Everything you need to know about aura

When describing a typical migraine headache, most experts will mention the “aura” that often precedes the headache. In fact, this is so common that experts consider migraine with aura as a “classic” example of this type of headache.

What is migraine aura?

About fifteen or twenty minutes before a migraine headache begins, you might begin to experience disturbances in your vision, including shimmering spots or stars, twinkling lights, zigzagging lines, blurred vision and even partial blind spots. These might be severe enough to interfere with reading or your ability to drive safely. There may also be other sensations in your body, including feelings of numbness, tingling, dizziness or trouble with speaking. Some people may notice a characteristic odor. If you do get the aura, it is likely that you will have the same collection of symptoms each time.

Women are more at risk for migraine with aura than men, which leads some to speculate that the phenomenon is associated with monthly hormonal changes, including menstruation, pregnancy and menopause.

A typical aura will begin with barely noticeable symptoms, grow in intensity and subside in about twenty minutes. The headache may begin after the aura stops or may overlap with it. Some people may have the aura without ever getting the headache; for these people the aura is usually more of a nuisance than anything else. They may need to take a break from the computer or reading, or may have to pull over to the side of the road if they are driving.

It is thought that author Lewis Carroll, who wrote Alice in Wonderland, suffered from migraine with aura, and that some of his writing may have described his own visual disturbances during these times. So if you have this classic form of migraine, you are in good company!

Causes of migraine aura

Whatever triggers your migraine (such as foods, fatigue, stress, or hormones) will also trigger a migraine aura. According to the National Headache Foundation, “migraine aura is not due to lack of blood flow (ischemia) or constriction of the brain’s blood vessels. Instead, aura is produced by hyper-excited nerves in the brain that are activated prior to migraine pain. When the excited nerves are activated in the visual processing areas of the brain, the patient experiences visual symptoms.”

We know that aura originates in the brain, rather than in the eye, because it occurs in both eyes. If you shut either eye, you still have the visual disturbance. (Another type of migraine, called “ocular migraine,” occurs only in one eye and the part of the head behind that eye.)

Treatment recommendations

Don’t ignore the aura. Take it as a warning sign that a migraine is coming and take action to ward off or diminish the headache pain. The further along the headache progresses, the harder it is to stop.

When treating migraine with or without aura, always consult with your health care provider. There are effective treatments that can be used at the onset of an aura to ward off or reduce the pain of the headache, but if you don’t consult with an expert, you won’t know about them. Another reason for seeking medical advice is that the symptoms of aura, if they are not related to migraine, may signal a more serious problem that requires immediate treatment.

If your symptoms are those of a migraine aura, however, there are several treatment options to explore with your provider that may prevent or diminish the headache if you use them as soon as the aura begins. These include medications, herbal products, acupuncture and acupressure. Lying down and resting in a darkened room, as well as taking medications specifically formulated to prevent the headache from maturing into that ‘mushroom cloud’ of pain, can be effective.

Migraine aura can be frightening when you first experience it, but it is actually a useful tool. Not only does the aura warn you of an impending headache in time to take some preventive action, it may also be the only reason that people seek medical attention for their migraines. We know that half of people with migraines try — usually unsuccessfully — to treat their headaches on their own. So if a scary visual symptom is the only thing that gets you to seek medical help, at least it gets you in the door of someone who can help treat your migraine headaches.

Best, of course, is to avoid both migraine and aura completely by avoiding your personal migraine triggers. There are also a number of medications that help to prevent both migraine and aura, including blood pressure medicines, beta-blockers and some antidepressants. Your health care provider can help you determine the medication that is best for you.

References

Podoll, K. & Robinson, D. (1999). Lewis Carroll’s migraine experiences. Lancet, 353(9161), 1366.