Migraine aura

A migraine with aura is a type of migraine that begins with warning signs such as visual disturbances or other symptoms. Typically these warning signs are followed by a severe headache and other symptoms such as feeling or being sick.

Although the causes of migraines aren’t well understood, you may be able to reduce their frequency by learning your migraine triggers and finding ways to avoid them. You can also limit the severity of a migraine attack by taking over-the-counter painkillers when it first starts. People who get repeated severe migraines may be able to get preventative medications. Speak to your GP for help if migraines affect your quality of life.

What is a migraine aura?

Migraine with aura is a less common type of migraine than classic migraines without aura. Aura symptoms are a warning sign of a migraine attack before the start of a migraine headache.

Migraine auras can include visual symptoms such as flashing lights, blind spots (scotomas), and seeing zig-zag-like shapes. There can be other symptoms, too, including pins and needles with numbness that travels up the arm and face, and speech and concentration difficulties. Aura symptoms usually last for up to an hour before a migraine headache.

Migraine auras can affect what you see but differ from another rare type of ocular migraine called retinal migraine. Retinal migraine causes temporary partial or total vision loss in one eye, whereas migraine auras affect both eyes.

Migraine aura symptoms

Migraines often come in stages, with different symptoms as the migraine attack develops. The order in which symptoms happen is fairly typical, but people’s experiences and particular symptoms differ. The stages can go as follows:

• A pre-headache stage (called prodrome) which can affect your mood, energy, and appetite.
• Aura with visual disturbances or other sensory disturbances and symptoms that are often the warning sign of a migraine headache.
• Severe headache, a throbbing, pulsing head pain that can be accompanied by other symptoms such as nausea and sensitivity to light and sound.
• Resolution (or postdrome) is when migraine pain and other symptoms subside. This stage can last a few days, during which you may feel exhausted and need rest.

People can experience different migraine aura symptoms, which can include:

• Visual aura - you may see flashes of light, blind spots (scotomas), and zig-zag lines across your peripheral vision.
• Sensory aura - numbness and pins and needles starting in your hand and travelling up the arm to the face, lips and tongue. Speech problems and muscle weakness can also occur.

Other types of aura can include food cravings, noticing a strange smell, and other sensory disturbances.

Migraines affect people of all ages but are more common in women than men (Source: NICE). Some people have frequent, chronic migraines. Others only get migraines occasionally.

Migraines with aura are a risk factor for ischaemic stroke. However, the overall risk is still very low (Source: American Journal of Medicine). It’s a good idea to discuss this with your GP and ask how to minimise other factors which can increase the risk of stroke, such as taking the combined contraceptive pill.

What is a silent migraine?

Some people can get migraine auras without a migraine headache. This is known as silent migraine.

Migraine aura causes

The precise causes of migraines aren’t well understood by scientists, but they’re thought to be a result of changes in chemicals, nerves, and blood vessels in the brain. For example, menstrual migraine may be due to changing levels of oestrogen hormones in the body.

People with a family history of migraines are more likely to get them. Due to hormonal changes, women are also more likely to have migraines than men.

Migraines are often triggered by certain things, and keeping a migraine diary can help you discover your own migraine triggers. Note the time and symptoms of migraine attacks and what you were doing in the run-up. Different people have different migraine triggers, but common ones include:

• Emotions - being stressed, anxious, in shock or depressed can all be migraine triggers.
• Physical changes - tiredness and lack of sleep, being jet-lagged, and having low blood sugar are all physical factors that can potentially trigger migraines.
• Hormone changes - some people get migraines around the time of their period, known as menstrual migraine. Menopausal hormone changes can also trigger migraines.
• Diet - irregular meals and dehydration, specific foods and drinks can trigger migraines. Common dietary triggers include alcohol, caffeine, chocolate, citrus, and some cheeses. Foods with tyramine (cured meats, yeast extract, pickled and smoked fish) and foods containing monosodium glutamate (MSG) can also trigger migraines in some people.
• Environment - exposure to bright light, flickering screens, smoky or noisy settings, climate changes, strong smells and stuffy rooms can trigger migraines for some people.
• Medication - can trigger migraines, including sleeping tablets, contraceptive pills, and hormone replacement therapy.

Migraine aura treatment

There are different treatment options to relieve migraine pain. If over-the-counter painkillers aren’t effective, or you get more than five migraines a month, see your GP, who can explore preventative treatment options.

Most migraine treatments should be used sparingly or not at all while pregnant or breastfeeding. Ask your GP or midwife for advice, and focus on managing your migraine triggers.

How to prevent migraine aura

By keeping a diary, you might be able to identify your personal migraine triggers. If you can learn what triggers your migraines, you can start to make lifestyle changes to avoid these triggers and reduce your migraines.

Although migraine triggers vary for different people, there are some common themes that many people find helpful:

• Sticking to regular mealtimes
• Drinking plenty of water and limiting caffeine and alcohol
• Building regular exercise into your routine
• Consistently getting enough sleep

It’s not always easy with a busy life, but if you can start to spot and manage your migraine triggers, you may begin to see the impact of migraines on your life improve.

You could also discuss preventative treatments with your GP if managing your migraine triggers hasn’t been effective. Most of these medications are for use daily, instead of at the start of a migraine. These include:

• Propranolol - beta-blocker medicine typically used for high blood pressure but can also prevent migraines. Propranolol isn’t suitable if you have heart problems, COPD, or asthma. It can cause side effects such as cold hands and feet, pins and needles, and sleep problems.
• Anticonvulsant medications, including topiramate - originally an epilepsy medication, now often used to prevent migraines. This medicine is not suitable if you are pregnant and can also stop hormonal contraceptives from working effectively. Side effects can include feeling or being sick, constipation, diarrhoea, drowsiness, sleep problems and reduced appetite.
• Botulinum toxin type A (botox) - some chronic migraine sufferers may be offered botox under the care of a specialist. Botox is injected into specific muscles in the head and neck muscles. This is reserved for people who have tried other treatments which have not been effective.
• Amitriptyline - an antidepressant which is not licensed for treating migraines but which doctors may suggest in some circumstances.
• Monoclonal antibodies - are given by injection every month or few months if you have severe migraines, and at least three other preventative treatments have not worked.

Frequently asked questions