When you live with migraine, you become acutely aware of how migraine is not “just” a headache. Sometimes the symptoms seem to last way longer than the max duration of 72 hours of pain. Sometimes, symptoms such as mood and sleep changes, precede the pain phase and sometimes symptoms (such as the “hangover feeling”) continue even if the pain is gone. Or perhaps you have chronic migraine, more than 15 migraines each month (and oftentimes migraine symptoms every single day). There are many ways migraine can show up for the 35 million Americans who experience at least one migraine each year.
According to the International Classification of Headache Disorders (ICHD-3), one way migraine presents is with aura (formally known as classic migraine). Aura usually occurs five to 60 minutes before the pain of a migraine, almost like a series of warning signs. Migraine with aura occurs in about 25 to 30 percent of those who experience migraine. The most common signs of aura are visual disturbances, like flashing lights, or sensory experiences, like tingling in your arm. Another, but less common, aura symptom you may have is transient aphasia.
What Is Transient Aphasia?
Transient aphasia is “a condition that results [in a] temporary inability or decreased ability to speak, read or comprehend,” according to Svetlana Blitshteyn, M.D., a neurologist and the director and founder of Dysautonomia Clinic. When this happens, you may gradually or suddenly experience the inability to speak or understand what others are saying, have trouble reading or writing and sometimes have trouble with math-related understanding. Symptom severity can vary from person to person and between attacks.
Mighty community member Rebecca A. described what transient aphasia can feel like in the article, “15 Migraine Symptoms That Aren’t ‘Just a Headache.'” She said:
It makes it super difficult to find words and talk sometimes and can last for hours. For me I can read, write and understand language but I cannot speak whole words or phrases and sometimes I switch words for others.
During an attack, transient aphasia symptoms can be debilitating, but when it’s due to migraine with aura your speech and language skills are only temporarily affected. “The definition of an aura is that it should be completely reversible without any residual deficits,” Blitshteyn told The Mighty. Once the aura symptoms subside, your speech and language skills should return to normal.
What Causes Transient Aphasia?
One theory behind the cause of transient aphasia can be traced back to an unusual electrical wave in your brain called spreading cortical depression. This is the same process that causes visual aura symptoms. The wave disrupts the normal flow of electrical currents among your neurons. As this effect spreads throughout your brain, the brain gets confused by the messages received from the abnormal electrical signals.
Though it’s unclear why this happens, the spreading cortical depression seems to lead to aura symptoms, like seeing things that aren’t there. If the electrical wave spreads to areas of your brain related to speech — Broca’s and Wernicke’s areas — it’s likely you will experience difficulty with your speech and language skills.
The Broca’s area of your brain largely controls your ability to express language — to speak words or create sentences. Your Wernicke’s area controls your ability to understand or comprehend language. If this part of your brain is theoretically affected during an aura attack, you could have trouble understanding others. And while you can still speak, your words might make less sense.
Who Can Have Transient Aphasia?
Anyone can experience transient aphasia as part of migraine with aura, but it’s much more likely in people who have a history of visual aura. Keep in mind you most likely won’t experience aura with every migraine. In addition, as you get older, your migraines can change.
Migraine impacts more women than men. Blitshteyn said this is partly because migraine is affected by changes in your hormone levels. You may find your migraine symptoms shift after pregnancy, for example. It’s also relatively common for older women in the years before menopause to experience an uptick in migraine with aura as well.
Another age-related migraine change includes having just aura symptoms for up to 60 minutes, but they’re not followed by the “typical” migraine head pain, nausea or light and sound sensitivity. Blitshteyn said this is referred to as “transient migraine accompaniments or silent migraine.” However, you can experience just aura that’s not followed by head pain at any age.
When to See Your Doctor For Transient Aphasia
Transient aphasia symptoms related to migraine aura should reverse completely on their own and don’t cause any permanent damage. However, having difficulty with your speech and language skills can also be symptoms of other conditions that require immediate attention, like seizures or transient ischemic attack (TIA), a stroke-like condition that can serve as a “warning” for later strokes.
It can also be the onset of a stroke. If you develop aphasia that does not go away within an hour, or comes on with other symptoms (such as weakness or facial droop), you should seek immediate attention as these can be the signs of a stroke.
If it’s the first time you’re having transient aphasia symptoms, you should visit your doctor or neurologist for a full medical history and potential tests such as an MRI or CAT scan to rule out other conditions that could be causing speech and language difficulties. After an initial evaluation, discuss with your doctor which situations warrant further medical attention.
“I ask my patients to keep a headache diary where you can mark the type and severity of headache and the kind of aura that you’re having and how long it lasts,” Blitshteyn said. “If possible, you can make a video recording while you’re having the episode of transient aphasia so that your doctor can see exactly what happens, which would be very helpful in determining the nature of your symptoms.”
Studies show that there is a small increased risk of stroke in those who have a history of migraine with aura. This risk is still very low and doctors still don’t understand why it occurs. However, it is important to address other stroke risk factors such as high blood pressure or diabetes. Birth control pills may also slightly increase this risk for stroke, so make sure to tell your doctors (including primary care and OB-GYN) if you live with migraine.
When aura symptoms last much longer than usual (typically longer than an hour), you’ll want to call your doctor right away or head to the emergency room to rule out stroke or seizures. Despite the need to evaluate for stroke, Blitshteyn emphasized that “in the majority of cases, there is no immediate risk of stroke involved when one is having their typical migraine with aura.”
How to Cope With Transient Aphasia
Living with migraine can be unpredictable, especially if you add in aura symptoms like transient aphasia that can interrupt your daily life. One strategy Blitshteyn recommends, in addition to your regularly prescribed migraine treatment, is to take abortive “over-the-counter, non-steroidal medications like ibuprofen or naproxen … at the onset of aura that precedes your migraine.” You can also take your triptan medications. By doing this, you may be able to reduce or “break” the severity of the migraine with aura.
You can also do a little planning in case of emergency and create a simple text or text signal to send to a trusted support person if you start having symptoms and are alone. Identify several loved ones you can contact in case of emergency and make sure they know how they can assist before you’re in the middle of transient aphasia symptoms, including what to do if you’re not at home when you contact them.
Living With Transient Aphasia
Though living with migraine and aura symptoms like transient aphasia can be complicated, unpredictable and at times even scary, know you’re not alone. Engage your loved ones so you have support and work with your doctor to rule out other conditions and find a treatment plan to minimize the effect of transient aphasia on your daily life.
“When people can’t get the words out or feel acute onset of difficulty understanding for the first time in their life they may feel scared,” Blitshteyn said. “Once stroke and seizures are ruled out and once there is a proper diagnostic workup to exclude other diagnoses, we can arrive at the diagnosis of migraine with aphasic aura, and people experiencing transient aphasia can be reassured that it’s not dangerous and to treat the symptoms accordingly.”