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Migraine with aura

Overview

Migraine with aura (also called classic migraine) is a headache that strikes after or along with sensory disturbances called aura. These disturbances can include flashes of light, blind spots and other vision changes or tingling in your hand or face.

Treatments for migraine with aura and migraine without aura (also called common migraine) are usually the same. You can try to prevent migraine with aura with the same medications and self-care measures used to prevent migraine.

Symptoms

Migraine aura symptoms include temporary visual or sensory disturbances that usually strike before other migraine symptoms — such as intense head pain, nausea, and sensitivity to light and sound.

Migraine aura usually occurs within an hour before head pain begins and generally lasts less than 60 minutes. Sometimes migraine aura occurs with little or no headache, especially in people age 50 and older.

Visual signs and symptoms

Most people who experience migraine with aura develop temporary visual signs and symptoms of aura. These may include:

  • Blind spots (scotomas), which are sometimes outlined by simple geometric designs
  • Zigzag lines that gradually float across your field of vision
  • Shimmering spots or stars
  • Changes in vision or vision loss
  • Flashes of light

These types of visual disturbances tend to start in the center of your field of vision and spread outward.

Other sensory disturbances

Other temporary sensations sometimes associated with migraine aura include:

  • Feelings of numbness, typically felt as tingling in one hand or in your face
  • Difficulty with speech or language
  • Muscle weakness

When to see a doctor

See your doctor immediately if you experience the signs and symptoms of migraine with aura, such as temporary vision loss or floating spots or zigzag lines in your field of vision. Your doctor will need to rule out more-serious conditions, such as a stroke or retinal tear.

Once these conditions are ruled out, you won't need to see your doctor about future migraines unless your symptoms change.

Causes

The cause of migraine with aura isn't clearly understood. It's believed that the migraine with visual aura is like an electrical or chemical wave that moves across the part of your brain that processes visual signals (visual cortex) and causes these visual hallucinations.

Many of the same factors that trigger migraine can also trigger migraine with aura, including stress, bright lights, some foods and medications, too much or too little sleep, and menstruation.

Risk factors

Although no specific factors appear to increase the risk of migraine with aura, migraines in general seem to be more common in people with a family history of migraine. Migraines are also more common in women than men.

Complications

People who have migraine with aura are at a slightly higher risk of stroke. Women who have migraine with aura appear to have an even higher risk of stroke if they smoke or take birth control pills.

Diagnosis

If you experience signs and symptoms of aura followed by typical signs and symptoms of migraine, it's likely you have migraine with aura. Your doctor may diagnose the condition on the basis of your medical history and a physical exam.

But if your aura isn't followed by head pain, or the visual disturbances affect only one eye, your doctor may recommend certain tests to rule out more-serious conditions, such as a retinal tear or a transient ischemic attack — a temporary decrease in blood supply to part of your brain — that could be causing your symptoms.

Your doctor may recommend:

  • An eye examination. During this exam, your doctor will use an instrument the size of a small flashlight (ophthalmoscope) to project a beam of light into your eye to examine the back of your eyeball (funduscopy).
  • Computerized tomography (CT). This X-ray technique produces detailed images of your internal organs, including your brain.
  • Magnetic resonance imaging (MRI). This diagnostic imaging procedure produces images of your internal organs, including your brain.

Your doctor may also refer you to a doctor who specializes in nervous system disorders (neurologist) to rule out brain conditions that could be causing your symptoms.

Treatment

There is no specific treatment for the signs and symptoms of aura, but there are ways to treat migraine pain. Treatments and medications for migraine with aura are similar to treatment for migraine without aura.

Pain-relieving medications

Medications used to relieve migraine pain work best when taken at the first sign of an oncoming migraine: for example, as soon as you notice signs and symptoms of a migraine aura beginning.

Types of medications that can be used to treat migraine pain include:

