Understanding migraine aura

By: Ria Bhola, Headache nurse specialist

14th September 2020

Every day at The Migraine Trust we receive enquiries and requests for help and advice from people who experience a wide range of symptoms. I was struck this week by the variety of enquiries about aura symptoms. This is interesting because people experience so many different presentations of aura. Furthermore, not all migraine attacks are accompanied by aura, nor are all aura symptoms followed by pain.

I was therefore prompted to write about aura to remind us of what is typical. Migraine is disabling in so many ways but it is fascinating how the brain expresses the changes that are occurring during an attack.

What is aura?

Aura is a term used to describe a neurological symptom of migraine, most commonly visual disturbances. About a third of people affected by migraine will experience aura and even fewer will experience aura with each and every attack. Many people still believe that a migraine attack must involve an aura that is followed by one-sided throbbing and severe headache associated with nausea, vomiting, and sensitivity to light and sound.

In fact, people with migraine do at times suffer such attacks, but only a relative few have their migraine always involving a particular array of symptoms.

A migraine attack may also consist of aura only and no headache whatsoever. Some people affected by migraine report that with aging, their aura symptoms become more prominent while the headache stage of the attack lessen or disappear completely. For others, migraine may also be experienced as incapacitating head pain and hence any degree of pain on the scale between these two extremes may be experienced.

It is now understood that most, if not all headaches suffered by someone with migraine, are ‘migraines’ or ‘migrainous’ since they result from the same underlying biology.

Types of aura

The most common type of aura involves visual symptoms, but these are by no means the only type of migraine aura. Visual aura symptoms can be positive (e.g. flashing lights, geometric patterns) or negative (e.g. temporary vision loss).

People with migraine may also experience sensory aura, which can begin with numbness and tingling of the lips and tongue, on one side of the face, spreading to involve the cheek and gradually extending to involve the hand on that side of the body.

Some people also suffer motor aura symptoms which present as weakness of the arm and leg on one side of the body. This is a less common presentation. There may however be variations on this pattern but crucially, aura symptoms will typically develop gradually over 5-20 minutes and last for less than 60 minutes. Aura symptoms would also usually build in intensity before receding and resolving completely.

There are less common variants of prolonged or persistent aura and these would more often than not be diagnosed and managed by a neurologist or headache specialist. The range of treatments available at headache clinics tend also to be greater and so if the symptoms are disabling and frequent, it may become appropriate for a referral.

For the group of people who frequently experience aura prior to headache onset, this can be a useful association to prompt early acute treatment (painkillers). Early treatment of migraine (at pain onset), is critical to obtaining total relief of symptoms and reducing the chance of headache recurrence.

While it is normal for migraine symptoms to fluctuate over time, if your symptoms change dramatically, you should consider seeing your doctor for a review, in case there are other contributing factors that will require a different treatment.