Migraine with Aura – Diagnosis and Treatment
Migraine with aura is a type of migraine that includes temporary sensory changes before or during the headache phase.
These changes—known as auras—can affect vision, touch, or hearing, and typically last less than an hour. Not everyone with migraine experiences aura, but it is a recognized pattern in certain cases.
The table below outlines key terms often used to describe features of migraine with aura:
| Key Terms | Description |
|---|---|
| Aura | Temporary sensory changes before/during migraine. |
| Visual disturbances | Includes flashing lights, blurred vision, or spots. |
| Sensory disturbances | May involve tingling, numbness, or sound issues. |
| Migraine attack | Period of headache and associated symptoms. |
Diagnosis
Doctors use a combination of the patient’s medical history, family background, and symptom details to identify migraines with aura. Key factors include looking for sensory changes like visual disturbances or tingling.
They also ask about possible migraine triggers, such as stress, hormonal changes, caffeine, weather shifts, alcohol use, and anxiety. Family history and genetics are important risk factors for this headache disorder.
Doctors usually perform a physical exam. If symptoms are unusually severe or if aura occurs without a headache, doctors may order further tests. These may include:
| Test | Purpose |
|---|---|
| Eye Examination | Checks for eye issues causing visual symptoms. |
| CT Scan | Produces brain images to spot other problems. |
| MRI | Gives detailed pictures of the brain and organs. |
Additional Details
Doctors may send patients to a neurologist if they suspect another brain issue. Keeping a record of triggers and symptoms can also help with diagnosis and ongoing care.
Treatment
Medicines for Fast Relief
Medicines for migraine relief work best if taken as soon as the aura or headache begins. Both over-the-counter and prescription options exist.
Some people may need a combination of different treatments, depending on how strong their symptoms are.
Common medicines for fast relief include:
| Drug Type | Special Notes |
|---|---|
| Pain relievers | Overuse can cause more headaches and stomach problems. |
| Serotonin receptor agonists | Blocks pain signals in the brain; not for people with heart or stroke risks. |
| Ergot derivatives | Use soon after symptoms start; avoid in heart, liver, or kidney disease. |
| Serotonin receptor agonist (Selective) | Can cause drowsiness; avoid driving. |
| Calcitonin gene-related peptide (CGRP) antagonists | Helps with pain and other migraine symptoms. Can cause sleepiness or dry mouth. |
| Opioids | Used rarely due to addiction risk. |
| Anti-nausea medications | Helps with nausea and vomiting, often used with pain relievers. |
For migraines with moderate pain, medicines that combine caffeine, acetaminophen, and aspirin can sometimes help.
Doctors may prescribe stronger treatments like serotonin receptor agonists, which target pain pathways and come as pills, nasal sprays, or injections. These may not be safe for everyone, especially people with heart or blood vessel problems.
Doctors recommend ergot drugs such as dihydroergotamine soon after symptoms start, especially for migraines that last more than a day. Some people experience more nausea with these, and those with certain health issues should not use them.
Doctors may use newer treatments like lasmiditan and CGRP blockers (ubrogepant, rimegepant) for migraine pain and related symptoms.
People who take lasmiditan should avoid driving for several hours due to possible drowsiness. CGRP blockers can cause side effects like dry mouth or sleepiness and should not be mixed with some other drugs.
If a person cannot take standard medications, doctors may prescribe opioids, but only as a last resort due to addiction risk.
If nausea is part of the migraine, certain drugs can ease this along with the pain. Pregnant women or those trying to become pregnant must check with their doctor before using any of these treatments.
Medicines to Help Prevent Attacks
People who get migraines often or have severe headaches might need medicine to reduce how often migraines happen and make them less severe. These drugs are usually taken every day, not just during symptoms.
Main options for ongoing prevention:
- Blood Pressure Medications: Drugs that lower blood pressure—such as beta-blockers and calcium channel blockers—may help reduce how often migraines occur.
- Antidepressants: Some tricyclic antidepressants can help prevent migraines. These may cause sleepiness or other side effects, so dosing and selection vary by patient need.
- Anti-Seizure Medications: Certain anticonvulsants can reduce migraine frequency in some people. However, they may cause side effects like weight changes, dizziness, or nausea and are not recommended during pregnancy.
- Neurotoxin Injections: Injecting a botulinum neurotoxin at regular intervals can help prevent migraines in some adults. This approach is generally used in people with frequent or chronic migraine.
- CGRP Monoclonal Antibody Treatments: These calcitonin gene-related peptide (CGRP) inhibitors are given as injections and may lower the number of migraine days per month. Side effects are typically mild and may include irritation at the injection site.
Doctors recommend preventive drugs for people with chronic migraines—defined as migraine attacks on 15 or more days each month or if headaches do not respond to other treatments.
Some of these drugs are not safe for use during pregnancy. People should talk to a healthcare provider about risks and benefits before starting these treatments.
Practical Habits and Ways to Manage Stress
Besides medications, lifestyle steps make a big difference for people living with migraine with aura. Knowing and avoiding personal triggers—like certain foods, skipping meals, or dehydration—can help.
Tips for managing migraines through daily habits:
- Stay away from loud noises and bright lights. When migraine signs start, resting in a dark and quiet place may help lower symptoms.
