Migraine with aura (also known as classic migraine) is a recurrent headache that occurs in conjunction with sensory disturbances called aura. You may experience changes in your vision, tingling and a tingling sensation in your hand or face.
It is usually the same treatment for migraines with aura and migraines without aura (also called common migraines). Migraines with aura can be prevented using the same medications and self-care measures you use for migraine prevention.
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Migraine with aura symptoms
The migraine aura usually causes temporary visual disturbances or other symptoms that are occurring before other migraine symptoms, such as severe headaches, nausea, and a sensitivity to light and noise.
The aura of migraine usually occurs a few hours before the headache starts and lasts about an hour. People older than 50 are more likely to experience migraine aura without headache.
Visual signs and symptoms
Migraines with aura commonly produce temporary visual symptoms, which usually begin in the center of the visual field and then spread outward. Some of these symptoms include:
- There are sometimes simple geometric patterns around blind spots (scotomas)
- You are likely to see zigzag lines moving across your field of view
- There may also be stars or sparkling spots
- Loss or change of vision
- Light flashes
Occasionally, migraine aura is accompanied by other temporary disturbances, such as:
- Numbness, sometimes referred to as a tingling sensation or numbness in a limb that drifts slowly along the limb
- Language or speech difficulties
- Muscle weakness
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Migraine with aura causes
It is believed that migraine auras are caused by electrical or chemical waves traveling across the brain. What kind of symptoms you may experience depends on what part of the brain is affected by the electrical or chemical wave.
Electrical or chemical waves can be generated in sensory centers, speech centers, or areas that control movement. An aura is usually characterized by visual symptoms, which are a result of electrical activity spreading through the visual cortex and causing these symptoms.
There is no evidence that electrical or chemical waves can lead to harm to the brain when nerves are functioning normally.
In addition to migraines, migraines with aura can be triggered by a variety of factors such as stress, bright lights, health foods and medications, sleep deprivation and menstruation.
In general, migraines with aura appear to be more common among people with migraines in their family history, even though no specific factors seem to increase the risk. Men tend to experience migraines less often than women do.
There is a slight stroke risk for people who suffer from migraines with aura.
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Diagnosis of migraine aura
If you exhibit the signs and symptoms of migraine with aura, and your medical and family history, your doctor may diagnose it as migraine with aura. The doctor might recommend certain tests about your aura if it is not accompanied by head pain, such as a transient ischemic attack (TIA).
Examples of assessments include:
- An eye examination: It is possible to rule out eye problems affecting your vision by having an eye specialist (ophthalmologist) do a thorough eye exam.
- Head computerized tomography (CT) scan: CT scans show detailed images of the brain.
- Magnetic resonance imaging (MRI): Diagnostic imaging, including imaging of the brain, is used during this procedure.
The doctor may refer you to a neuropathologist so that you can rule out conditions of the nervous system that may be causing your symptoms.
Migraine with aura treatment
Just like migraine without aura, migraine with aura is treated to alleviate pain.
Medications for relief
The best time to start taking migraine medicine is as soon as signs and symptoms of an oncoming migraine appear. Migraine pain can be treated with various types of medications depending on its severity:
The pain relievers above, including aspirin and ibuprofen (Advil, Motrin IB, etc.), are available over-the-counter or by prescription. These medications may occasionally cause migraine headaches due to medication overuse, as well as ulcers and gastrointestinal bleeding.
Migraine relief medications containing caffeine, aspirin, and acetaminophen (Excedrin Migraine) are sometimes helpful, but usually only for people with mild migraines.
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There are prescription drugs that are used to treat migraines, including sumatriptan (Imitrex), rizatriptan (Maxalt), and tosymra (Tosymra-MLT) which block pain pathways in the brain. They can relieve many of the migraine symptoms when taken as pills, shots, or nasal sprays. They may not be suitable for people with a history of strokes or heart attacks.
Dihydroergotamine (D.H.E. 45, Migranal)
This pharmaceutical is available as a nasal spray or an injection and is most effective when taken soon after the onset of migraine symptoms. It is not recommended for migraines that last more than 24 hours. Side effects include nausea and vomiting as a result of migraines.
Diahydroergotamine should be avoided by people with heart disease, high blood pressure, kidney disease, or liver disease.
