If you’re prone to migraines, you might be used to having weird vision issues before a it hits. But those vision (or any other sensory issues) that precede the pain could be symptoms of migraine with aura — and they warrant a trip to your doctor. A headache specialist can help you figure out exactly what’s going on and create an individualized gameplan to prevent and treat your migraine with aura. As with most health conditions, the earlier you address it, the better off you’ll be.
What is migraine with aura?
“Migraine in general is usually classified as head pain and nausea or sensitivity to light or sound,” says Simy Parikh, M.D., an assistant professor of neurology at the Jefferson Headache Center at Thomas Jefferson University. “But people with migraine with aura have another feature that usually occurs within an hour before the head pain starts and that feature usually lasts less than an hour.”
What’s interesting is that additional feature can manifest differently in different people. “Basically, aura is an electrical disturbance that spreads over the brain,” says Lauren Natbony, M.D., the medical director of Integrative Headache Medicine of New York and an assistant clinical professor of neurology at the Icahn School of Medicine at Mount Sinai. “It’s like this wave of activity spreading from the back of the brain to the front of the brain and when it spreads, it sets off signals that cause symptoms from that part of your brain.” Not everyone who has a migraine will experience an aura, though: Research estimates that 12% of the general population have a migraine disorder and a quarter of those people get migraines with aura.
Migraine with aura symptoms:
Migraine aura symptoms can affect your eyesight, sense of touch or ability to speak (as outlined below), and they generally last more than five minutes but resolve within an hour. The aura symptoms often accompany or are followed by a headache, but not always. Try to track your symptoms in a journal or an app like Migraine Buddy so that you can provide your physician with as many details as possible.
Visual symptoms: “Visual aura is the most common,” says Dr. Natbony. “There are different types of visual aura, but it usually is a partial loss of vision that’s surrounded by colors, shapes, shimmers — called a scotoma.” It might be blurry or sparkly or have zigzag lines around it. “The most important thing about aura is that it progresses,” adds Dr. Natbony. “It’s not static in the sense of you just lose your vision. It’s something that starts small, maybe shimmering in the corner of your vision and then it will get bigger and grow to obscure your vision over time.” Dr. Parikh says one way to tell if you’re experiencing an aura instead of a vision problem is to close one eye. “If they close the eye that they feel like is affected, with aura they should typically still see it from the other eye,” she says. “If it goes away when the eye is closed, then I would be more worried about an actual eye issue.” Dr. Natbony suggests drawing a picture of your aura or looking online to see if you can find aura images that are similar to what you see and then showing your doctor.
Sensory symptoms: If an aura produces sensory symptoms, it’s typically in the form of tingling, numbness or a pins-and-needles feeling. “It most commonly starts in a hand and works its way up the arm into the face,” says Dr. Natbony. “It could be on one side of the tongue.”
Speech symptoms: An aura can also cause slurred speech or make it difficult to get words out. “One thing that we know about migraine is that it’s a sensory-processing disorder,” says Dr. Natbony. “So auras typically affect the ways that people express themselves or sense the world.”
Causes of migraine with aura:
No one knows exactly what causes migraine with aura. “There's a genetic component to all of migraine, but why some people get the aura — aside from genetic susceptibility — it's really unclear,” says Dr. Natbony. Research does seem to show that a heart condition, patent foramen ovale or PFO, increases a person’s risk of having migraine with aura, says Dr. Parikh, but the reason why is unknown.
Diagnosing migraine with aura:
In order to get a diagnosis of migraine with aura, you must first fit the criteria for a general migraine diagnosis. That includes these four things, according to the American Headache Society:
A headache that lasts between 4 and 72 hours
At least two of these features: one-sided, throbbing, moderate to severe intensity, exacerbation caused by physical activity
At least one of these features: nausea and/or vomiting, sensitivity to light, sensitivity to sound
At least five attacks in your lifetime
On top of that, a migraine with aura diagnosis requires these attributes:
At least one visual, sensory, speech and/or language symptom that appears and then goes away
At least three of these features: one aura symptom that spreads gradually for more than 5 minutes, two or more aura symptoms that occur one after the other, each symptom lasts 5 to 60 minutes, at least one aura symptom exists on just one side of the head, at least one aura symptom adds a sensation (i.e. tingling adds sensation while numbness takes it away), a headache accompanies or follows the aura within 60 minutes
Migraine with aura treatments
Generally, the treatments for migraine with aura are similar to the treatments for migraine without aura. The difference is that oftentimes the aura is a warning sign that migraine pain is headed your way so it gives you an opportunity to initiate treatment and stop the migraine in its tracks. “There are a few wearable devices actually on the market that can stop aura, but those are obviously something that you want to talk to a headache specialist about because I don’t think they’re very well-known,” says Dr. Natbony. But usually when an aura hits, a doctor will recommend that you take a prescription medication (most commonly a triptan, gepant or ditan) or even a supplement, according to Dr. Natbony.
