Migraine with aura

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Migraines are a tricky topic, because despite affecting over 6 million people in the UK alone, we still don’t really understand them. Migraine with aura is one of the many types of migraine, and often manifests with visual ‘hallucinations’ like flashing lights, tunnel vision, or even temporary blindness, making them a very scary experience.

Migraine with aura is actually one of the most common types of migraine, but is still poorly understood. They can sometimes be mistaken for more serious conditions such as ocular migraines or even strokes, which can be frightening.

In this article, we'll shine a light on this unique type of migraine, looking at the symptoms, potential triggers, and more, to help those living with aura migraines better understand their condition and get the help they need.

Migraine with Aura

Types of migraine with aura

There are many different types of migraine, and even more subtypes within those, which is part of the reason it’s such a complex area of research.

‘Migraine with aura’ as a term actually covers three specific subtypes of aura migraine, which can present with either visual, auditory, or physical aura symptoms. These subtypes are:

Migraine with brainstem aura: sometimes called a basilar migraine, this type of migraine starts in the lower part of the brain, called the brainstem. People with this type might experience symptoms like dizziness, slurred speech, ringing in the ears, and double vision.
Hemiplegic migraine: a slightly rarer type of aura migraine, people with this type might feel like one side of their body has ‘gone weak’, similar to a limb falling asleep.
Retinal migraine: a very rare subtype of migraine, usually accompanied by short-term vision loss or blindness, specifically in one eye. This loss of vision can be scary, and might be a sign of a deeper problem, so you should speak to your doctor as soon as you can to rule it out.

What does migraine with aura look like?

An aura will generally present itself in one of seven ways: flashes of light, zig-zags, blind spots, tunnel vision, geometric shapes, shimmers, or temporary blindness. You can see some visual examples of what this might look like below.

Flashing lights

Flashes of light are very common in migraine with aura. This might be caused by the ‘jelly’ inside the eye shrinking slightly and stretching the retina, the light-sensitive layer at the back of the eye.

Although flashing lights are normal, if new or very intense flashes occur, or you’re also experiencing dark shadows in your vision, this could be a sign of retinal detachment, and you should go to A&E.

Zig-zags

“Zig-zag” lines are another very common type of visual aura, where objects in view are distorted into spiky or jagged lines.

Blind spots

Some people might experience small spots of total blindness or darkness in their vision before or during a migraine. Although this is normal, if you’re also getting bright or intense flashes, you should go to A&E to rule out retinal detachment.

Tunnel vision

In this type of aura, your peripheral vision (the edges of your eyesight) might go black, dim, or blurry. Tunnel vision can be a sign of mini-strokes, so if it comes on very suddenly, or you lose sight in one eye only, you should call 999.

Geometric shapes

Geometric shapes are another common type of aura, and usually appear in a range of different colours in regular ‘lines’ or ‘shapes’, distorting your vision. If you’ve ever used a kaleidoscope, you’ll have a good idea of what a geometric aura can look like.

Shimmers

With a shimmer aura, you might experience ‘shimmering’ or ‘flickering’ in one particular area of your vision, usually in the middle.

Temporary blindness

One of the scariest types of aura, loss of vision can leave you in complete darkness, but thankfully it usually lasts less than half an hour. However if it lasts longer than this, or if you’re experiencing it for the first time after the age of 45, you should seek medical assistance as soon as possible to rule out a stroke.

What are the causes of migraine with aura?

As mentioned above, we don’t really understand why migraines happen. It’s a popular area of research, and we’re learning more every day, but there’s still no definitive answer. However, there are some common factors which have been linked to migraines, either in studies or reported by people who experience migraines.

Some potential causes of migraines include:

Chemical changes in the brain

Just like a computer, our brain can struggle with all the tasks it has to manage, leading to glitches. When certain chemicals in the brain get out of balance, it can lead to a migraine, sometimes with aura. The actual symptoms of migraine with aura are thought to be due to very rapid expansion of the blood vessels in your brain, known as vasodilation. Find out more about the chemicals we think might cause migraines here.

Genetics

If your mum, dad, or grandparents had migraines with aura, it might be more likely that you’ll experience them too. Just like our eye or hair colour, it’s thought genes play a role in determining who gets migraines. In fact, one study found that about 40% of the differences in migraines between people can be explained by genetics.

Environmental factors

Bright lights, strong smells, or even the weather can set off a migraine with aura. We don’t know what it is exactly about these things that cause migraines or aura, but the environment is often included in anecdotal reports of migraine triggers.

Hormones

Rapid changes in hormone levels, like an increase in oestrogen for women during their period or pregnancy, could be a potential trigger for migraines and aura. This might also be why women generally get migraines more than men.

Food and drinks

Foods like dark chocolate and sharp cheese have been linked to migraines, as well as red wine, thought be down to the presence of a chemical called tyramine. The caffeine in coffee or energy drinks can also be a potential trigger. Keeping track of the things you eat or drink before a migraine starts can help you identify a pattern and avoid the things that trigger your migraines.

Sleep

Getting the right amount of sleep is very important, as too many sleepless nights - or even too much sleep - can set off a migraine in certain people.

Stress

We all know that too much stress isn't great for us, but for many people, it's a ticket straight to a migraine. Long-term stress can alter the chemicals in our brain, leading to the inflammation we think causes the symptoms of migraines.

