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An aura is a collection of symptoms that occur before or along with a migraine attack. Aura can cause disturbances in your vision, sensation, or speech.
The American Migraine Foundation estimates that between 25 and 30 percent of people with migraine experience aura.
Because an aura can begin before a migraine attack starts, it can often be a warning sign that one is coming.
An aura typically begins about an hour before migraine pain starts and lasts less than 60 minutes. Not all migraine attacks involve an aura.
An aura can cause a variety of different symptoms.
Visual aura is the most common type of aura. Some symptoms you may experience during a visual aura include:
- seeing jagged flashes of light, stars, or bright spots
- having zigzagging lines or geometric shapes in your field of vision
- partial vision loss or blind spots (scotomas)
Aura can also lead to changes in sensation. These symptoms can occur with or without a visual aura.
The main symptoms of a sensory aura are feelings of numbness or tingling, or a “pins and needles” sensation.
This tingling sensation may begin in one arm and travel upward. This feeling can also occur on one side of your face, lips, or tongue.
Speech and language symptoms
Disturbances in speech and language are less common aura symptoms. Symptoms may include:
- slurred speech
- not being able to form the right words
Preheadache signs and symptoms
Pre-migraine, also called prodrome, is the earliest of four stages of a migraine attack. This stage happens before an aura and may occur several hours to several days before a migraine attack begins.
Recognizing the symptoms of pre-migraine may help individuals avoid triggers and prevent an attack. Pre-migraine symptoms may be different for individuals and may include:
- constipation or diarrhea
- light and sound sensitivity
- mood changes
- neck and shoulder stiffness
- trouble focusing
prodrome vs. aura
While an aura happens right before or during a migraine attack, the prodrome stage can start days before to indicate an attack is coming on. Prodrome symptoms might include fatigue, irritability, or neck pain.
It’s possible for an aura to occur without a migraine attack. This is called silent migraine. Although the migraine pain doesn’t occur, the aura symptoms themselves can still be disruptive to daily activities.
Ocular migraine, a type of migraine attack characterized by visual symptoms, can sometimes occur without pain. Migraine with aura and retinal migraine are sometimes considered types of ocular migraine.
It’s not well understood what exactly causes an aura. It’s believed to be caused by a wave of electrical activity that spreads across the cortex of the brain.
This wave is then followed by a prolonged suppression of nerve cell activity. This can lead to various changes, like changes in blood flow, which may lead to migraine symptoms.
It’s also possible that an aura may be triggered by the same things that can trigger migraine attacks without aura. These can include:
- stress or anxiety
- not getting enough sleep
- missing or having irregular meals
- consumption of alcohol or caffeine
- certain foods, like chocolate, aged cheeses, and cured meats
- food additives like MSG or aspartame
- hormonal changes, like during menstruation
- bright lights, strong smells, or loud noises
- vigorous exercise
- changes in the weather
- some medications
When aura symptoms begin, it can be helpful to move into a quiet, dark room and close your eyes.
Placing a cold compress on your forehead or the back of your neck may also help ease ensuing migraine pain.
Like other types of migraine, treating migraine with aura involves a combination of medications. These include medications for both prevention and relief of symptoms.
Preventive medications that may stop migraine attacks from occurring include:
- antidepressants, like amitriptyline
- blood pressure medications, like beta-blockers or calcium channel blockers
- anti-seizure drugs, like topiramate
Medications for symptom relief help decrease the severity of an oncoming migraine attack. They’re typically taken as soon as the symptoms of an aura develop.
Examples of some of these medications are:
- over-the-counter pain relievers like acetaminophen (Tylenol) or ibuprofen (Motrin, Advil)
- triptans, like rizatriptan and sumatriptan
- anti-nausea medications
- gepants like ubrogepant (brand name Ubrelvy) or rimegepant (brand name Nurtec)
- ditans, like lasmiditan (brand name Vyepti)
There are several other types of migraine that involve neurological symptoms besides pain, like:
- Migraine with brain stem aura. Also known as basilar migraine, this is a rare type of migraine where aura symptoms originate in the brain stem. Symptoms can include vertigo, ringing in the ears, and speech problems.
