What Is an Aural Migraine? Symptoms and Triggers of a Migraine With Aura

Fact checked by Olga Sadouskaya, MD
Clinical Pharmacologist, Chief Medical Officer

The correlation between migraines and auras has captivated and perplexed both patients and medical professionals.

In fact, while making a diagnosis of migraine in an individual, doctors may classify the person as having migraine with aura, migraine without aura, or both types of migraine.

The aura stage of a migraine is distinctive, since it is only experienced by 25 to 30 percent of people who have migraine. This stage is sometimes referred to as a “warning sign.”

What is an aural migraine?

A migraine with aura, also known as a classic migraine, is a recurrent headache that may occur either immediately after or in conjunction with a sensory disturbance known as an aura.

A person experiencing one of these disturbances could experience flashes of light, blind patches, or other variations in their vision, as well as tingling in their hands or face.

In most cases, migraines with aura and migraines without aura (also known as common migraine) respond similarly to treatment. The same drugs and self-care practices that are used to prevent migraines may also be used to attempt to avoid migraines accompanied by an aura.

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Let’s talk about what the aura of a migraine is. There are three primary categories of migraine auras:

  • Visual aura. Visual disturbances, such as flashing lights or zigzags, are one of the most prevalent types of migraine auras. These disturbances might last for a short period of time.
  • Sensorimotor aura. Tingling, numbness, or weakness are examples of sensory or motor abnormalities that could occur, and a visual aura might or might not be present at the same time.
  • Dysphasic aura. This is the kind of migraine aura that occurs least often. It manifests in the form of verbal and linguistic symptoms, such as slurred speech or muttering.

Symptoms of a migraine with aura

Symptoms of a migraine with aura involve transient visual or other disruptions that frequently arrive before other migraine symptoms, such as acute head pain, nausea, and sensitivity to light and sound. These migraine aura symptoms may last for a few minutes to a few hours.

The symptoms are classified as the following:

Prodrome symptoms

Thirty-five percent of people who experience migraines will have pre-migraine symptoms between 24 and 48 hours before the onset of a migraine. This is the prodrome phase, or period before a headache. You may have the following symptoms:

  • Cravings for specific foods
  • Anxiety or irritability
  • Weariness, with more yawning than normal
  • Stiffness, particularly in the neck
  • The need to urinate more frequently
  • Constipation or diarrhea

Visual manifestations of migraines

There may be a glint of light in your eyes, as though a lightbulb is flickering. You may see horseshoe-shaped jagged lines that become larger. This is referred to as a fortification spectrum.

Other possible symptoms include Alice in Wonderland syndrome. When this occurs, your body parts may seem deformed, or you may get the sensation of being a large person in a tiny space.

Common signs of a visual aura include:

  • Numerous flashes of brilliant lights
  • Hazy or blurry vision
  • Zigzag lines
  • Blind spots
  • Partial vision impairment
  • Small luminous dots
  • Variously hued specks
Blurred vision as one of the manifestations of a migraine with aura

Occasionally, you may experience:

  • Diminished depth perception
  • Fragmented vision, as though gazing through shattered glass
  • Visions of nonexistent objects (hallucinations)
  • Tunnel vision
  • Short-term blindness

Sensory manifestations of migraine

The aura often starts within 5 to 20 minutes and lasts for less than an hour. It may influence any of your senses. Examples of symptoms include seeing, hearing, or smelling nonexistent objects, sounds, or odors.

In addition, there can be prickling, tingling, or numbness (paresthesia).

Verbal migraine symptoms

You may have difficulty speaking, but it’s quite rare. You may not be able to find the right words, or your statements may lack logic. You may be unable to comprehend what others say. Other possible symptoms include:

  • Difficulty finding the right words or speaking (aphasia)
  • Mumbling
  • Lisping

Migraine pain may be constant or pulsating. Typically, it is felt on the front or side of the head, near the eyes. Adults are more prone to feel discomfort on only one side. It is a headache that may last anywhere from a few hours to three days.

In addition to discomfort, your symptoms can include:

  • Upset stomach or vomiting
  • Flashes of heat and cold
  • Stuffy or runny nose
  • Dizziness or whirling (vertigo)
  • Sore neck or jaw
  • Sensitivity to light, noises, odors, touch, or motion
  • Confusion
  • Muscle weakness

Can you get a migraine with aura without a headache?