Physical activity

Although exercise is usually a great thing, a sudden or very intense workout, especially if you're not used to it, might trigger a migraine. You should always go at a pace you’re comfortable with, and avoid over-exerting yourself if you get migraines after the gym.

Medication

Certain medications, like the birth control pill, or medications that open up (dilate) your blood vessels, can often be behind migraines. If you’ve recently started a new medication and are experiencing migraines, you should speak to your doctor, as they might be able to offer an alternative.

Symptoms of migraine with aura

As we discussed above, auras are often visual, but this isn’t always the case. As well as things like flashing lights, zig-zag patterns, blind spots, and the severe headache, migraines with aura can also appear with physical or auditory symptoms. These include:

Pins and needles: starting in one hand and travelling up your arm.
Trouble speaking (aphasia): finding it hard to get your words out or sounding confused.
Hearing noises: ringing in your ears or hearing things that aren't really there.
Changes in smell, taste, or touch: foods might taste ‘weird’ or ‘off, or there could be strange smells that others can't detect.
Dizziness or balance problems: feeling like the room is spinning or like you might fall over.
Confusion: being unsure of where you are or what you're doing, even if it's somewhere familiar.

These auras or warning signs can last for about 5 minutes to an hour, usually before the headache, and sometimes they might even occur without a headache. This is known as migraine without aura.

Important: some symptoms of migraine with aura are similar to stroke symptoms, like numbness, aphasia, smelling things that aren’t there, balance problems, and confusion. These symptoms do not always mean you’re having a stroke, but if they come on very suddenly, or happen for the first time later in life, you should call 999 immediately to rule out the possibility of a stroke.

Migraine with aura: how to get diagnosed?

If you think you're experiencing migraines with aura, your first step should be talking to your doctor. There’s no need to be worried; your doctor will talk with you about what you’re experiencing and help you identify what the problem might be.

At your appointment, your doctor will ask you about the auras or warning signs you've had, like flashing lights or zigzag patterns. They'll also ask if anyone else in your family gets migraines to see if there’s a genetic component.
Your doctor might want to give you a physical examination, checking your reflexes, balance, and senses to rule out any other causes for your symptoms.
Before giving you a diagnosis, your doctor might ask you to keep a headache diary for a couple of weeks. You might need to jot down when you get your migraines, what you were doing at the time and where, and what the warning signs were. This can help spot patterns and triggers and make it easier to give you a diagnosis.
Your doctor will then check and explain the diagnosis criteria for migraine with aura. According to NICE, the most important criteria for diagnosing migraine with aura are:
- The aura should last between 5 minutes to an hour
- The headache should start during the aura or within an hour after it
- You should have had at least two attacks with auras.

Your doctor might send you for more tests, but most of the time, they’ll be able to tell if you’re experiencing migraine with aura just by chatting with you.

When to seek medical help

Migraines with aura can be unsettling or even scary, especially if it's your first time. While some people can and do manage their migraines at home, it's important to know when to get some extra help.

Home migraine treatments

There are a few thing you can try at home to minimise how often you get migraines and how severe they are.

Rest and relax: many people find that resting and reducing sensory input from noise and light by lying down in a dark, quiet room can help reduce the severity of their migraines.
Stay hydrated: drinking plenty of water and staying hydrated might ease the pain of your migraines or stop them altogether.
Identify and avoid your triggers: if you know that certain foods, environments, or activities cause migraines, try to cut them out or limit your exposure to them. A headache diary can be useful in keeping track of when and where you get migraines.

When to definitely see a doctor

Although some migraines can be managed at home, there are certain times when it’s in your best interest to speak to a doctor to rule out more serious conditions and identify an effective, long-term treatment.

First-time aura: if you've never had an aura before and suddenly experience one, particularly if you’re older, you should speak to a doctor.
More frequent auras: you’ve experienced migraines for a while, but they suddenly start happening a lot more often.
Longer-lasting aura: if the aura lasts longer than an hour or doesn’t go away.
More severe symptoms: if your symptoms suddenly worsen, or if you develop symptoms like trouble speaking, weakness, or confusion along with your migraine.
During pregnancy: if you get a migraine with aura for the first time when you're pregnant, it's really important to see a doctor, as there could be an issue with your hormone levels or something else.

Other times to seek help for migraine with aura

Even if your symptoms haven’t worsened, there’s never a wrong time to get help with your migraines.

Whether it’s because the treatments you've tried before aren't helping anymore, your migraines are affecting your daily life, making it hard to go to work or spend time with family, or even just because something doesn’t feel right, speak to your doctor - they’re there to help.

Summary

Migraines with aura are a bit of a mystery, but we’re learning more about them every day, and new migraine treatments are regularly being approved to help make them more bearable and less scary.

Migraines don't have to spoil your life. With the right support from your doctor, you’ll be able to find an effective treatment for you, allowing you to navigate your migraines more confidently and get back on track.

References

https://www.nice.org.uk/guidance/ta260/documents/migraine-chronic-botulinum-toxin-type-a-final-scope
https://migrainetrust.org/understand-migraine/types-of-migraine/
https://thejournalofheadacheandpain.biomedcentral.com/articles/10.1186/s10194-023-01547-8
https://cks.nice.org.uk/topics/migraine/background-information/prevalence/
https://cks.nice.org.uk/topics/migraine/diagnosis/diagnosis/

Migraine with aura

Types of migraine with aura