Demystifying Migraine with Aura

Find out what aura is and how to differentiate it from other migraine symptoms or neurological conditions.

Not everyone experiences migraine aura. But for those who do, aura usually acts as a warning sign for the headache pain phase of a migraine attack. While it is a distinct phenomenon, aura can be difficult to distinguish from other conditions.

To learn more about migraine with aura, we spoke to Dr. Robblee, a neurologist and headache specialist at St. Joseph’s Hospital and Medical Center in Phoenix, AZ. She clarified some of the confusion surrounding aura and shared some pointers about how to recognize it accurately.

Symptoms of Aura

“A migraine attack really stretches beyond just that headache phase,” says Dr. Robblee. There are four phases of a migraine attack: It starts with a prodrome, also called the premonitory phase. Next is the aura phase, which only about a third of people with migraine experience. That’s followed by the headache phase and then postdrome, or the residual symptoms.

Aura is a distinct set of neurological symptoms that can vary depending on the type of aura. Aura is often visual, appearing as spots, flashes, zig-zags or other disturbances in both eyes. It can also involve physical sensations like numbness and tingling, and it can affect speech or language.

It is possible to experience migraine aura without headache. In this case, a person has a migraine aura that isn’t followed by the typical headache pain.

Aura can be tricky to diagnose because there are various symptoms that are sometimes vague or difficult to describe. But Dr. Robblee cautions against labeling more general symptoms as aura. “A migraine aura has very distinct types of symptoms,” she says. But while symptoms like dizziness can be aura, they do not constitute aura itself. The symptoms must also meet well-defined criteria regarding onset and duration to be aura.

A migraine aura typically lasts for 5 to 60 minutes. It may correspond with other migraine symptoms, but aura is distinct and has a specific timeline. “You should be able to have a really clear start and finish to the attack. If you’re not able to identify a really clear start and finish to your attack, then it’s less likely an aura,” Dr. Robblee says.

Other Types of Migraine with Aura

Understanding the different types of aura is important, especially because some aura are more complex. For instance, retinal migraine is similar to a visual aura but only affects one eye. Some people have brainstem aura, which originates in the lower part of the brain and may cause incoordination of movement, dizziness and double vision. Hemiplegic migraine can cause a person to experience weakness or numbness on one side of the body.

With these overlapping symptoms, it can be difficult to distinguish between different types of migraine with aura. Dr. Robblee shared the example of hemiplegic migraine. This type of migraine has weakness as a symptom. However, some people experience weakness with other types of aura or other conditions.

“A hemiplegic migraine, again, is a very distinct episode,” says Dr. Robblee. “It may come with numbness and tingling. It may actually come with some of the speech loss. Some of the vision changes can actually have brainstem aura features, as well. But [with hemiplegic migraine], you have a full-on weakness… neurologic abnormal weakness. We’d actually see a difference in how your facial muscles activate.” Because it can be hard to pinpoint what’s causing which symptoms, it’s crucial to dig into your specific migraine history with your doctor.

How do we differentiate between aura and other neurological conditions?

For some people, aura symptoms can be hard to distinguish from other neurological conditions, such as a stroke or a transient ischemic attack (TIA, which is a brief period where blood flow to the brain is blocked.) We recommend discussing migraine with aura with your healthcare provider to find the right treatment and rule out serious conditions like stroke and TIA. It’s important to note that people with migraine with aura, especially women, can be at a higher risk for stroke.

Sudden onset, short-lasting symptoms (less than five minutes) or symptoms lasting longer than an hour may be clues that you’re experiencing something different than migraine with aura. “If you’re presenting purely with new speech loss—like you’re not able to talk, even if you have a headache and some light sensitivity or some nausea—if that’s never happened to you before, you should seek emergency help because that could actually be a new stroke,” says Dr. Robblee.

She adds that it’s vital to talk to your doctor about your symptoms to ensure that your diagnosis is accurate, as it can affect your treatment. The details of your situation and your personal medical history can clarify what’s happening. “If you have migraine and you have aura, and you’ve been told you have a TIA, that’s a time when you may want to ask, ‘Can we reassess and look into that? Do you really think I’ve had a TIA?’” says Dr. Robblee.

How to Talk to Your Provider About Aura

Start with the right doctor. “Find a provider where you don’t feel like you have to prove yourself. When you’re with the right healthcare professional, they believe you. They know you’re really affected by this,” says Dr. Robblee. She emphasizes the importance of good communication. When you and your doctor communicate well, they will ask the right questions to fully understand your symptoms, provide an accurate diagnosis and offer clear explanations.

As with any type of migraine symptoms, keep a headache diary to share with your doctor. Include descriptions that explain exactly what your symptoms are, perhaps even writing them down as they’re happening, and be careful not to jump to a name or diagnosis.

“You’re going to get more accurate diagnoses and a better conversation with your healthcare professional if you’re able to give those details and not jump to labeling your symptoms,” says Dr. Robblee. “I often tell people, ‘Forget what you’ve been told. I want you to just describe for me what it actually feels like. Videotape it for me. Take pictures of it so I can see what it looks like during that time.’”

It’s also helpful to provide a summary of treatments you’ve tried, medications, doctors you’ve seen and other medical conditions you have. “I don’t want you to feel like it’s a burden,” says Dr. Robblee. “But do try to keep track of things so I know what you’ve done.” Details like how long you tried a medication, what dosage you took and why it didn’t work for you can give your doctor insight into whether a different dose or a longer trial could help.

Can lifestyle changes help?

Because migraine with aura overlaps other health conditions, it’s sometimes hard to know if, or how, lifestyle changes affect symptoms. For example, sleep and migraine can influence each other. Also, people with migraine may have sleep apnea, trouble sleeping, restless leg syndrome and other sleep problems.

While there isn’t much research specific to preventing or treating aura, maintaining consistency in your daily routine can help head off migraine symptoms in general. “I like to say the migraine brain likes routine,” says Dr. Robblee. “Your brain doesn’t want to have sudden changes.” The same amount of sleep each night, regular meals, adequate hydration and consistent caffeine intake could help you manage your migraine with aura. It may take some time, but in partnership with your doctor, it’s possible to find a plan for migraine with aura that prevents or relieves your symptoms.

The American Migraine Foundation is committed to improving the lives of those living with this debilitating disease. For more of the latest news and information on migraine, visit the AMF Resource Library. For help finding a healthcare provider, check out our Find a Doctor tool. Together, we are as relentless as migraine.