  • Pain relievers. Over-the-counter or prescription pain relievers, such as aspirin or ibuprofen (Advil, Motrin IB, others). When taken too long, these may cause medication-overuse headaches, and possibly ulcers and bleeding in the gastrointestinal tract. Migraine relief medications that combine caffeine, aspirin and acetaminophen (Excedrin Migraine) may be helpful, but usually only against mild migraine pain.
  • Triptans. Triptan medications (Imitrex, Maxalt, others) are prescription drugs used specifically for migraine because they block the pathways of pain in the brain. They can relieve many symptoms of migraine, and can be taken as pills, shots or nasal sprays. They may not be safe for anyone at risk of a stroke or heart attack.
  • Ergots. Ergots (Migergot, Cafergot) are another family of drugs used for migraine. They're most effective when taken shortly after the start of migraine symptoms, and in migraines that tend to last longer than 48 hours. Side effects of ergots can include medication-overuse headaches and worsening of migraine-related vomiting and nausea.
  • Opioid medications. For migraine sufferers who can't take triptans or ergots, narcotic opioid medications (especially those that contain codeine) may be helpful. To avoid addiction, these are usually used only if no other treatments are effective.
  • Anti-nausea drugs. These can help if your migraine with aura is accompanied by nausea and vomiting. Anti-nausea drugs include chlorpromazine, metoclopramide (Reglan) or prochlorperazine (Compro). These are usually taken along with other medications.
  • Glucocorticoids. A glucocorticoid (prednisone, dexamethasone) is sometimes used along with other medications to provide better pain relief. Because of side effects, glucocorticoids should not be used frequently.

People who have auras that last a long time should not take ergot medications, as they may reduce blood flow to the brain.

Preventive medications

Medications can help prevent frequent migraines, with or without aura. Your doctor may recommend preventive medications if you're having frequent, long-lasting or severe headaches that don't respond well to treatment.

After a few weeks of taking them, preventive medications can help you have fewer migraines and help treatments work more effectively when you do have a migraine.

Preventive medication options include:

  • Blood pressure-lowering medications. These include beta blockers such as propranolol (Inderal LA, Innopran XL, others), metoprolol tartrate (Lopressor) and timolol (Betimol). Calcium channel blockers such as verapamil (Calan, Verelan, others) can be helpful in preventing migraines with aura.
  • Antidepressants. Amitriptyline, a tricyclic antidepressant, has been found effective in preventing migraines. Because of the side effects of amitriptyline (such as sleepiness, weight gain and more), sometimes other antidepressants are prescribed.
  • Anti-seizure drugs. Valproate (Depacon) and topiramate (Topamax) may help you have less frequent migraines, but may cause side effects such as dizziness, weight changes, nausea and more.
  • Botox injections. Injections of onabotulinumtoxinA (Botox) about every 12 weeks can help prevent migraines in some adults.

Stress management and lifestyle

You may be able to soothe migraine with aura pain with the self-care techniques that can be used for migraine without aura:

  • Cognitive behavioral therapy (CBT). This technique teaches you more-appropriate ways to deal with stressful situations, and may help reduce the number of migraines you have. CBT may be combined with another strategy called learn to cope (LTC). LTC involves slowly exposing you to common headache triggers to help you become less sensitive to them.
  • Get a healthy amount of sleep. Don't sleep too much or too little. Set a consistent sleep and wake schedule that you follow each day and night.
  • Relax when symptoms start. When migraine aura symptoms start, head to a quiet, dark room and rest with an ice pack (wrapped in a towel or cloth) placed at the back of your neck.

Preparing for an appointment

If you're experiencing temporary visual or sensory disturbances, see your family doctor or a general practitioner. In some cases, you may be referred to a doctor who specializes in nervous system disorders (neurologist).

Here's information to help you get ready for your appointment and to know what to expect from your doctor.

What you can do

  • Keep track of your symptoms. One of the most helpful things you can do is keep a headache diary. Write a description of each incident of visual disturbances or unusual sensations. What are they? When did they happen? How long did they last? What followed them? Did something seem to trigger them? A headache diary may help your doctor diagnose your condition.
  • Make a note of key personal information, including things like recent life changes, or major stresses.
  • Write down a list of questions to ask your doctor.

For migraine with aura, some basic questions to ask your doctor include:

  • What's the likely cause of my symptoms?
  • What tests, if any, do I need?
  • Is my condition likely temporary or chronic?
  • What treatments are available? Which do you recommend?
  • What are the alternatives to the primary approach you're suggesting?
  • I have other health conditions. How can I best manage them together?
  • Are there dietary restrictions I need to follow?
  • Is there a generic alternative to the medicine you're prescribing?
  • Are there written materials I can take with me or websites you recommend?

Don't hesitate to ask other questions you have.

What to expect from your doctor

Questions your doctor is likely to ask include:

  • When did you begin having symptoms?
  • What types of visual symptoms or other sensations do you have?
  • How long do they last?
  • Are they followed by a headache?
  • If you have headaches, how often do you get them and how long do they last?
  • How severe are your symptoms?
  • What, if anything, seems to improve your symptoms?
  • What, if anything, appears to worsen your symptoms?

Last updated: May 5th, 2016

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