Different Types of Auras You May Experience During A Migraine

All of us have experienced headaches from time to time. Many people misunderstand a migraine as being just another type of more severe headache. However, a migraine is not just a headache but a neurological condition. One of the defining feature of migraine is having intense headaches, but there are many other symptoms that co-occur, one of them being an aura. An aura is a set of symptoms that tend to occur before or during a migraine attack. Aura can cause problems with sensation, speech, or vision and can last anywhere between 20 to 60 minutes. Here’s everything you need to know about the different types of auras you may experience during a migraine.

A migraine aura is a set of symptoms that occur before or during a migraine episode. There are different types of auras, and they can cause disruptions in your vision, speech, and sensation. According to estimates by the American Migraine Foundation, around 25 to 30 percent of people who have migraine experience aura. Because an aura can start just before a migraine attack begins, it is usually regarded as a warning sign that a migraine episode is coming. An aura usually begins around an hour before the migraine pain starts and lasts for less than 60 minutes. It is important to understand that not all migraine attacks are accompanied by an aura.^{(1, 2, 3, 4)}

When an aura occurs just before or during a migraine attack, the prodrome stage can begin some days before to indicate that an attack is coming on. Prodrome symptoms may include neck pain, irritability, or fatigue.^{(5, 6, 7)}

The more you know about the different types of migraine auras, the better you will be able to identify if an aura has set in, indicating the oncoming migraine attack. This will help you prepare for the migraine episode, and you can take any medication you are on.

Migraine auras come in six major types. These are:

• Visual disturbances
• Language difficulty
• Tactile disturbances
• Brainstem aura
• Weakness
• Retinal migraine

Some people also tend to experience multiple forms of auras at the same time, occurring back to back.

Visual aura, as the name indicates, is an aura that is accompanied by visual symptoms. This is the most common form of migraine aura, occurring in nearly 90 to 99 percent of migraine episodes.⁽⁸⁾ Apart from being the most common type, these auras are also the most varied, and there have been reports of many different and complex symptoms of visual auras.

Some of the common features of visual aura may include:^{(9, 10)}

• Foggy vision
• Flashes of bright light
• Small bright dots
• Blind spots, known as scotomas
• Zigzag lines
• A feeling like you are seeing things through water or heat waves
• Seeing stars or sparkles
• Tunnel vision

More often than not, these visual symptoms start at the center of your field of vision and then outward. Some people even experience temporary blindness when they have a migraine.

Sensory auras involve sensory disturbances. Sensory aura is present in nearly 36 percent of migraine auras.⁽⁸⁾ Sensory disturbances that occur can take place with or without a visual aura. The main symptoms of a sensory aura are as follows:⁽¹¹⁾

• Feeling a pins and needles sensation
• Feelings of tingling or numbness

The physical sensations like tingling or numbness can start in a small part of the body and then spread to other parts of the body or even the face, usually on the same side. It can even affect your lips or tongue.

A dysphasic aura involves language and speech disturbances. This is known to affect just ten percent of migraine auras.⁽⁸⁾

Symptoms of a dysphasic aura include:

• Slurred speech
• Not being able to form the right words
• Mumbling

A dysphasic aura may set in before or during a migraine, and some people find themselves having a challenging time trying to speak to and communicate with other people during this duration. They may also find it tough to find the words they need to use to make a sentence, though they are able to understand what others are saying without any issue.

There are some subtypes of migraines that are accompanied by rare types of auras. These include:

Migraine with Brainstem Aura: This was earlier called as a basilar-type migraine, and migraines with brainstem auras are one of the rarest types. Studies have shown that even less than ten percent of people experience this type of migraine aura. Symptoms of migraine with brainstem aura include double vision, vertigo, ringing in the ears, and slurred speech.^{(12, 13, 14)}

Retinal Migraine: This is another type of rare migraine with aura that only affects the vision in one eye. It usually causes the appearance of flickering lights or sometimes temporary blindness in one eye. Only about one out of 200 people who experience migraines ever experience a retinal migraine, and that too this type of migraine with aura tends to commonly affect those who are under the age of 40.^{(15, 16, 17, 18)}

