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What a Migraine Aura Looks Like

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You might be familiar with the unsettling onset of visual changes that signal a migraine attack is on its way. These changes, known as migraine auras, are not just simple visual quirks — they are complex neurological events. Understanding what a migraine aura looks like can arm you with knowledge to prepare for an attack and seek appropriate care.

The Prevalence and Importance of Recognizing Migraine Auras

For those living with migraine, experiencing auras is not uncommon. Research shows that up to 30% of people with migraine experience auras. This makes understanding and recognizing these auras not only common but an essential aspect of managing life with migraine.

Identifying a Migraine Aura

Distinguishing a migraine aura from other health concerns is critical. While auras are typically harmless and transient, they can sometimes mimic more serious conditions like strokes or retinal detachment.

A migraine aura typically manifests as sensory disturbances that unfold over several minutes. For many, visual symptoms are the most noticeable aspect, characterized by unusual visual experiences like various shapes, bright spots, or flashes of light. Some describe these visual changes as shimmering or zig-zagging lights, often called “fortification spectra” because they resemble the battlements of a fort.

Auras aren’t just visual. They can also involve other sensory disruptions, such as tingling sensations on one side of the face or body or difficulty speaking. However, since visual auras are the most common, recognizing these signs can prompt you to take action, such as taking prescribed medication, seeking a calm environment, or notifying someone if you need assistance.

The onset of a migraine aura can also vary from person to person. Some people report a slow build-up where the visual disturbances expand and become more intense, while others may experience a sudden onset.

Characteristics of Migraine Auras

Visual symptoms are at the heart of most migraine auras, presenting in various forms:

  • Flashes of light: You might see flickering or shimmering lights, often described as stars or zig-zags, that move across your field of vision.
  • Blind spots: Areas of vision loss or scotomas can occur where parts of your vision are obscured, which may grow or move across your visual field.
  • Geometric patterns: Some experience patterns, often with a jagged edge, that can be colorful or black and white.
  • Alterations in size or shape: Also known as metamorphopsia, objects may appear larger, smaller, closer, or farther away than they are.
  • Visual hallucinations: In rare cases, you may see things that aren’t there, which can be complex images like scenes, objects, or people.

Apart from visual disturbances, auras may also affect other senses and functions:

  • Sensory symptoms: This can include numbness or tingling, often starting in the hand and moving up the arm to involve the face, lips, and tongue.
  • Speech or language problems: You may have difficulty articulating or understanding spoken language, even though you know what you want to say.

These aura symptoms typically develop gradually over several minutes and can last from five to 60 minutes, often serving as a warning that a migraine attack is about to begin. Not everyone with migraine will experience an aura, and for those who do, not every migraine attack will be preceded by an aura.

The Spectrum of Visual Disturbances

When you experience a migraine aura, the range of visual disturbances can vary widely, not just from person to person but even from one episode to another. Understanding that there is a broad spectrum of how these disturbances manifest can help you better anticipate and manage your migraine episodes.

The spectrum of visual disturbances includes:

  • Subtle changes: You might notice only slight changes in your vision, such as a mild blurring or sensitivity to light. These can be easy to miss but can signal the onset of a migraine episode.
  • Fortification spectra: Named for their resemblance to the fortified walls of a castle, these are visual phenomena where zig-zag lines form a curve in the visual field, often with a scintillating or flickering border.
  • Phosphenes: These are the sparks or flashes of light that can occur even when the eyes are closed.
  • Negative scotomas: These appear as dark or “missing” areas in the vision where nothing can be seen.
  • Positive visual phenomena: This refers to seeing patterns, spots, or shapes not present in the environment.
  • Temporary blindness: Rarely, some people experience complete but temporary vision loss in one or both eyes.

These disturbances typically originate in the central visual field and can spread outward, sometimes leaving a scotoma in their wake. It’s also not uncommon for the visual phenomena to occur in both eyes, even if it seems to affect one side more than the other.

Timeline of a Migraine Aura

A migraine aura typically unfolds over five to 60 minutes and might present in stages or suddenly. You might experience a crescendo of visual symptoms that recede as the headache begins.

