What is a migraine with aura?
Migraine is one of the most common neurological conditions. Around one in seven people in Austria is affected, with women considerably more often than men. In about one third of those affected, so-called migraine with aura occurs – a particular form in which temporary neurological symptoms precede or accompany the headache.
The aura is a warning signal from the brain: due to a temporary change in nerve activity in the cerebral cortex, short-lived functional disturbances arise, most frequently in the area of visual perception. These phenomena are generally harmless, but can be unsettling, especially when they occur for the first time.
Typical aura symptoms at a glance
Aura symptoms usually develop slowly over several minutes and typically last between 5 and 60 minutes. They then subside completely. The most common complaints include:
Visual disturbances in migraine
Visual disturbances are by far the most common aura symptoms. Those affected report:
- Flickering zigzag lines (so-called "fortifications")
- Flashes, bright spots or light flashes in the field of vision
- Blind spots (scotomas) that slowly enlarge
- Blurred or "flickering" vision
- Temporary partial loss of the visual field
Characteristically, these phenomena affect both eyes, even though they are often perceived on only one side.
Sensory disturbances
In some people, visual disturbances are followed by sensory symptoms:
- Tingling ("pins and needles") in the hand, arm or face
- Numbness that slowly spreads
- A furry feeling around the mouth or tongue
Speech disturbances
Less common, but possible, are word-finding difficulties, slurred speech or problems understanding what is being said (so-called aphasia).
Motor symptoms
In a very rare special form, hemiplegic migraine, there is additionally a temporary paralysis of one side of the body. This form always requires thorough neurological assessment.
Typical course of a migraine with aura
A migraine attack with aura usually proceeds in four phases:
1. Prodromal phase: Hours to days before the attack, fatigue, irritability, food cravings or difficulty concentrating may occur.
2. Aura phase: The neurological symptoms develop gradually over 5 to 20 minutes and rarely last longer than an hour.
3. Headache phase: The typical, often one-sided, pulsating headache usually begins shortly after the aura – sometimes also simultaneously or with a slight delay. It is often accompanied by nausea, vomiting and sensitivity to light and noise.
4. Postdromal phase: After the pain subsides, a feeling of exhaustion often remains; some describe it as a "hangover feeling".
Not every attack follows the same course. In some cases, an aura also occurs without a subsequent headache – the so-called "aura without headache". This form is particularly recognised in older people.
What triggers a migraine with aura?
The precise causes are not yet fully understood. A temporary wave of altered electrical activity in the cerebral cortex ("cortical spreading depression") accompanied by changes in blood flow is being discussed. Known triggers may include:
- Stress or sudden relaxation after periods of stress
- Lack of sleep or an irregular sleep rhythm
- Hormonal fluctuations, for example during the menstrual cycle
- Certain foods or alcohol (particularly red wine)
- Changes in the weather
- Flickering light or prolonged screen work
Identifying individual triggers – for example by keeping a headache diary – can help to better classify attacks.
Differentiation: migraine aura or stroke?
Because aura symptoms can resemble a stroke, differentiation is particularly important. Typical differences:
- Time course: A migraine aura develops slowly over minutes, whereas stroke symptoms usually occur suddenly.
- Type of symptoms: With aura, "positive" phenomena (flickering, flashes, tingling) often predominate. With a stroke, deficits are often in the foreground (sudden loss of vision, paralysis, drooping corner of the mouth).
- Duration: Aura symptoms usually resolve completely within one hour.
- History: Known migraine patients usually experience recurring, similar episodes.
Important: If neurological symptoms occur for the first time, particularly suddenly, after the age of 40 or in an unusual form, the emergency number 144 should be called immediately. When in doubt: better to seek clarification once too often than to overlook a stroke.
Other possible differential diagnoses
Not every aura-like phenomenon is a migraine. The following conditions can also cause similar complaints:
- Transient ischaemic attack (TIA): Short-term disturbance of blood flow to the brain
- Epileptic seizures: Focal seizures in particular can begin with sensory symptoms
- Retinal diseases: For example, retinal detachment or vitreous opacities
- Multiple sclerosis: May be associated with visual disturbances (e.g. optic neuritis)
- Low blood sugar (hypoglycaemia): May trigger concentration and visual disturbances
A careful neurological examination, supplemented where necessary by imaging procedures such as MRI, helps to distinguish these conditions.
When should you seek medical advice?
Medical assessment is particularly advisable if:
- the aura occurs for the first time
- the type, duration or intensity of the usual attacks changes significantly
- the aura lasts longer than one hour
- headaches are perceived as unusually severe or "like never before"
- accompanying symptoms such as fever, neck stiffness or disturbances of consciousness occur
A range of medicinal and non-medicinal approaches is available for treatment today. These include acute medication, preventive therapies, relaxation techniques, endurance sports and structured advice on dealing with triggers. Which measures are useful in individual cases should be discussed with a doctor on a case-by-case basis.
Conclusion
Migraine with aura is a well-researched and usually well-treatable condition. Those who know the typical aura symptoms – above all visual disturbances typical of migraine – can better understand what is happening in their own body. Careful differentiation from other, sometimes serious conditions such as stroke remains crucial. When in doubt, the rule is always: it is better to seek medical assessment once too often.
This article does not replace medical advice.