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Migraine headaches can be painful and debilitating. If you experience migraine attacks, you may also experience auras. These can occur before a migraine attack and involve sensory changes. These can include seeing sparks, zigzags, or bright dots or experiencing numbness or tingling sensations in the body.
In this article, we’ll explore the different types of migraine with aura, the symptoms they cause, and ways to prevent and treat them.
There are several different categories of migraine with aura, including:
A migraine with brainstem aura is an aura connected with a migraine headache consisting of head pain in the back and on both sides. Warning signs that you have an MBA can include slurred speech, dizziness, and loss of balance. According to the American Migraine Foundation, MBAs may be more common among adolescent girls, but they can affect people of any age.
Migraine with aura is less common than migraine without aura. Around 25 percent to 30 percent of people with migraine get them with auras.
With a hemiplegic migraine, people may experience temporary weakness on one side of their body, along with auras like changes in vision or speech. Retinal migraine can cause vision loss for 10 to 20 minutes.
Some people may experience migraine without aura. With this type of migraine attack, you don’t experience any sensory disturbances. Instead, you might experience symptoms during what’s called the premonitory or prodrome phase before the migraine attack. These symptoms may include food cravings, constipation, fatigue, and sensitivity to light or sound. A moderate to severe migraine headache then follows, accompanied by pain on one side of the head or throbbing pain. In a postdrome phase — sometimes called a migraine hangover — you may feel depressed and fatigued and have difficulty concentrating and comprehending.
A migraine without aura is much more common than a migraine with aura. In fact, approximately 70 percent to 75 percent of people have migraine without aura, according to the American Migraine Foundation .
When you experience a migraine with aura, you can have symptoms in the center of your field of vision that can spread to the sides. These symptoms include zigzag lines, bright spots, or flashing lights. You may also lose part of your vision or experience a blind spot, a condition called scotoma. The blind spots can resemble simple geometric designs. Some visual auras resemble a shimmering spot or star.
Other symptoms include muscle weakness, difficulty speaking, and tingling in one hand or on one side of the face.
Some of the symptoms of a migraine with aura could be similar to people with transient ischemic attacks or epilepsy, a condition that causes neurological symptoms like unpredictable seizures.
Members of MyMigraineTeam have written about their experiences with migraine auras. One member described experiencing multiple phases of auras, which presented with different sensory changes. “Apparently I am in a new mode, which is giving me new visual auras different from anything I have ever had before,” they wrote. “The newest one was a small spot missing in the center of my vision, making the first two letters of words disappear. It lasted 10 minutes and then was followed by another aura of bright wavy lines on the outside of my left eye, which lasted for 15 minutes. This was followed by a full-blown migraine encasing my entire head and both eyes.”
“My visual auras affect a big portion of my vision, so doing day-to-day things is difficult (because I can’t see).”
— A MyMigraineTeam member
Another member noted that the frequency of their migraine attacks with aura varied from two to three times per month to every one to two months. “Today was hard,” they said. “At around 12:30 p.m. I started getting the usual visual aura that comes with my migraines. My visual auras affect a big portion of my vision, so doing day-to-day things is difficult (because I can’t see).”
Some visual auras can be colorful and appear like hallucinations. People living with migraine sometimes find it difficult to describe their aura sensations. “I had a particularly nasty migraine this morning, but I also experienced visuals during it,” one member shared. “I won’t call them hallucinations or auras as they weren’t. They were black-and-white pictures, but some areas were colored with one single color. In the first visual it was bright pink, and in the second visual, it was bright blue, and the colors hurt my eyes!”
Visual auras are like an electrical or chemical wave in the brain. Some members report experiencing more sensitive hearing during a visual aura. “If I don’t wake up with a migraine, then before it comes on I feel really achy and sluggish,” a member shared. “I also go blind for about 10-15 seconds, but my hearing is amplified at the same time.”
Sometimes, the symptoms that accompany an aura can be so intense that a person may think they’re having a more serious problem, like a stroke. “I’m curious to know if anyone else has had Alice in Wonderland syndrome as a visual aura?” one member asked. “It’s intense, and I honestly thought I was having a stroke the first time.”
If you experience a migraine attack that includes visual disturbances or auras, consult a health care provider right away. They’ll examine you to make sure you’re not having a different medical issue, like a stroke or a retinal tear. You may need to see a neurologist, who will consider your medical history when determining your diagnosis. The doctor may perform an eye exam and an MRI or CT scan to gather more information.
Scientists don’t know the exact cause of migraine with aura. However, research shows that severe headaches and migraine attacks with auras can result from:
In addition, migraine runs in families. It’s also possible that environmental factors like a change in weather can bring on auras. One member wrote, “Ugh, more storms coming our way. Feeling the aura.”
Migraine with aura doesn’t have a clear cause, but it can be triggered by factors like certain foods, menstruation, caffeine withdrawal, and fatigue.
Another member reflected on how stress can trigger their migraine with aura. “Plans were all mixed up today,” they wrote. “Everything I planned for didn’t happen. I feel guilty I didn’t do certain things, and I’m frustrated by others’ actions. All these things always cause me stress, which in turn causes headaches and sometimes migraines.”
There are several treatments available for migraine with aura. Some are the same as those prescribed for migraine without aura.
Some people benefit from taking over-the-counter remedies, such as aspirin (Bayer) and ibuprofen (Advil), if they’re feeling aura symptoms or a migraine headache.
Prescription drugs for treating migraine include triptans like sumatriptan (sold as Imitrex) and rizatriptan (Maxalt). These drugs can block brain pathways that cause pain.
Other medications include dihydroergotamine — such as Migranal, available as a nasal spray, and D.H.E. 45, available as an injection. Dihydroergotamine can induce vomiting and nausea, which are migraine symptoms. Anti-nausea drugs like metoclopramide (Reglan) or prochlorperazine (such as Compro) can help with these symptoms.
Calcitonin gene-related peptide receptor (CGRP-R) antagonists aim to help prevent migraine attacks. Examples of drugs in this class include erenumab-aooe (Aimovig), eptinezumab-jjmr (Vyepti), and galcanezumab-gnlm (Emgality).
Neuromodulation for treating acute migraines involves using devices that modify brain activity, either by increasing or decreasing it, often via electrical, temperature, or magnetic interventions. These devices may be used to prevent migraine attacks or to stop ongoing attacks.
Types of neuromodulation devices approved by the U.S. Food and Drug Administration (FDA) include:
These treatments are an option for people who can’t tolerate medications or are concerned about medication overuse. Cost can be a barrier for some people.
Doctors may suggest some treatments as a preventive measure. Among them are:
Finally, onabotulinumtoxinA (Botox) injections help prevent migraine attacks in some people with chronic migraine. One member wrote, “I started Botox five years ago. It was amazing. I went almost three years with barely any migraines, and now just this year, mine started back up again. But I still think the Botox is helping.”
MyMigraineTeam is the social network for people with migraine and their loved ones. On MyMigraineTeam, more than 81,000 members come together to ask questions, give advice, and share their stories with others who understand life with migraine.
Have you experienced migraine attacks with visual symptoms like auras? What were your symptoms? What treatments have you tried? Share your experiences in the comments below or make a post on your Activities page.
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Angelica Balingit, M.D.
is a specialist in internal medicine, board certified since 1996.
Learn more about her here.
Brian T. Horowitz
is a graduate of Hofstra University in New York with a B.A. in English. He is a longtime health and technology journalist.
Learn more about him here.
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