Migraine with aura (also called classic migraine) is a recurring headache that appears after or at the same time as sensory disorders called an aura. These disturbances may include flashes of light, blind spots, and other vision changes or tingling in the 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 migraines with aura with the same medications and self-care measures that are used to prevent migraine.
Migraine aura symptoms include temporary visual disturbances or other disturbances that usually appear before other symptoms, such as severe headache, nausea, and sensitivity to light and sound.
The migraine aura usually occurs an hour before the headache starts and usually lasts less than 60 minutes. Sometimes, especially in people 50 and older, the migraine aura occurs with little or no headache.
Visual signs and symptoms
Most people with 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 include:
- Blind spots (scotomas), which are sometimes outlined with simple geometric designs
- Zigzag lines gradually floating across the field of view
- Shining dots or stars
- Vision changes or vision loss
- Flashes of light
Other temporary disturbances sometimes associated with migraine aura include the following:
- Numbness, which usually feels like a tingling in one hand or side of the face that can slowly spread along one limb
- Speech or language difficulty
- Muscular weakness
When to see a doctor
See your doctor immediately if you have the signs and symptoms of migraine with aura, such as temporary loss of vision or floating spots or zigzag lines in the visual field. The doctor will need to rule out more serious conditions, such as a stroke or a retinal tear.
The cause of migraine with aura is not fully understood. There is evidence that migraine with visual aura is like an electrical or chemical wave that moves through the part of the brain that processes visual signals (visual cortex) and causes these visual hallucinations.
Many of the same factors that trigger migraines can also trigger migraines with aura, including stress, bright lights, some foods and medications, too much or too little sleep, and menstruation.
Although no specific factor appears to increase the risk of migraine with aura, migraines, in general, appear to be more common in people with a family history of migraine. Migraines are also more common in women than men.
People with migraine with aura have a slightly higher risk of having a stroke.
Your doctor may diagnose a migraine with aura based on your signs and symptoms, your medical and family history, and a physical exam. If you don’t feel a headache after an aura 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 transient ischemic attack (TIA).
Assessments may include the following:
- An eye exam. A complete eye exam, performed by an eye doctor (ophthalmologist), can help rule out eye problems that could be causing the aura.
- Computed tomography of the head. This radiographic technique generates detailed images of the brain.
- Magnetic resonance imaging (MRI). This imaging procedure creates images of internal organs, including the brain.
Your doctor may refer you to a doctor who specializes in disorders of the nervous system (neurologist) to rule out brain conditions that could be causing your symptoms.
For migraine with aura, as for migraine alone, treatment aims to relieve migraine pain.
Medications used to relieve migraine pain works best when taken at the first sign of an approaching migraine, as soon as the signs and symptoms of a migraine with aura begin. Depending on the intensity of the migraine pain, the types of medications that can be used to treat it include the following:
- Analgesics. Some of these over-the-counter or prescription pain relievers are aspirin or ibuprofen (Advil, Motrin IB, others). When taken for a long time, they can cause headaches from overuse of medications, and possibly ulcers and bleeding in the gastrointestinal tract.
- Migraine relief medications that combine caffeine, aspirin, and acetaminophen (Excedrin Migraine) can be helpful, but usually only for mild migraine pain.
- Triptans These prescription drugs like sumatriptan (Imitrex, Tosymra) and rizatriptan (Maxalt) are used for migraine headaches because they block pain pathways in the brain. Taken in the form of pills, injections, or nasal sprays, they can alleviate many of the symptoms of migraine headaches. They may not be safe for those at risk for stroke or heart attack.
- Dihydroergotamines (DHE45, Migranal). Available as a nasal spray or injection, they are most effective when taken shortly after the onset of migraine symptoms for migraines that tend to last longer than 24 hours. Some of the side effects may be worsening vomiting and nausea related to migraine headaches.
- People with coronary artery disease, high blood pressure, or kidney or liver disease should avoid dihydroergotamines.
- Opioid medications. If you can’t take triptans or ergotamines, narcotic opioid medications, especially those containing codeine, may be helpful. Since they can be highly addictive, they are usually only used when no other treatment is effective.
- Anti-nausea medications. These can help if the migraine with aura is accompanied by nausea and vomiting. Some of the anti-nausea medications are chlorpromazine, metoclopramide (Reglan), or prochlorperazine (Comprar). They are usually taken with pain relievers.
Medications can help prevent frequent migraines, with or without aura. If you have frequent, long-lasting, or severe headaches that don’t respond well to treatment, your doctor may recommend preventive medications.
Preventive medications aim to reduce the frequency with which a migraine occurs with or without aura, the severity of the attacks and their duration. Some options are:
- Medicines to lower blood pressure. 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), may be helpful in preventing migraines with aura.
- Antidepressants Amitriptyline, a tricyclic antidepressant, can prevent migraines. Due to the side effects of amitriptyline, such as drowsiness and weight gain, other antidepressants may be prescribed.
- Antiseizure medications. Valproate (Depacon) and topiramate (Topamax) may help reduce the frequency of migraines, but they can cause side effects, such as dizziness, weight changes, nausea, and more.
- Botox injections. Onabotulinumtoxin A (Botox) injections about every 12 weeks help prevent migraines in some adults.
- Monoclonal antibodies that inhibit the calcitonin gene-related peptide. Erenumab (Aimovig), fremanezumab (Ajovy), and galcanezumab (Emgality) are newer drugs approved by the Food and Drug Administration (FDA) to treat migraines. They are administered monthly by injection. The most common side effect is a reaction at the injection site.
Stress management and lifestyle
When the symptoms of a migraine with aura start, try going to a quiet, darkroom. Close your eyes and rest or take a nap. Place a cold washcloth or an ice pack wrapped in a towel or cloth on your forehead or the back of your neck.
Other practices that might relieve migraine with aura pain include the following:
- Relaxation techniques. Biofeedback and other relaxation techniques teach you ways to cope with stressful situations, which may help you have fewer migraines.
- Develop a routine for sleeping and eating. Don’t sleep too much or too little. Establish and stick to a consistent sleep and wake schedule each day. Try to eat at the same time every day.
- Drink lots of fluids. Staying hydrated, particularly with water, may help