Migraines are more than just a headache. They also cause symptoms such as nausea, vomiting, sensitivity to light, tingling in the extremities — and for about 25 percent of patients, sensory disturbances called an aura. These sensory disturbances are usually predominantly visual. They can range from blind spots to flashes of light in the visual field, and they usually begin before the headache. Some patients even experience aura symptoms without the classic headache associated without migraine. Most patients experience the symptoms of their classic head pain after the aura.
The world of migraines with aura can be debilitating and scary, but the more you know, the better you’ll be able to manage this condition. So let’s take a closer look.
Various patients experience auras differently. You may see blind spots in your visual field, forcing you to turn your head to the side or look at something sideways in order to see it clearly. Some patients see zigzag lines in their visual field. These lines may appear to jump or bounce when you move your head. For other patients, an aura comes with flashing lights, scintillating lights or a black and gray pattern called fortification spectra that appear as the grey and white in an old castle. These images that tend to march across their vision, and then it may be followed by what is termed negative symptoms–that is, a blind spot. Visual auras tend to be the most common type of sensory disturbance making up the majority of cases of the symptoms of aura.
You may also notice changes in your other senses such as numbness or tingling in your arm, tongue, face and leg. Some patients have trouble finding words–this is termed aphasic symptoms. You might feel like you have to think hard to complete a thought, or really take your time forming sentences. Changes in the sense of smell, such as smelling odors that are not really there, are also possible.
Other atypical aura symptoms include hemineglect, seeing half of a visual field from your eye, strong emotions especially anxiety, loss of color vision, trouble calculating, trouble with coordination, fluctutation of sound and distorted. This a long list of possible symptoms but migraine with aura typically occurs in a stereotyped and repeated fashion in each episode.
An aura often appears before the actual headache — patients often see it as a warning sign that a migraine is coming on. The aura typically only lasts 5 to 60 minutes and disappears once the headache begins.
When people experience an aura for the first time, they sometimes assume they have had a stroke. Migraine aura symptoms and symptoms of a stroke are similar, but there can be a few key differences. Aura symptoms usually come on gradually, whereas stroke symptoms appear suddenly. If you experience facial drooping, a lopsided smile, trouble walking, or sudden confusion, you may be having a stroke and should seek emergency medical care. If you are ever uncertain whether your symptoms are due to a stroke or migraine, always err on the side of caution and seek medical help. Let a doctor determine whether something is a migraine aura or stroke.
Researchers are not yet sure why some migraine sufferers experience an aura, while others do not. An aura, like other migraine symptoms, appears to be due to changes in the blood vessels and nerves in certain parts of the brain. There have been different genetic locations attributed to aura. The part of the brain that causes the symptoms are typically correlated with the anatomic region that has been activated. For example visual symptoms are often attributed to activation of neurons in the visual cortex.
Migraine with aura triggers vary between patients, with common triggers including:
As you can see, almost anything can trigger a migraine — but most patients only react to a few of these triggers. This is one reason why it’s so important to see a doctor if you suffer from migraine aura symptoms. They can help you pinpoint and avoid your personal triggers, leading to a reduced frequency of migraines.
Most patients who experience migraine aura symptoms are experiencing a typical migraine of which this happens to be one symptom. However, there are a few more serious sub-types of migraine that can also cause auras, and your doctor will want to rule them out since they often require a different treatment protocol than the typical migraine.
Basilar Type Migraine
This type of migraine originates in the brainstem, which is the part of the brain located where the back of your head meets your neck. In addition to typical aura symptoms, it can also cause dizziness, ringing in the ears, double vision, uncoordinated movements, and reduced level of consciousness.
Optic or Retinal Migraine
The term “optic migraine” is sometimes misused to refer to any migraine with aura symptoms, but in fact, it is its own subtype of migraine — also known as retinal migraine. (The retina is the part of your eye which detects light and sends signals to the optic nerve in response to that light.)
This rare but serious form of migraine causes visual disturbances in only one eye. These disturbances are usually twinkling lights, blind spots, or temporary blindness. If you close the affected eye, your vision will appear normal. (With a typical migraine, you see visual disturbances with both eyes, even if they do appear to be on one side of the visual field.)
Retinal migraines can sometimes lead to lasting vision loss, so if you experience migraine aura symptoms, it’s very important that your doctor rule out this cause. If you are diagnosed with retinal migraines, it is vital to treat and prevent subsequent migraines since they can lead to permanent eye damage.
This is another very rare form of migraine. It causes typical aura symptoms along with fever, sensitivity to sound and light, and weakness in one side of the body. In patients with hemiplegic migraine, these symptoms can last for hours or days — significantly longer than the typical aura phase experienced by traditional migraine patients. These patients need to work closely with a migraine doctor to keep their migraines under control with both preventive and acute treatments.
Those who suffer from migraine aura symptoms are at an increased risk for stroke and heart disease. Researchers surmise that the narrowed blood vessels seen in migraine patients who experience auras make strokes more likely. Strokes are caused by clots becoming trapped in a blood vessel, and narrow vessels are more easily blocked.
To reduce your risk of stroke and heart disease, work closely with your migraine doctor to find preventative treatments that work for you. Also control blood pressure and blood lipid levels with plenty of exercise, a healthy diet, and weight control.
Another important risk factor for stroke is the birth control pill. Estrogen in the contraceptive pill is a separate risk factor for stroke. People who have migraine with aura and are taking the pill need to have a conversation with their neurologist and gynecologist to decide the risks and benefits of continuing the birth control pill. This is an often overlooked risk factor for stroke.
In addition to helping you identify and avoid your personal migraine aura symptoms triggers, your doctor will likely prescribe a combination of preventive and acute treatment medications.
Preventive medications are intended to keep you from developing a migraine in the first place. Blood pressure medications, anti-seizure drugs, and antidepressants are common options. Acute treatments include triptans, which work by blocking the pain pathways in the brain, and dihydroergotamine, a drug sold as a nasal spray that can stop a migraine from worsening when administered as soon as the aura begins.
For my patients with frequent auras, or prolonged auras (those lasting more than 60 minutes), I tend to treat with preventative medicines as I want those patients to have less auras. The symptoms can be debilitating and I want less stroke risk in these patients. For my patients who have infrequent auras, often abortive medicines at the time of the aura can get rid of the headache before the pain starts.
Treating migraine aura symptoms is a very personalized matter. If you suffer from visual disturbances or other debilitating aura symptoms associated with migraine, an online telemedicine appointment can help you discuss options for treatment.
For more information on aura and migraines, book an online consultation with me, Dr. Risa Ravitz, here.