Yes. Some individuals get quiet migraine auras. It might be challenging to treat migraines with aura without a headache, since the majority of drugs need a longer amount of time to take effect than the length of the aura.

Ocular migraines, a subtype of migraine attacks that are marked by visual symptoms, may occasionally manifest without any accompanying pain.

Ocular migraines may refer to a variety of headaches, including migraines with aura and migraines that affect the retina.

Nevertheless, taking pain medicine at the first indication of an aura may lower the likelihood of experiencing discomfort, nausea, and sensitivity to loud sounds or bright lights.

How common are aural migraines?

Among those who suffer from migraine headaches, only around a quarter to a third will also have an aura.

  • An estimated 90 to 99 percent of those who get a migraine has some kind of visual aura.
  • An estimated 36 percent of the population experiences some kind of sensory aura.
  • Around 10 percent of the population will get dysphasic aura.
A woman lying on a sofa with an aural migraine

What causes a migraine with aura?

It is not quite clear what precisely triggers an aura in a person. A wave of electrical activity that travels through the cortex of the brain is thought to be the root cause of this condition.

The activity of nerve cells is then inhibited for an extended period of time after this wave passes.

This might result in a variety of changes, such as alterations in blood flow, which can cause symptoms of migraine headaches.

It’s also possible that the same factors that bring on migraine episodes without aura can also bring on an aura. These factors may include the following:

  • Tension or distress
  • Not getting enough sleep
  • Skipping or having irregular meals
  • Consuming alcoholic beverages or stimulants
  • Eating chocolate, aged cheeses, or cured meats
  • Eating food additives such as monosodium glutamate and aspartame
  • Changes in hormone levels, such as those that occur during menstruation
  • Intense lights, pungent odors, or loud sounds
  • Arduous physical activity
  • Variable weather conditions
  • Several drugs

How to relieve a migraine with aura

Stay in a place that is quiet and dark if you are experiencing an aura along with your migraine. You might try applying cold compresses or pressure to the areas that are hurting.

Over-the-counter medications

Pain medicines that are available without a prescription are:

  • Acetaminophen
  • Aspirin
  • Ibuprofen
  • Naproxen

Your physician may recommend taking a higher dosage of a nonsteroidal anti-inflammatory drug. However, aspirin should not be taken by anyone younger than 19 years old.

Prescription drugs

Help is available in the form of prescription drugs known as triptans or ditans. These drugs are also referred to as abortive medications because of how quickly they work. Some of the examples include:

  • Almotriptan
  • Eletriptan
  • Frovatriptan
  • Lasmiditan
  • Naratriptan
  • Rizatriptan
  • Sumatriptan

Other drugs, such as those for nausea and vomiting, may help alleviate the discomfort caused by this condition.

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Transcranial magnetic stimulation

By stimulating your brain in a certain manner, these gadgets are intended to prevent migraines from occurring in the first place. Transcranial magnetic stimulation (TMS) is the methodology that is used by both SpringTMS and eNeura sTMS.

To generate a magnetic energy pulse, you will need to position the device on the back of your head for around one minute. When positioned over the vagus nerve in the neck, this device is capable of relieving pain via the application of gentle electrical stimulation.

If you want to use any of these technologies, you’ll need a prescription.

Prevention of migraine with aura

While you can’t completely prevent migraine aura, you may be able to reduce the length, severity, and frequency of attacks. If you have severe migraines that don’t respond well to treatment, your doctor may recommend:

  • Timolol
  • Propranolol
  • Metoprolol
  • Topiramate
  • Valproate sodium

In conclusion

A migraine aura manifests as visual, sensory, or auditory changes. Usually lasting a little more than an hour, it may happen either before or during a migraine episode. For others, the aura alone may not signal a migraine.

A combination of drugs can be effective for treating migraines with aura. Migraine symptoms may be avoided with preventive medicine and addressed acutely with additional treatments.

Aura symptoms may be confused with those of a stroke or a seizure, both of which need immediate medical attention. If you have never had a migraine with aura before but are experiencing difficulty speaking or tingling on one side of your body, you should get medical help right away.

If you get a severe, abrupt headache that is accompanied by neck stiffness, fever, disorientation, or convulsions, you should seek immediate medical attention.

January 26, 2023