Recognizing the Harbingers of Migraine: The Role of Aura in Premonitory Symptoms
An aura presents as a series of sensory disturbances that herald the onset of a migraine or accompany its progression. These disturbances can manifest as visual disruptions, tactile sensations, or speech difficulties.
According to the American Migraine Foundation, approximately 25 to 30 percent of individuals with migraines have been found to experience auras.
Given their emergence prior to the migraine’s full onset, auras serve as precursory indicators, signaling the impending arrival of a migraine episode.
Typically, an aura unfolds about an hour before the advent of migraine pain and subsides within an hour. However, it is noteworthy that not every migraine episode is prefaced by an aura.
The Multi-Faceted Nature of Migraine Aura: Identifying Symptomatic Patterns
Migraine auras are sensory disturbances that commonly precede or occur during migraines. They manifest in various ways, including visual, sensory, and speech symptoms.
Visual Symptoms
The most frequent aura involves visual disturbances. Individuals may notice:
- Flickering or shimmering lights, often described as stars or bright spots
- Zigzag or geometrical patterns obstructing their vision
- Areas of vision loss or blind spots, medically termed as scotomas
Sensory Symptoms
Auras may also trigger sensory changes, sometimes accompanying visual symptoms or occurring independently.
- A prevalent sensory symptom is a numbness or tingling, resembling a “pins and needles” feeling.
- This sensation typically starts in one arm, progressing upwards, and may affect one side of the face, lips, or tongue.
Speech and Language Symptoms
Speech and language disruptions are rarer in aura experiences. These can manifest as:
- Slurred or slow speech
- Difficulty in articulating words
- Inability to produce the correct words
Preheadache Symptoms
The prodrome phase, also known as pre-migraine, refers to the initial stage of a migraine, which could begin hours or even days before the headache itself. Early recognition of prodromal symptoms enables some individuals to sidestep triggers and mitigate an impending migraine. Prodromal symptoms vary considerably but may include:
- Gastrointestinal disturbances such as constipation or diarrhea
- Feelings of depression
- Sleep disturbances including insomnia
- Increase in irritability
- Heightened sensitivity to light and sound
- Mood fluctuations
- Nausea
- Stiffness in the neck and shoulders
- Concentration difficulties
- General fatigue
Is it possible to experience an aura without the accompanying headache?
Yes, this phenomenon is known as a silent migraine. While the painful headache typically associated with a migraine may not be present, the aura symptoms can still significantly disrupt daily life. The exact cause or trigger of a migraine aura is not entirely understood. It is believed to originate from a wave of electrical activity spreading across the brain’s cortex, followed by a period of reduced nerve cell activity. This can result in various changes, such as altered blood flow, and potentially lead to migraine symptoms.
Triggers for a migraine aura may be similar to those of a typical migraine, including stress, lack of sleep, irregular meals, alcohol or caffeine consumption, certain foods, hormonal fluctuations, sensory overstimulation, physical exertion, weather changes, and certain medications.
To manage a migraine with aura, it’s advisable to retreat to a calm, dark space and rest with your eyes closed. Applying a cold compress to the forehead or neck may also help alleviate the migraine pain that follows.
Treating migraines with aura typically involves a combination of preventive and symptomatic medications. Preventive options include antidepressants like amitriptyline, blood pressure medications such as beta-blockers or calcium channel blockers, and anti-seizure drugs like topiramate. Symptomatic medications, taken at the onset of aura symptoms, aim to reduce the severity of an impending migraine and include over-the-counter pain relievers, triptans, dihydroergotamine, anti-nausea medications, gepants, and ditans.
Emerging migraine treatments like biofeedback, acupuncture, and relaxation techniques are also being explored. Although distinct, ocular migraines, characterized by visual disturbances, also fall within the migraine spectrum and can manifest without pain, akin to migraine with aura or retinal migraine.
Migraine episodes lacking pain can sometimes be misdiagnosed as transient ischemic attacks or seizures due to overlapping symptoms.
Are various migraine attacks distinct from each other?
Indeed, numerous migraine variations exist that encompass neurological symptoms beyond pain, such as:
- Migraine with brain stem aura: This rare kind, also known as a basilar-type migraine, features aura symptoms that emanate from the brain stem, including vertigo, tinnitus, and speech impediments.
- Hemiplegic migraine: This variant is marked by aura symptoms that cause weakness, numbness, and a tingling sensation on one side of the body. It can present with or without the classic migraine pain.
- Vestibular migraine: Characterized by abrupt spells of vertigo, disorientation, and balance challenges, vestibular migraines can occur even in individuals with no history of headache.
- Retinal migraine: Unique to this type is an aura that leads to a temporary loss of vision in one eye.
Individuals experiencing migraine symptoms for 15 or more days a month may be diagnosed with chronic migraine.
How can a migraine aura be identified?
A migraine with aura is typically diagnosed clinically. A healthcare professional, often a neurologist, diagnoses it based on the patient’s medical history and a comprehensive account of their symptoms. Additionally, a physical exam is conducted.
The International Classification of Headache Disorders, 3rd edition (ICHD-3), offers diagnostic criteria for migraine with aura, which require at least two episodes meeting the following points:
- Presence of one or more aura symptoms categorized as visual, sensory, brainstem-related (including pain across the back of the head), motor, or speech/language-related.
- At least three of these six features:
- One or more aura symptoms developing gradually over 5+ minutes.
- Sequential occurrence of two or more aura symptoms.
- One or more aura symptoms being unilateral.
- One or more aura symptoms being positive in nature.
- Aura symptoms lasting between 5 to 60 minutes.
- Aura with concurrent or subsequent headache within an hour.
- No alternative diagnosis explaining the symptoms.
Typically, neuroimaging tests such as MRI or CT scans might not be required to diagnose a migraine with aura. However, they may be suggested if the individual has other concerning symptoms such as:
- Head pain unresponsive to treatment.
- A notable change in headache frequency, type, or intensity.
- Emergence of new neurological symptoms.
- Intense, sudden headaches.
- New headache patterns in individuals over 50, with HIV, or cancer.
- Symptoms indicative of meningitis like double vision, nausea and vomiting, dizziness.
- Stroke-like symptoms including numbness, one-sided weakness (particularly in an arm or leg), sudden confusion, speech or comprehension difficulties, walking challenges, dizziness, loss of balance, or vision loss in one or both eyes.
When to Seek Immediate Medical Attention for Migraine Aura
Experiencing an aura for the first time, particularly if it includes one-sided tingling or numbness, slurred speech, or difficulties in communication, warrants immediate medical evaluation. These symptoms, while associated with migraine aura, can also indicate a stroke—promptly excluding such critical conditions is crucial.
Moreover, it’s imperative to obtain emergency medical assistance for any headache that:
- Strikes abruptly and with extreme intensity
- Coincides with neck stiffness, fever, or a rash
- Presents alongside confusion, seizures, or loss of consciousness
- Follows a head injury
As a general guideline, schedule a consultation with your healthcare provider for headaches that:
- Occur frequently and persist for hours or days
- Interfere with your daily routine
- Become a recurrent issue in someone who typically does not suffer from headaches
If migraine concerns are affecting you and you’re currently without a doctor, consider using the Healthline FindCare tool to locate healthcare professionals in your vicinity.
Resources and Support for Migraine Sufferers
Living with migraine can be challenging and disruptive to your everyday life. Knowing that you’re not alone—that others face similar struggles—can offer comfort. The Migraine Healthline app, available for both iPhone and Android users, provides a supportive community and resource hub for individuals managing life with migraine.