbances, also known as dysphasic aura, are less common but can be particularly distressing for those who experience them. These symptoms may include:

• Difficulty finding words or speaking (aphasia)
• Slurred or mumbled speech
• Trouble understanding what others are saying
• Problems with reading or writing

Approximately 10% of people who experience migraine with aura develop dysphasic symptoms. These language difficulties are typically temporary and resolve completely on their own.

It’s important to note that while migraine aura symptoms can be alarming, they are generally not dangerous and do not cause permanent damage. However, if someone experiences new or unusual aura symptoms, especially those involving speech difficulties or weakness on one side of the body, it’s crucial to seek medical attention immediately to rule out other potentially serious conditions.

Understanding these common symptoms of migraine aura can help individuals better recognise and manage their condition. By identifying the specific type of aura experienced, people with migraine can work with healthcare professionals to develop tailored treatment strategies and improve their quality of life.

Suggestion for read: 5 Effective Chronic Migraine Treatments

Causes and Triggers of Migraine Aura

Neurological Factors

The exact causes of migraine aura remain unknown, but research suggests that it may be due to an electrical or chemical wave that moves across the brain. This phenomenon, known as cortical spreading depression, is believed to underlie the aetiology of both the headache and aura associated with migraine. The wave of neuronal and glial depolarization spreads across the cerebral cortex, affecting various brain regions and resulting in the diverse symptoms experienced during an aura.

The part of the brain where this electrical or chemical wave spreads determines the type of symptoms a person might experience. For instance, when it occurs in the visual cortex, it leads to visual aura, the most common type of migraine aura. This neurological event can occur with normal functioning of the nerves and does not cause harm to the brain.

Common Triggers

Nearly 75% of migraine sufferers report at least one trigger for their attacks. Many of the same factors that trigger migraine can also trigger migraine with aura. Common triggers include:

1. Stress and anxiety
2. Bright lights, especially sunlight and transitioning from dark to light environments
3. Sleep disturbances, such as too little or too much sleep
4. Certain foods and food additives
5. Alcohol consumption, particularly red wine
6. Weather changes, including storm fronts and altitude changes
7. Strong odours, especially perfumes or colognes
8. Physical exertion or exercise
9. Neck pain
10. Hormonal changes

Interestingly, relaxation after stress has been identified as a prominent catalyst for migraine with aura, impacting up to 70% of patients. This “let-down stress” headache or migraine attack is most likely to occur within 18 hours after the release of anxiety.

Hormonal Influences

Hormonal factors play a significant role in migraine, particularly in women. The female reproductive cycle, regulated by the hypothalamic-hypophyseal-ovarian axis through the release of oestrogen and progesterone, has a substantial impact on migraine occurrence. Various stages of a woman’s life can influence migraine patterns:

1. Menstruation: Migraine without aura is most likely to occur during a 5-day window starting two days before menstruation and continuing through the first three days.
2. Pregnancy: Most women experience improvement in their migraine symptoms during pregnancy, particularly from the first to the third trimester.
3. Menopause: The transition to menopause can lead to a worsening of migraine attacks for some women, but postmenopause is often associated with improvement.
4. Hormonal contraceptives: Combined oral contraceptives may induce migraine in women without a previous history, worsen existing migraine, or change the pattern of existing migraine.
5. Hormone replacement therapy (HRT): HRT has variable effects on migraine, with some women experiencing improvement and others noting worsening of symptoms.

Understanding these neurological factors, common triggers, and hormonal influences can help individuals better manage their migraine aura symptoms and work with healthcare professionals to develop effective treatment strategies.

Diagnosis and Treatment Options

Diagnostic Process

The diagnosis of migraine aura relies on a comprehensive clinical assessment, including a detailed patient history and physical examination. Doctors consider various factors such as the onset, location, and intensity of pain, as well as the presence of accompanying symptoms like nausea or sensitivity to light and sound. The International Classification of Headache Disorders, 3rd edition (ICHD-3) provides standardised criteria to help clinicians accurately diagnose migraine with and without aura.

For migraine with aura, at least two attacks must meet specific criteria, including the presence of fully reversible aura symptoms such as visual, sensory, or speech disturbances. These symptoms typically spread gradually over five minutes or more and last between 5 to 60 minutes. Headache often follows within 60 minutes of the aura symptoms.