- Use cold packs. Applying a cool washcloth or ice pack to the forehead can ease the pain.
- Sleep and eat on a schedule. Getting up and going to bed at the same time every day, and keeping regular meal times, can reduce the chance of migraines.
- Drink enough water. Staying hydrated by drinking water throughout the day can help prevent headaches.
- Try relaxation techniques. Biofeedback, deep breathing, meditation, or gentle exercise like yoga may reduce both stress and migraine frequency.
- Write down your symptoms. Keeping a migraine diary lets people track their headaches and find possible triggers.
- Limit caffeine and alcohol. Too much caffeine or alcohol can lead to more headaches.
| Healthy Habit | What to Do | How It Helps |
|---|---|---|
| Rest in a dark and quiet place. | Go to a calm room at the first sign of a migraine. | Reduces pain and sensitivity. |
| Use cold packs or cloths. | Place a cool pack on your forehead. | Eases pain. |
| Set sleep/eating routines. | Stick to a regular sleeping and eating schedule. | Prevents attacks. |
| Stay hydrated. | Drink water all day to avoid dehydration. | Fewer headaches. |
| Try relaxation methods. | Practice deep breathing, biofeedback, and yoga. | Lowers stress frequency. |
Learning how to handle stress is vital for people with chronic migraines. Sometimes, seeing a counselor to learn coping skills can be useful as well.
Additional Resources and Where to Learn More
People seeking advice or support for migraine with aura may want more information beyond what is shared here. Talking to a healthcare provider is important for anyone seeking new treatments or not finding relief.
Support groups and organizations can offer helpful stories and tips from others dealing with migraine. There are apps and online diaries to help track symptoms and spot triggers.
People who notice new, stronger, or more frequent headaches should check with a doctor promptly.
Some migraine-like symptoms may be signs of other health problems. Personalized treatment plans from a health professional are the best way to manage chronic migraines safely and effectively.
Getting Ready for Your Visit
Steps You Can Take
Before seeing a doctor or a headache specialist, taking a few steps at home can make your appointment go smoother. Keeping a headache diary is very helpful.
Write down each time you have a headache or unusual vision changes, when it started, how long it lasted, and anything that might have triggered it. Note if you also had nausea, light sensitivity, or other symptoms.
List out any major stressors or big life changes that have happened recently. Bring information about other health conditions or medications with you.
Prepare a list of questions you want to ask, such as:
- What is most likely causing these symptoms?
- Are there any tests that will help?
- Are these symptoms likely to keep happening?
- What treatments might work best?
- Can I still treat my other health problems?
- Are there any foods or drinks I need to avoid?
- Are there resources like websites or pamphlets for more information?
Tip: If you have sudden, severe headaches, weakness on one side, trouble speaking, or vision loss, get medical attention fast. These could be stroke symptoms. In that case, go to an emergency room without waiting for an appointment.
Below is a simple table to keep track of your symptoms:
| Date | Symptom | Duration | Trigger | Severity (0-10) | Other Notes |
|---|---|---|---|---|---|
| 2025-05-12 | Vision spots | 20 min | Skipped lunch. | 7 | Felt dizzy after symptom. |
| 2025-05-14 | Headache | 2 hours | Strong perfume. | 5 | Used cold pack, got better. |
What Your Doctor Will Do
At your visit, the doctor or specialist will ask questions about your symptoms and medical background. They may ask:
- When did your headaches or visual changes begin?
- What do the vision changes or other sensations feel like?
- How long does each episode last?
- Do you always get a headache after these symptoms?
- How often do you get these symptoms?
- How intense is the pain or discomfort, using a 0-10 scale?
- What makes your symptoms better or worse?
Your doctor may also go over your headache diary and discuss possible triggers, like diet, stress, or sleep patterns. They may do some basic tests to check your nervous system and rule out other causes.
Sometimes, if your doctor thinks it is needed, you may get referred to a headache specialist or neurologist for more detailed testing or treatment options.
Bringing a full list of your symptoms, questions, and history helps your doctor find out what is going on and give you the best care.
If the doctor suspects something more serious or sees warning signs of a stroke or other emergency, they will arrange urgent medical care right away. Always let your doctor know if your symptoms change or get worse between visits.
Remember, keeping a good record and sharing details with your doctor helps you get more out of each appointment.
Further Details
People with migraines and aura often experience changes in brain activity. This involves hyperexcitability in certain nerve cells.
Researchers believe that the trigeminal nerve, which is important for facial sensation, plays a key role. Issues with brainstem function might also trigger these headaches.
Chemical Messengers Involved:
- Serotonin: This chemical helps control pain and blood flow in the brain.
- Calcitonin Gene-Related Peptide (CGRP): Levels of this peptide can rise during a migraine, which can increase pain.
The International Headache Society has set guidelines for diagnosing and studying migraines with aura. These guidelines help doctors identify symptoms and manage treatment.
Common symptoms linked to aura include:
- Visual changes such as flashing lights or zigzag lines
- Temporary trouble speaking
- Numbness or tingling
Different people can have different symptoms and triggers, so finding the best way to manage migraines may take time.
