Symptoms

Migraine aura symptoms include temporary visual or sensory disturbances that typically precede the usual migraine symptoms — such as intense head pain, nausea and sensitivity to light and sound. Migraine aura usually occurs within an hour before head pain begins and generally lasts less than 60 minutes before disappearing. Sometimes, migraine aura may occur with little or no headache.

Visual signs and symptoms
The majority of people who experience migraine aura develop visual signs and symptoms. These may include:

• Blind spots (scotomas), which are sometimes outlined by simple geometric designs
• Zigzag lines that gradually float across your field of vision
• Shimmering spots or stars
• Changes in vision
• Flashes of light

These types of visual disturbances tend to start in the center of your visual field and move outward, or spread.

Other sensory disturbances
Other temporary sensations sometimes associated with aura include:

• Feelings of numbness, typically felt as tingling in one hand or on your face
• Difficulty with speech or language
• Muscle weakness

When to see a doctor
If you experience the signs and symptoms of migraine with aura, such as temporary vision loss or floating spots or zigzag lines in your field of vision, see your doctor immediately to rule out more serious conditions, such as stroke or retinal tear. Once these conditions have been ruled out, future migraines with aura don't need to be considered a potential sign of a more serious condition and won't require a visit to your doctor, unless your symptoms change.

Causes

The cause of migraine with aura isn't clearly understood. It's believed that the visual aura that may accompany migraine is like an electrical or chemical wave that moves across the part of your brain that processes visual signals (visual cortex). As the wave spreads, it may cause these visual hallucinations.

Many of the same factors that trigger migraine can also trigger migraine with aura, including stress, bright lights, fatigue and changes in sleep patterns.

Risk factors

While no specific factors appear to put you at risk for migraine aura, migraines in general seem to be more common in people with a family history of migraine. Migraines are also more common in women than men.

Complications

People who have migraine with aura are at a slightly higher risk of stroke. Women who have migraine with aura appear to have an even higher risk of stroke if they smoke or take birth control pills.

Preparing for your appointment

If you're experiencing temporary visual or sensory disturbances, a first step in having your symptoms evaluated is to see your family doctor or a general practitioner. In some cases you may be referred to a doctor who specializes in nervous system disorders (neurologist).

Here's some information to help you get ready for your appointment, and what to expect from your doctor.

What you can do

• Keep track of your symptoms. One of the most helpful things you can do is keep a symptoms journal. Each time you experience visual disturbances or unusual sensations, write down a description of them — What are they? When did they happen? How long did they last? What followed them? Did they seem to be triggered by anything? Also, include what you were eating or drinking before they started, and if you're taking any medications or dietary supplements. A symptoms journal can offer valuable clues that may help your doctor diagnose your condition.
• Write down key personal information, including any major stresses or recent life changes.
• Write down questions to ask your doctor.

For migraine with aura, some basic questions to ask your doctor include:

• What's the likely cause of the symptoms I'm experiencing?
• What kinds of tests, if any, do I need?
• Is my condition likely temporary or chronic?
• What types of treatments are available? Which do you recommend?
• What are the alternatives to the primary approach that you're suggesting?
• I have other health conditions. How can I best manage them together?
• Are there any dietary restrictions that I need to follow?
• Is there a generic alternative to the medicine you're prescribing me?
• Are there any brochures or websites you recommend?

In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask questions during your appointment.

What to expect from your doctor
Your doctor is likely to ask you a number of questions. Being ready to answer them may reserve time to go over any points you want to spend more time on. Your doctor may ask:

• When did you begin experiencing symptoms?
• What types of visual symptoms or other sensations do you have?
• How long do they last?
• Are they followed by a headache?
• If you have headaches, how often do you get them and how long do they last?
• How severe are your symptoms?
• What, if anything, seems to improve your symptoms?
• What, if anything, appears to worsen your symptoms?

Tests and diagnosis

If you experience signs and symptoms of aura that are followed by typical signs and symptoms of migraine, it's likely you have migraine with aura. Your doctor may diagnose the condition on the basis of your medical history and a physical exam.

But if your aura isn't followed by head pain, or the visual disturbances affect only one eye, your doctor may recommend certain tests to rule out more serious conditions, such as a retinal tear or a transient ischemic attack — a temporary decrease in blood supply to part of your brain — that could be causing your symptoms.

Your doctor may recommend:

• An eye examination. During this exam, your doctor will use an instrument the size of a small flashlight (ophthalmoscope) to project a beam of light into your eye to examine the back of your eyeball (fundoscopy).
• Computerized tomography (CT). This X-ray technique produces detailed images of your internal organs, including your brain.
• Magnetic resonance imaging (MRI). This diagnostic imaging procedure produces images of your internal organs, including your brain.

Your doctor may also refer you to a doctor who specializes in nervous system disorders (neurologist) to rule out brain conditions that could be causing your symptoms.

Treatment and drugs

There is no specific treatment for the signs and symptoms of aura. Treatment for migraine with aura is similar to treatment for migraine without aura.

Pain-relieving medications
Medications used to relieve migraine pain work best when taken at the first sign of an oncoming migraine; for example, as soon as you notice signs and symptoms of a migraine aura beginning.

Types of medications that can be used to treat migraine pain include:

• Over-the-counter or prescription pain relievers
• Triptans, prescription drugs used specifically for migraine
• Ergots, another family of drugs used for migraine
• Anti-nausea drugs, to help with nausea and vomiting

Preventive medications
Medications can help prevent frequent migraines, with or without aura. Your doctor may recommend preventive medications if you're having more than four headaches a month, your headaches last more than 12 hours or you feel disabled by your migraines. Preventive medication options include:

• Blood pressure-lowering medications
• Antidepressants
• Anti-seizure drugs
• Botox injections

Stress management
Cognitive behavioral therapy, a technique that teaches you more appropriate ways to deal with stressful situations, may help reduce the number of migraines you have.