7 Key Symptoms of Migraine with Aura You Should Know

Migraine with aura is a neurological condition characterized by recurrent headaches preceded or accompanied by temporary sensory disturbances known as aura. Approximately 25-30% of people who experience migraines also experience aura symptoms. These warning signs typically occur before the headache phase begins, though they can sometimes happen during or even without a subsequent headache. Understanding the symptoms of migraine with aura is crucial for early recognition and proper management of this condition.

The aura phase usually develops gradually over 5-20 minutes and can last up to 60 minutes. While the experience varies from person to person, most individuals with migraine aura report visual disturbances as the most common symptom. However, the condition can manifest through various neurological symptoms that affect different senses and bodily functions.

1. Visual Disturbances and Zigzag Patterns

Visual aura is the most prevalent symptom, affecting approximately 90% of people who experience migraine with aura. These disturbances can manifest in several distinctive ways:

• Zigzag lines or geometric patterns: Often described as shimmering, flickering, or fortification spectra that resemble the walls of a medieval fortress
• Bright spots or flashes: Sudden appearances of light or sparkles in the visual field, similar to looking at a camera flash
• Blind spots (scotomas): Temporary areas of partial or complete vision loss that typically start small and expand
• Tunnel vision: A narrowing of the visual field where peripheral vision becomes limited

These visual symptoms typically begin in the center of the visual field and gradually expand outward. They affect both eyes simultaneously and can make it difficult to read, drive, or perform detailed tasks. The patterns often move across the field of vision and can be described as kaleidoscopic or psychedelic in nature.

2. Sensory Changes and Tingling Sensations

Sensory aura, also known as paresthesia, is the second most common type of aura symptom, occurring in about 30-40% of people with migraine aura. This symptom involves altered sensations that typically follow a specific pattern:

Characteristics of sensory aura include:

• Tingling or “pins and needles” sensation that usually begins in the fingertips of one hand
• Numbness that slowly progresses up the arm toward the shoulder
• Spread to the face, particularly affecting the lips, tongue, and cheek on the same side
• Occasionally extending to the leg on the same side of the body

The sensory symptoms develop gradually and migrate from one area to another over several minutes. Unlike stroke symptoms, which appear suddenly, aura symptoms evolve slowly and are completely reversible. The tingling sensation is often described as a “marching” feeling as it moves across different body parts.

3. Speech and Language Difficulties

Language disturbances, medically termed aphasia or dysphasia, occur in approximately 10-20% of individuals experiencing migraine aura. These communication challenges can be particularly alarming but are temporary and reversible.

Common speech-related symptoms include:

• Difficulty finding words: Struggling to recall common words or names during conversation
• Slurred speech: Speaking in a way that sounds unclear or mumbled
• Mixing up words: Substituting incorrect words or sounds when trying to speak
• Difficulty understanding language: Trouble comprehending what others are saying
• Writing difficulties: Problems forming coherent written sentences

These language symptoms can be frightening for both the person experiencing them and observers, as they may resemble stroke symptoms. However, migraine-related speech difficulties develop more gradually and resolve completely, typically within an hour.

4. Severe Throbbing Headache Pain

Following or occasionally accompanying the aura phase, a characteristic migraine headache typically develops. This headache has distinct features that differentiate it from other types of headaches:

Key characteristics of migraine headache pain:

• Location: Usually affects one side of the head (unilateral), though it can occur on both sides
• Quality: Throbbing or pulsating sensation that often synchronizes with the heartbeat
• Intensity: Moderate to severe pain that interferes with daily activities
• Duration: Typically lasts 4 to 72 hours if untreated
• Aggravation: Worsens with physical activity, movement, or routine activities like walking or climbing stairs

The pain often begins on the same side where the aura symptoms were most prominent. Some individuals experience the headache starting mild and gradually intensifying over hours, while others may have a sudden onset of severe pain.

5. Sensitivity to Light, Sound, and Smells

Heightened sensitivity to environmental stimuli is a hallmark symptom of migraine with aura, significantly impacting quality of life during an episode. These sensitivities can occur during the aura phase but are typically most pronounced during the headache phase.

