Migraine With Aura: Symptoms And Safety

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Migraine with aura is a type of migraine that causes temporary changes in vision, sensation, or speech before or during an attack. Some people see flashy lights or zigzag lines, while others may experience tingling or difficulty speaking. These symptoms usually last for a short time, but it is important to recognise them and know when to seek medical care. 

What Migraine Aura Is

Migraine aura refers to temporary changes in vision, sensation, or speech that some people experience before or during a migraine attack. It may cause flashing lights, zigzag lines, blind spots, or tingling sensations in the face or hands. These symptoms usually develop gradually and last between 5 to 60 minutes. Not everyone with migraine experiences aura, and it can sometimes occur without a headache. 

First Or Changed Aura

If aura occurs for the first time or feels different from your usual migraine symptoms, seek medical care. Symptoms lasting longer than 60 minutes also need prompt evaluation. Do not wait for symptoms to pass or assume they are caused by migraine. Seek immediate help if migraine triggers bright lights, strong smells, weather changes, hormonal changes, or low blood sugar. A sudden increase in migraine with aura can increase stroke risk.

Visual Aura

Visual aura is one of the most common symptoms of migraine with aura. It causes temporary vision changes that may appear before or during a migraine attack. These changes usually develop gradually, start in the centre and then spread outwards. Common visual symptoms include:

• Flashing lights or sparkles in the field of vision
• Bright, zigzag or wavy patterns
• Scotomas or blind spots 
• Shimmering shapes in the visual field
• Vision changes 

Sensory And Speech Symptoms

Migraine with aura can affect more than just vision. Some people experience temporary changes in sensation or have difficulty speaking during an attack. These symptoms usually develop gradually and may occur before or during a headache. 

Symptoms include:

• Tingling or a needle-like feeling that starts in the fingers and spreads up to the arms or to the face.
• Numbness or temporary reduced sensation in certain body parts.
• Some people notice changes in sensations that move from one area to another.
• Difficulty finding words even when you know what you want to say.
• Having trouble speaking clearly.
• Finding it hard to communicate or express your thoughts during an attack.

Typical Timing And Duration

In migraine with aura, symptoms usually develop gradually over several minutes and may appear before or during a headache. Most aura symptoms last between 5 and 60 minutes, and then disappear. A headache may begin while the aura is still present or shortly after it ends. If symptoms last longer than an hour or feel different from usual, seek immediate medical help. Sudden weakness, difficulty speaking, or vision loss require emergency care. 

Aura With Or Without Headache

In migraine with aura, visual, sensory, or speech symptoms may occur before or during a headache. Some people notice the aura first, followed by throbbing head pain, nausea, or sensitivity to light and sound. However, not everyone develops a headache after an aura. Some people experience aura on its own, even without any head pain. This is called typical aura without headache. The symptoms usually develop gradually and last between 5 and 60 minutes, although the experience can vary from person to person. 

The absence of headache does not necessarily mean the symptoms are harmless. If you experience aura for the first time, notice a sudden change in your usual symptoms, or develop sudden weakness, vision loss, and difficulty speaking, you must consult a doctor. These symptoms can sometimes indicate a stroke or other condition that needs immediate medical help. 

How Doctors Diagnose It

Doctors usually diagnose migraine with aura by asking about the symptoms, when they begin, how long they last, and whether a headache follows. There is no single test that confirms it. Doctors may also ask about previous attacks, family history, and other health conditions. 

During the assessment, doctors may:

• Ask about flashing lights, blind spots, tingling, numbness, or difficulty speaking.
• Check whether symptoms develop gradually or last between 5 and 60 minutes. 
• Perform a physical and neurological examination to check vision, sensations, speech, and coordination. 
• Recommended tests include MRI or CT scan if symptoms are unusual or there is a concern about another condition such as stroke.

Pregnancy And Contraceptive Discussions

People with migraine with aura should discuss pregnancy and contraceptives with their doctor. Some migraine medicines should not be used during pregnancy, so treatment may need to be reviewed in advance. Oestrogen- containing contraceptives, including some combined pills, can increase the risk of stroke in people with migraine with aura. A healthcare professional can help choose a safer alternative based on individual need. Do not stop taking prescribed medicines or start any medicines by yourself without medical guidance. 

Treatment And Prevention Overview

Treatment for migraine with aura focuses on managing symptoms during an attack and reducing how often they occur. The right approach depends on the frequency of attacks, their severity, and a person’s overall health. A doctor may recommend some medicines for pain and nausea.

Treatment and prevention may include: 

• Take medicines as advised by your doctor. Some medicines are not suitable for everyone, so avoid self-medicating. 
• Try to maintain a sleep schedule.
• Eat on time because skipping meals and dehydration trigger the attack.
• Keep a diary to track possible triggers, symptoms, and attack patterns. 
• Gentle exercise, relaxation techniques, and regular breaks may help reduce the impact of stress. 
• Magnesium supplements may help during visual aura, and they may reduce pain.

Stroke-Like Warning Signs Needing Emergency Care

Migraine with aura can sometimes cause symptoms that resemble a stroke, such as visual changes, numbness, or difficulty speaking. Sometimes oestrogen-containing contraceptives may increase stroke risk. However, a stroke is a medical emergency, and these symptoms should never be assumed to be migraine.

Seek Emergency Medical Help If You Notice: 

• Sudden weakness or numbness
• Speech difficulties
• Sudden vision changes
• Sudden dizziness, problems with walking, or loss of coordination
• Sudden difficulty in understanding and responding
• Sudden or intense headache.

Do Not Self-Diagnose Weakness

Weakness during a migraine attack should never be assumed to be a normal aura symptom. Sudden weakness, especially on one side of the body, can be a warning sign of a stroke or another serious condition. Seek immediate medical help rather than trying to identify the cause by yourself. Even if the weakness improves, do not ignore it. 

Reference

Migraine With Aura - StatPearls - NCBI Bookshelf

Migraine with and without headache - PubMed

Migraine aura-like symptoms at onset of stroke and stroke-like symptoms in migraine with aura - PubMed