While no specific diagnostic test exists for migraine, neuroimaging may be necessary in certain cases. Magnetic resonance imaging (MRI) is the preferred method when imaging is required, with computed tomography (CT) scans reserved for emergencies. Indications for neuroimaging include sudden onset of severe headache, new neurological symptoms, or significant changes in headache patterns.

Medication Options

Treatment for migraine aura focuses on relieving pain and preventing future attacks. Medications for acute relief work best when taken at the first sign of an oncoming migraine. Options include:

1. Over-the-counter pain relievers such as aspirin or ibuprofen
2. Triptans, prescription drugs that block pain pathways in the brain
3. Dihydroergotamine, available as a nasal spray or injection
4. Newer medications like lasmiditan and calcitonin gene-related peptide (CGRP) antagonists

For preventive treatment, doctors may recommend:

1. Blood pressure-lowering medications like beta blockers
2. Antidepressants, particularly tricyclic antidepressants
3. Anti-seizure drugs such as valproate and topiramate
4. Botox injections
5. CGRP monoclonal antibodies

Lifestyle Changes

Alongside medication, lifestyle modifications play a crucial role in managing migraine aura. These changes can help reduce the frequency and severity of attacks:

1. Maintaining a consistent sleep schedule
2. Following regular meal times
3. Staying hydrated, particularly with water
4. Practising stress management techniques like biofeedback and relaxation training
5. Exercising regularly, aiming for 30 to 0 minutes of moderate-intensity aerobic activity, three to five days a week

Alternative Therapies

Some individuals find relief through alternative treatments. These may include:

1. Acupuncture, which has shown some evidence in reducing headache frequency
2. Magnesium supplements, which may be effective for migraine prevention, particularly for menstrual migraine and migraine with aura
3. Biofeedback and cognitive-based therapy, which can help reduce migraine frequency by 3% to 0%
4. Green light therapy, a promising area of research that may help reduce the intensity of migraine attacks

It’s important to note that while these alternative therapies show promise, their effectiveness can vary among individuals. Always consult with a healthcare professional before incorporating any new treatments into your migraine management plan.

Conclusion

Migraine aura, a complex neurological phenomenon, has a significant impact on the lives of many individuals worldwide. This article has shed light on its symptoms, causes, and treatment options, providing valuable insights to help sufferers better understand and manage their condition. From visual disturbances to sensory and speech-related symptoms, the diverse manifestations of migraine aura highlight the need for personalised approaches to diagnosis and treatment.

To wrap up, effective management of migraine aura involves a combination of medication, lifestyle changes, and alternative therapies tailored to each individual’s needs. By working closely with healthcare professionals and staying informed about the latest advancements in migraine research, those affected by this condition can take steps to improve their quality of life. At Inquire Talk, we understand the importance of mental health and well-being in relationships, and our online counselling services are designed to support individuals in managing stress and promoting emotional well-being, which can be beneficial for those dealing with chronic conditions like migraine.

FAQs

What is the most effective treatment for migraines accompanied by aura?
The most effective treatments for migraines with aura include a variety of options. Over-the-counter or prescription pain relievers such as aspirin, ibuprofen, and others can be used. Triptans are also widely recommended. Other treatments include Dihydroergotamine, Lasmiditan, Calcitonin gene-related peptide (CGRP) antagonists, opioid medications, and anti-nausea drugs.

How can one halt a migraine at the aura stage?
To stop a migraine during the aura stage, you can use several treatments. Pain relievers like acetaminophen, ibuprofen, or aspirin can help alleviate the aura and pain. Other options include Triptans, Dihydroergotamine via nasal spray or injection, opioids, antinausea medications, and magnesium supplements.

What causes a migraine aura?
Migraine aura is typically caused by an electrical or chemical wave that travels across the brain. The specific symptoms experienced depend on the area of the brain affected by this wave.

What is the primary treatment for migraines that include an aura?
Triptans are considered the primary treatment for moderate to severe migraines that include an aura. There are various triptans available, differing in pharmacokinetics and routes of administration. The choice of triptan should be tailored to the individual’s specific migraine characteristics as well as considerations like the method of administration, pharmacokinetics, and cost.

Inquire Talk certified therapists who you can get in touch and book a therapy session with:

Sylvia Cowell

Diego Tinte

Sandra Retmanski