Photophobia (light sensitivity):

• Bright lights, sunlight, or even normal indoor lighting can feel unbearable
• Computer screens, television, and phone displays may cause discomfort
• Flickering or fluorescent lights are particularly problematic
• Many people seek dark rooms to find relief

Phonophobia (sound sensitivity):

• Normal conversation levels may seem extremely loud
• Everyday sounds like traffic, music, or children playing become intolerable
• Quiet environments are strongly preferred during episodes

Osmophobia (smell sensitivity):

• Ordinary odors from food, perfume, or cleaning products can trigger nausea
• Previously pleasant smells may become overwhelming
• Strong scents can intensify headache pain

6. Nausea and Digestive Disturbances

Gastrointestinal symptoms are extremely common during migraine with aura, affecting approximately 80% of sufferers. These symptoms can sometimes be as debilitating as the headache itself.

Common digestive symptoms include:

• Nausea: Ranging from mild queasiness to severe waves of sickness
• Vomiting: Occurs in about 30% of migraine episodes and may provide temporary relief for some individuals
• Loss of appetite: Complete disinterest in food, even favorite meals
• Stomach discomfort: Feelings of fullness, bloating, or general abdominal unease
• Diarrhea or constipation: Changes in bowel habits before, during, or after the migraine

The nausea associated with migraines can be so severe that it prevents individuals from taking oral medications or keeping down food and fluids, potentially leading to dehydration. Some people report that vomiting marks the end of their migraine episode.

7. Confusion and Cognitive Impairment

Cognitive symptoms during migraine with aura can significantly affect mental clarity and thinking processes. These symptoms may occur during the aura phase or throughout the entire migraine episode.

Mental and cognitive changes include:

• Difficulty concentrating: Inability to focus on tasks or maintain attention
• Mental fog or confusion: Feeling disconnected or unclear in thinking
• Memory problems: Trouble recalling recent events or forming new memories during the episode
• Disorientation: Brief moments of not knowing where you are or what time it is
• Slowed thinking: Taking longer than usual to process information or respond to questions
• Difficulty with complex tasks: Problems with activities requiring planning or organization

These cognitive symptoms can persist into the postdrome phase (the recovery period after the headache subsides), sometimes lasting for 24-48 hours after the migraine has ended. During this time, many people report feeling mentally exhausted or experiencing what is commonly called “migraine hangover.”

Main Causes of Migraine with Aura

The exact cause of migraine with aura is not completely understood, but research suggests it involves a wave of electrical activity that spreads across the brain’s cortex, known as cortical spreading depression. This phenomenon affects blood flow and nerve cell activity, leading to aura symptoms.

Genetic Factors:

• Migraine with aura tends to run in families, with up to 70% of sufferers having a family history of migraines
• Specific genetic mutations have been identified in some forms of migraine with aura
• Having a parent with migraines increases your risk significantly

Common Triggers:

• Hormonal changes: Fluctuations in estrogen, particularly during menstruation, pregnancy, or menopause
• Dietary factors: Aged cheeses, processed meats, alcohol (especially red wine), artificial sweeteners, and excessive caffeine
• Environmental factors: Bright lights, strong smells, loud noises, weather changes, and high altitude
• Sleep disturbances: Too much or too little sleep, irregular sleep patterns, or jet lag
• Stress: Emotional stress, anxiety, or sudden relaxation after stressful periods
• Physical factors: Intense exercise, poor posture, neck tension, or skipping meals
• Medications: Certain medications including oral contraceptives and vasodilators

Neurological Factors:

• Abnormalities in brain chemicals, particularly serotonin levels
• Changes in the brainstem and its interactions with the trigeminal nerve
• Imbalances in neurotransmitters that regulate pain perception

Prevention Strategies

While migraine with aura cannot always be prevented entirely, several strategies can help reduce the frequency and severity of episodes. A comprehensive prevention approach typically combines lifestyle modifications with trigger avoidance.