Triggers and Management of Migraine Auras

Migraine auras can be precipitated by an array of triggers, which can be as individual as the people experiencing them. Common triggers include stress, hormonal changes, bright lights, sleep disturbances, and certain foods or additives.

For managing these auras, it’s helpful to:

  • Identify triggers: Keep a diary to track the circumstances surrounding your migraine auras to identify potential triggers.
  • Manage stress: Stress-relief techniques such as meditation, deep-breathing exercises, or gentle yoga can be effective.
  • Monitor diet: Pay attention to your diet. Some people find relief by avoiding foods high in tyramine, MSG, or artificial sweeteners.
  • Regular sleep: Establish a consistent sleep schedule to prevent auras triggered by fatigue or sleep disturbances.
  • Limit screen time: Reduce the time spent in front of screens, and consider using anti-glare screens or glasses that filter blue light.

Lifestyle Adjustments to Mitigate Auras

To potentially reduce the occurrence of migraine auras:

  • Stay hydrated: Ensure adequate water intake daily.
  • Regular exercise: Engage in routine, moderate activity.
  • Balanced diet: Eat a well-rounded diet and consider identifying and avoiding any food triggers.
  • Sleep hygiene: Follow a consistent sleep schedule and a sleep-friendly environment.
  • Mindfulness practices: Incorporate stress-reducing activities like meditation or deep breathing into your daily routine.

These lifestyle adjustments create a stable environment for your body, possibly reducing the frequency of migraine auras.

Diagnosis and Treatment Options

If you suspect you’re experiencing migraine auras, it’s essential to consult a health care provider. They will likely ask about your symptoms, frequency of episodes, and any associated triggers or relief methods you’ve identified. A neurological examination may also be part of the evaluation.

In terms of treatment:

  • Preventive Medications: Beta-blockers, antiepileptic drugs, or CGRP (calcitonin gene-related peptide) inhibitors specifically target migraine pathways.
  • Acute Treatments: NSAIDs or triptans are common for immediate relief, and in some cases, CGRP inhibitors can also be used acutely.
  • Lifestyle Interventions: Incorporating certain lifestyle modifications could reduce the frequency and severity of migraine attacks with aura.

An individualized treatment plan, potentially including CGRP inhibitors, can be a game-changer in managing your condition.

When to Seek Medical Advice

Prompt medical advice can lead to effective management strategies and rule out other possible conditions. You may need to see a doctor if:

  • You experience a migraine aura for the first time.
  • The pattern of your migraine auras changes.
  • New or more severe symptoms accompany your auras.
  • The aura occurs without a subsequent headache or is followed by an unusually severe headache.
  • Auras last longer than an hour.
  • Your ability to function in daily activities is affected.

The Scientific Understanding of Migraine Auras

Current research suggests that migraine auras result from a wave of electrical activity that spreads across the brain, known as cortical spreading depression. Here’s how it works:

  • Cortical spreading depression: This phenomenon refers to a wave of electrochemical activity that moves across the brain’s cortex. It’s believed that this wave leads to the various aura symptoms you experience.
  • Neuronal activation: CSD activates neurons and then causes them to suppress their activity. This leads to visual disturbances, like zigzag lines, dots, or flashes of light, and other sensory, motor, or verbal disruptions.
  • Chemical changes: The brain’s chemistry changes during CSD, affecting neurotransmitters — the chemicals brain cells use to communicate. These changes can prompt or exacerbate a migraine aura.
  • Blood flow alteration: Research has shown that blood flow to the brain changes during a migraine aura, though these changes aren’t considered the primary cause of the symptoms.
  • Genetic factors: There is also evidence suggesting that genetics may play a role in your susceptibility to migraine with aura. Specific gene mutations are also linked to a higher risk of experiencing these episodes.

Scientists are investigating the exact triggers and mechanisms behind this wave to improve treatments and preventative strategies for those experiencing migraine auras. Each person living with migraine may have a different threshold for these neurological events, influenced by various factors, including stress, sleep, and hormonal changes.

Understanding what a migraine aura looks like and how it may affect you can equip you to handle this migraine phenomenon.

Getty image by Ivan Jekic

Originally published: November 8, 2023
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