That’s why it’s so important to see a doctor who specializes in headaches and can tailor your treatment plan to your needs. “No two patients are the same and they might require different treatment,” says Dr. Natbony. “For instance, if you have nausea, we might give you something different than if you don't have nausea.” She says the most valuable information you can provide for your doctor is an hourly timeline of what happens when you have a migraine. When it hits, what do you do to treat it, and then how does your body respond to each treatment that you try? “Now I can go back and think about what you should do differently,” says Dr. Natbony. “This is what we should add. This is what we should change. That way patients can really be in control.”
How to prevent migraine with aura:
“The world of prevention is so large,” says Dr. Natbony. “I feel like the most exciting thing is when someone comes to me and they’ve never been on anything preventatively because it’s like the whole world of opportunity is open.” Prescription medications, injections and Botox may be available to you, but the research-backed lifestyle modifications listed below may help as well. Just remember everything takes time to work so no matter which approach you take, it may be a few months before you notice a difference, notes Dr. Natbony.
Exercise: Although physical activity can exacerbate a migraine when you’re in the midst of one, research shows it can help prevent migraines if you do it on non-migraine days. “Cardiovascular exercise 30 to 40 minutes three to five days a week is actually equally as beneficial as a daily medication for reducing migraine frequency,” says Dr. Natbony.
Sleep: Too little, too much or poor quality shuteye can worsen migraines, but consistently getting the right amount can help. “Maintaining a regulated sleep schedule — in bed at the same time every night and waking up at the same time every morning —and getting seven to eight hours of sleep is key,” says Dr. Natbony.
Eating and drinking: “Eating consistently throughout the day—keeping blood sugar levels stable — is extremely important,” says Dr. Natbony. Contrary to popular belief, she says hydration is less important. Yes, you want to drink water, but there isn’t a ton of data to show it will make a big difference in migraine frequency. We have a list of foods you should add to your diet if you're suffering from migraines.
When to see a doctor:
“If anyone has a debilitating headache, they should bring it up with their doctor, especially if they’re having any sort of neurological changes which is what aura often presents with,” says Dr. Parikh. “That way the doctor can make sure that it’s truly aura and not anything else.” Once they confirm you are in fact having migraines with aura, your best bet is to see a neurologist who is an expert on headaches and can work with you to figure out the best approach for both prevention and treatment.
Keep in mind that migraine is a chronic condition. If you have a migraine a few times a year and you’re able to treat it effectively with over-the-counter meds and behavior changes, that’s great. But if migraines regularly keep you from doing activities that you want to do, it’s time to see a doctor. “If you have diabetes, you’re going to see a doctor for it at least annually, right?” Dr. Natbony points out. “I think that because people feel that migraine is just a headache, they could just pop something and take care of it. But the thing is, there’s so much we can do to prevent it from getting worse and to treat it better in the moment.”
“If you’re a woman and you’re experiencing migraine with aura, you should also talk to your gynecologist and make sure, if you’re taking any sort of hormonal contraceptive, that it is appropriate for you,” adds Dr. Parikh. “There is a thought that migraine with aura can increase someone’s risk for stroke and estrogen can play a role in that as well. So even though we think that risk is low, it’s important to bring up with your gynecologist. I wouldn’t say they should not take it, but that they should discuss the risks and benefits with their doctors before taking additional things like estrogen.” She says the same thing goes for smoking — smoking can increase your stroke risk on top of a potentially higher risk that might come with migraine with aura.
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