Hemiplegic Migraine: This is a very rare type of migraine with aura. Hemiplegic migraines cause temporary paralysis or extreme weakness on only one side of the body. Usually, this tends to go away within 24 hours, but in some cases, it can even last for a couple of days. Even though the National Organization for Rare Diseases notes that there are no estimates to understand how prevalent this type of migraine is, other sources suggest that only 1 out of 10,000 people will ever experience this type of a migraine aura.^{(19, 20, 21, 22)}

Along with aura, there are several other symptoms that tend to accompany a migraine episode, based on the various stages of a migraine. These vary depending on the stage of the migraine and from person to person, as well as with each attack. The major stages of migraine are as follows:

The prodrome stage is also known as the premonitory phase, and it can last for a couple of hours or even some days. Many people living with migraine may experience prodrome, but not necessarily with every migraine episode. During prodrome, taking any migraine medications, avoiding the known migraine triggers, and practicing some relaxation techniques may help prevent the migraine headache from setting in.^{(23, 24, 25)} Of course, while every person is different, but some of the common prodrome symptoms may include:

• Sudden mood changes
• Food cravings
• Fatigue
• Thirst
• Irritability
• Sore neck
• Constipation
• Yawning
• Headache

The headache phase is the main stage of migraine that most people think of whenever they hear about migraine. This stage is marked by intense pain on just one or both sides of the head. This phase can last for anywhere between a couple of hours to even up to three days. Headaches vary from person to person and also for each individual attack.

Apart from the head pain, symptoms at this stage may include:

• Nausea or vomiting
• High sensitivity to sounds, slight, or smells
• Loss of appetite
• Abdominal pain
• Heartburn
• Blurred vision
• Fainting
• Lightheadedness
• Worsening pain with any movement or physical activity

This is typically the last stage of a migraine, also known as the migraine hangover. This phase comes after the headache subsides, and not everyone with migraine experiences postdrome – nearly 80 percent of people who have migraine experience postdrome.⁽²⁶⁾ It might also not occur with every migraine episode. Some of the common symptoms of postdrome include:^{(27, 28, 29)}

• Body aches
• Fatigue
• Dizziness
• Sensitivity to light
• Trouble concentrating

If you find that your headaches or migraine attacks are beginning to interfere with your day-to-day life or functioning, it is better to see a doctor and seek proper treatment. If you have migraine with aura, your doctor will suggest a treatment plan that includes a combination of acute and preventative mediation.

A doctor will do an examination and determine whether your symptoms are being caused by a migraine or some other underlying cause. An accurate diagnosis is necessary to begin the appropriate treatment. Medical attention is also necessary if your symptoms:

• Tend to last for over an hour.
• Don’t completely resolve by themselves.
• Have a sudden onset.

If you experience symptoms such as weakness on one side of the body or loss of consciousness, you should either head to the nearest emergency room or call your local medical emergency number, such as 911. Migraine with aura is known to increase the risk of stroke. Therefore it is important that you avoid certain types of medications and also treat any related symptoms.^{(30, 31)}

When the aura symptoms begin, many people find it helpful to move into a quiet and dark place and close their eyes. Putting a cold compress on the forehead or at the back of the neck can help alleviate the migraine pain.

Just like with the other types of migraine, treating a migraine with aura also involves a combination of medications, which includes medicines for both prevention as well as relief from the symptoms.

Preventive medications that may help stop migraine episodes from occurring include:

• Anti-seizure drugs like topiramate⁽³²⁾
• Blood pressure medications like calcium channel blockers or beta-blockers
• Antidepressants like amitriptyline⁽³³⁾

Medications for relief from migraine symptoms help reduce the severity of an oncoming migraine attack, and they should ideally be taken as soon as you feel the onset of the aura symptoms.

Some of these medications include:

• Triptans like sumatriptan and rizatriptan^{(34, 35)}
• Over-the-counter pain relief medications like ibuprofen (brand name: Advil, Motrin) or acetaminophen (brand name: Tylenol)
• Anti-nausea medications

Several alternative methods of treating migraine are also being explored, including acupuncture, relaxation techniques, and biofeedback.

Not everyone living with migraine experiences aura. And even those people who have migraine with aura, there is always a lot of variation, even from one migraine episode to the next. It is also possible that you may not experience an aura with every migraine attack, and the symptoms of each migraine episode can also vary. Auras can be visual, sensory, or dysphasic, with visual auras being the most common type of auras. Knowing the symptoms of each kind of migraine aura can help you describe them better to your doctor so that you can get started on the appropriate treatment.

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