If you have ever experienced the twilight zone of migraine aura, you know how odd and unsettling it can feel. Aura is a sensory disturbance that comes in many guises. Some people may experience it as a swarm of dazzling lights in one eye. Others may be hit with intense vertigo; others slur their words. Some describe it as a full-scale assault on the senses, including disorienting changes in perception.
No matter how you might experience aura, it’s typically a brief state — five to 30 minutes — signaling that a migraine attack has begun. Some people have “aura-only migraine,” in which they typically have no headache. Either way, the phenomenon of aura is more common than you might think: Between 25 to 30 percent of people with migraine experience aura.
Migraine Aura Symptoms
Migraine aura symptoms fall into different types, with many people having symptoms of more than one type.
- Visual aura. Seeing bright spots, shimmering lights, zig zags, geometric designs and stars, fortification spectrum (called this because its pattern looks like a jagged line thought to resemble a medieval town wall), blank spots, tunnel vision.
- Sensory aura. Changes in sensation, tingling, and numbness, often beginning near the lips or the tongue on one side or with one hand.
- Auditory aura. Hearing noises, ringing in the ears (tinnitus), or music.
- Brainstem aura. Severe incoordination, temporary blindness, double vision, dizziness, vertigo, slurred speech, tinnitus, changes in level of consciousness, fainting.
- Dysphasic aura. Characterized by speech and language problems.
- Alice-in-Wonderland (metamorphopsia) aura. Your perception of yourself, your perspective, and your surroundings become distorted. Like Alice, you may feel larger or smaller than you are or that one part of your body might feel larger or smaller. Your surroundings may seem further or closer than they really are.
- Hemiplegic (motor) aura. Limbs and/or one side of the face becoming weak.
What is a Migraine Aura?
Changes in the brain produce this disorienting — and temporary — neurological event. Research suggests that aura occurs when a wave of altered electrical activity moves across the surface of the brain’s cortex, beginning at the back of the brain, which controls vision. This is likely why visual aura is the most common type. This wave of electrical activity causes temporary changes in the blood flow and chemicals in the brain cells, and is known as cortical spreading depression (CSD). It’s like an ocean wave rolling through the brain’s operating systems, affecting each as it moves through.
The spread of CSD is the reason aura symptoms seem to blossom over several minutes. For example, people frequently describe scotoma (blind spots in the visual field) getting bigger, or brighter, or more elaborate. When migraine aura consists of multiple symptoms, it almost always begins with visual symptoms, followed by numbness and tingling symptoms, because the next part of the brain to be affected by this electrical wave is the part that controls the sense of touch. Weakness or loss of speech can follow.
- Safety note: Migraine auras may slightly increase your lifetime risk for stroke. Certain precautions are recommended to reduce stroke risks, including screenings for high blood pressure, high cholesterol, and diabetes, and following a physician’s recommendations to treat any of these conditions. Smoking is another high-risk behavior for potential stroke. Further, those who experience aura may not want to take oral estrogen contraceptive pills, since that also is associated with the risk of stroke. Consult your healthcare provider.
- Consult a doctor.
- Though migraine aura is common and not dangerous, anyone with unusual migraine aura symptoms (such as inability to speak, sudden weakness on one side of the body, trouble seeing) or aura that appears for the first time in later life should see their doctor to ensure it is not a sign of a different condition (i.e., a stroke, brain tumor, retinal tear).
- Your doctor can work with you to come up with a migraine treatment plan.
- Treatments. Whether you have migraine with or without aura, treatment is typically the same:
- Preventives. These are medications you take consistently to reduce the frequency of attacks. Some preventive medications are favored for migraine aura, including lamotrigine (Lamictal), an anti-seizure medication found in studies to be effective for severe aura.
- Abortives (medicines that stop a migraine attack). Over-the-counter and prescription medications such as triptans are also used to manage headache with aura.
- Safety measures: Because the migraine aura experience has the potential for balance disturbances, you’ll want to sit or lie down to reduce the risk of falling. If you are driving, pull over till the aura passes.
It’s important to know your migraine aura symptoms and recognize them when they appear. The earlier you treat a migraine attack, the more effective the treatment will be. So when aura symptoms arrive — warning signs that a headache is on its way — use it as a cue to jump into action with your treatment plan. That early intervention can reduce the severity and duration of your headache, minimizing your suffering. Good for you! Through a little education, you’ve taken a step toward putting control within reach.