Lifestyle Modifications:

• Maintain regular sleep schedule: Go to bed and wake up at the same time daily, aiming for 7-8 hours of quality sleep
• Eat regular meals: Never skip meals and maintain stable blood sugar levels throughout the day
• Stay hydrated: Drink adequate water throughout the day, as dehydration is a common trigger
• Exercise regularly: Engage in moderate aerobic exercise for 30 minutes most days, but avoid sudden intense workouts
• Manage stress: Practice relaxation techniques such as meditation, yoga, deep breathing, or progressive muscle relaxation

Trigger Management:

• Keep a migraine diary to identify and avoid personal triggers
• Limit exposure to bright lights and wear sunglasses outdoors
• Avoid strong perfumes, chemical smells, and other odor triggers
• Be cautious with known dietary triggers and consider an elimination diet if needed
• Limit caffeine intake and avoid sudden caffeine withdrawal

Environmental Adjustments:

• Use blue light filters on electronic devices
• Maintain comfortable room temperature and good ventilation
• Reduce noise levels in your living and working spaces
• Create a calm, dark, quiet space for rest when needed

Medical Prevention:

• Consult with a healthcare provider about preventive approaches if you experience frequent migraines
• Some individuals may benefit from preventive treatments, which should be discussed with a physician
• Regular follow-ups with your doctor to monitor the condition and adjust prevention strategies

Frequently Asked Questions

How long does a migraine aura typically last?

A typical migraine aura lasts between 5 and 60 minutes, though most commonly around 20-30 minutes. The aura symptoms usually develop gradually and resolve before or as the headache begins. In rare cases, aura symptoms can persist for up to an hour.

Can you have aura without getting a headache?

Yes, this condition is called “migraine aura without headache” or “silent migraine.” Some people experience all the aura symptoms without the subsequent headache pain, particularly as they get older. This occurs in approximately 4% of migraine sufferers.

Is migraine with aura dangerous or a sign of something serious?

While migraine with aura can be frightening and disruptive, it is generally not dangerous. However, individuals with migraine with aura have a slightly increased risk of stroke, particularly women who smoke or take estrogen-containing contraceptives. It’s important to consult a doctor if you experience new or changing symptoms.

What is the difference between migraine with aura and migraine without aura?

The main difference is the presence of temporary neurological symptoms (aura) that occur before or during the headache in migraine with aura. Migraine without aura involves the same type of headache and associated symptoms but without the preceding warning signs. Both types can cause severe throbbing pain and sensitivity to stimuli.

When should I see a doctor about migraine aura symptoms?

You should seek medical attention if you experience aura symptoms for the first time, if your symptoms last longer than an hour, if you develop new types of aura, if symptoms appear suddenly rather than gradually, or if you experience aura symptoms after age 50. Also seek immediate medical care if aura symptoms are accompanied by fever, stiff neck, confusion, seizures, double vision, or weakness lasting more than an hour.

Can migraine aura occur without any previous history of migraines?

Yes, migraine with aura can develop at any age, even in people who have never experienced migraines before. However, it most commonly begins in adolescence or early adulthood. New onset of aura symptoms, especially after age 50, should be evaluated by a healthcare provider to rule out other conditions.

Are migraine aura symptoms the same for everyone?

No, aura symptoms vary considerably between individuals and can even differ from one episode to another in the same person. While visual disturbances are most common, some people primarily experience sensory changes, speech difficulties, or a combination of symptoms. The pattern and type of aura can be unique to each individual.

Can stress or anxiety cause migraine aura?

Yes, stress and anxiety are among the most common triggers for migraine with aura. Emotional stress can trigger the neurological changes that lead to aura symptoms and subsequent headache. Interestingly, relaxation after a stressful period can also trigger migraines in some people, known as “let-down” migraines.

References:

• Mayo Clinic – Migraine with Aura
• National Institute of Neurological Disorders and Stroke – Migraine Information
• American Migraine Foundation – What is Migraine with Aura
• NHS – Migraine
• Johns Hopkins Medicine – Migraine Headaches