It is approved for treating both migraines with and without aura with this newer type of oral tablet. It significantly reduced headache pain during drug trials. People who take Lasmiditan may feel dizzy and drowsy after taking it. They should avoid driving or operating machinery for at least eight hours after taking it.
Calcitonin gene-related peptide (CGRP) antagonists
It was recently approved that both Ubrogepant (Ubrelvy) and rimegepant (Nurtec ODT) may be used to treat acute migraines with or without aura in adults. Two hours after taking drugs from this class, the side effects such as nausea, sensitivity to light, and sound of migraine were reduced more than with a placebo.
Additional side effects may include fatigue and dry mouth. It is not recommended that Ubrogepant and Rimegepant be taken with drugs that inhibit CYP3A4.
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The use of narcotic opioid medications might be beneficial for migraine sufferers who are unable to take other migraine medications. Usually only used when no other treatment is effective, these drugs can be highly addictive.
Migraines with aura that cause nausea and vomiting can benefit from these treatments. There are several drugs that treat nausea, including chlorpromazine, metoclopramide (Reglan) and prochlorperazine (Compro). Pain medications are often taken with these.
There are some medications that should not be taken during pregnancy. Don’t take any of these medications if you’re pregnant or trying to get pregnant. Talk to your doctor first.
There are several medicines that can prevent migraine headaches, whether or not there is an aura. If you frequently have headaches, if they last for a long time, or if they are severe and don’t respond to treatment well, your doctor might recommend preventive medications.
Preventive medications reduce your migraine attack frequency, severity, and duration by reducing how frequently you get them. These medications include:
- Blood pressure-lowering medications: Several types of beta blockers are available, including propranolol (Inderal, InnoPran XL, and others) and metoprolol tartrate (Lopressor). Verapamil (Verelan) can assist in the prevention of migraines with aura when used as a calcium channel blocker.
- Antidepressants: Preventing migraines can be achieved with the use of tricyclic antidepressants (amitriptyline). Amitriptyline has side effects, such as sleepiness, which may make other antidepressants more suitable for people with depression.
- Anti-seizure drugs: You might be able to get relief from migraines if you take valproate and topiramate (Topamax, Qudexy XR, etc), but they can cause side effects such as nausea, dizziness, weight changes and others. Women who are pregnant or trying to conceive should avoid taking these medications.
- Botox injections: Approximately once every 12 weeks, some adults take onabotulinumtoxinA (Botox) to prevent migraines.
- CGRP monoclonal antibodies: These drugs are newer drugs approved by the FDA: erenumab-aooe (Aimovig), fremanezumab-vfrm (Ajovy), galcanezumab-gnlm (Emgality), and eptinezumab-jjmr (Vyepti). They’re injected monthly or quarterly. An injection site reaction is the most common side effect.
Find out if you are a candidate for these medications by speaking to your doctor. Pregnant women should not take some of these medications. Consult your doctor before using any of these medications if you’re pregnant or trying to get pregnant.
Lifestyle and stress management
If you start experiencing migraine with aura symptoms, head to a quiet, darkroom. Take a nap or rest. Wrap an ice pack or cool cloth around your forehead and place it on the area.
The following practices may soothe migraines with aura pain:
- Relaxation techniques. Stress can trigger migraines, so biofeedback and other relaxation techniques might help you deal with stressful situations.
- Set up a sleeping schedule and eat a healthy diet. Try not to oversleep or undersleep. Set yourself a sleep schedule on a daily basis and stick to it. Plan your meals so they are eaten at the same time each day.
- Stay hydrated. Drink a lot of water to stay hydrated.
A migraine aura causes problems with your vision, sensations or speech. The attacks usually last under 60 minutes, and they may occur before or during migraine attacks.
The aura can occur without causing a migraine headache in some people.
There are several medications that can be used to treat migraines with aura. Migraine prevention medications can prevent the onset of migraine symptoms while other medications can provide relief when they occur.
There is a chance that aura symptoms are similar to more serious medical conditions, such as strokes or seizures. Consult a doctor immediately if you have numbness on one side of your body or difficulty speaking after a migraine with aura.
In addition, if you have a severe headache, one that suddenly appears, or one that’s accompanied by convulsions, a stiff neck, fever, or confusion, get immediate emergency care.