- Hemiplegic migraine. A migraine attack that occurs with an aura that includes one-sided weakness as well as numbness and tingling. Hemiplegic migraine can occur with or without migraine pain.
- Vestibular migraine. A condition that includes sudden onset of vertigo, disorientation, and balance issues. Many people who experience vestibular migraine have no history of headaches.
- Retinal migraine. The aura associated with retinal migraine causes you to lose vision in one eye.
You may also be diagnosed with chronic migraine if you experience migraine symptoms that occur 15 or more days in a month.
Migraine with aura is a clinical diagnosis. This means the condition is generally diagnosed by a doctor, usually a neurologist, by reviewing your medical history and a detailed list and description of your symptoms. The doctor will also perform a physical examination.
The International Classification of Headache Disorders, 3rd edition (ICHD-3), includes guidelines to help diagnose migraine with aura. Individuals must have at least two migraine attacks that include these criteria:
- Having one or more aura symptoms in these categories:
- visual or retinal – symptoms that affect sight
- sensory – symptoms that affect the senses
- brainstem – symptoms charaterized by pain accross the back of the head
- motor – symptoms that affect movement
- speech or language – symptoms that affect words and speech
- having at least three of the these six characteristics:
- one aura symptom or more that spreads gradually over more than 5 minutes
- two or more symptoms together, one after the other
- one or more unilateral aura symptoms
- one or more positive aura symptoms
- aura symptom(s) that last 5 to 60 minutes
- aura along with or followed by headache within 60 minutes
- having no other diagnosis that could cause these symptoms
Since there’s no definitive test for migraine with aura, neuroimaging tests like MRI or CT scans may not be necessary for most people. But neuroimaging may be recommended if an individual has other symptoms like:
- head pain that does not respond to treatment
- changes in number, type, or severity of headaches
- new neurologic symptoms
- sudden, severe headache
- new headaches in individuals over 50 years old or in people with HIV or cancer
- signs or symptoms of meningitis like double vision, nausea and vomiting, and dizziness
- signs of stroke, like:
- weakness in face
- one-sided weakness especially in arm or leg
- sudden onset of confusion, difficulty speaking or understanding speech
- difficulty walking
- dizziness or loss of balance
- loss of vision or difficulty seeing from one or both eye
If you’re experieincing symptoms of a stroke, call 911 immediately. Have someone stay with you until they arrive.
If you haven’t had migraine with aura before and suddenly experience tingling or numbness on one side of your body, or slurred speech or difficulty talking, it’s important to get care right away.
Although these can be symptoms of a migraine aura, they can also be signs of a stroke. You’ll want to rule out the possibility of having a much more serious condition.
Additionally, seek emergency care for any headache that:
- comes on suddenly and severely
- is accompanied by a stiff neck, fever, or rash
- occurs with symptoms like confusion, convulsions, or loss of consciousness
- happens after a head injury
It’s also a good rule of thumb to make an appointment with your doctor for headaches that:
- happen frequently and last from hours to days
- disrupt your daily activities
- occur frequently when you used to be headache-free
If you’re concerned about your migraine and don’t already have a doctor, you can view some in your area through the Healthline FindCare tool.
Migraine can be disruptive and, in some cases, take a toll on your daily life. It can help to know that you’re not alone and that many other people are dealing with the same symptoms as you.
A migraine aura is characterized by disturbances in your vision, sensation, or speech. It can occur before or during a migraine attack and typically lasts less than 60 minutes.
Some people can have an aura without a migraine attack.
Migraine with aura can be treated with a combination of medications. Preventive medications may stop migraine symptoms from occurring, while other medications can help ease acute symptoms when they happen.
The symptoms of an aura can be similar to more serious conditions, like a stroke or seizure. If you haven’t experienced migraine with aura before and have numbness on one side of your body or trouble with your speech, seek immediate medical attention.
It’s also important to get emergency care if you have a headache that’s severe, comes on suddenly, or is accompanied by a stiff neck, fever, confusion, or convulsions.