Migraine headaches can be painful and debilitating. If you experience migraine attacks, you may also experience auras, which can occur before a migraine attack. Auras can involve sensory changes that include seeing sparks, zigzags, or bright dots, or experiencing numbness or tingling sensations in the body.

In this article, we’ll explore the different types of migraine with aura, their symptoms, and ways to prevent and treat them.

Types of Migraine With Aura

There are several types of migraine with aura. Three major kinds include migraine with brainstem aura, hemiplegic migraine, and retinal migraine.

1. Migraine With Brainstem Aura

Migraine with brainstem aura (MBA) is a migraine headache that causes head pain in the back and on both sides. Warning signs that you have an MBA can include slurred speech, dizziness, and loss of balance. According to the American Migraine Foundation, MBAs can happen at any age, but they are more common in women than in men. For every man who gets an MBA, about 1 to 4 women may be affected. Most people first develop an MBA between the ages of 7 and 20. Previously, MBA was called basilar artery migraine, basilar migraine, and basilar-type migraine.

Migraine with aura is less common than migraine without aura. Around 25 percent to 30 percent of people with migraine get them with auras.

2. Hemiplegic Migraine

With a hemiplegic migraine, people may feel temporary weakness on one side of their body, along with auras with changes in vision or speech. Head pain might start at the same time as body weakness or develop after the weakness begins.

Hemiplegic migraine is an extremely rare type of migraine, often seen running in families. If you experience weakness on one side of your body, go to an emergency department. A stroke can present similarly to hemiplegic migraine and is more common and serious.

3. Retinal Migraine

Retinal migraine is a type of migraine that affects one eye. It can cause alarming visual symptoms including vision loss, blind spots or blurred vision, and seeing twinkling lights, which can last between five minutes to one hour. Headache symptoms may occur at the same time as the visual symptoms, or slightly afterwards.

Migraine Without Aura

Some people experience migraine without aura. With this type of migraine attack, there are no sensory disturbances before the headache. It happens in three stages: premonitory, headache, and postdrome.

• Premonitory phase — This occurs before the migraine attack and includes food cravings, constipation, fatigue, and sensitivity to light or sound.
• Headache phase — This is when the migraine headache begins. It can be moderate to severe and usually comes with pain on one side of the head or throbbing pain.
• Postdrome phase — Sometimes called a migraine hangover, this phase may include feelings of depression, fatigue, and difficulty concentrating.

A migraine without aura is much more common than a migraine with aura. In fact, approximately 70 percent to 75 percent of people have migraine without aura, according to the American Migraine Foundation.

Migraine Aura Symptoms

During a migraine with aura, you might experience symptoms in the center of your field of vision that can spread to the sides. These symptoms can include zigzag lines, bright spots, or flashing lights. You may also lose part of your vision or experience a blind spot, a condition called scotoma. These blind spots might appear as simple geometric shapes. Some visual auras resemble a shimmering spot or star.

Other symptoms include muscle weakness, trouble speaking, and tingling in one hand or on one side of the face.

Some of the symptoms of a migraine with aura are similar to those seen in other conditions like transient ischemic attacks or epilepsy, a condition that causes neurological symptoms like unpredictable seizures. That’s why if you have new signs or symptoms of vision loss, muscle weakness, or trouble speaking, you should see a doctor right away to rule out more serious conditions.

How MyMigraineTeam Members Experience Migraine Auras

Members of MyMigraineTeam have shared their experiences with migraine auras. One member described going through multiple phases of auras, each with different sensory changes. “Apparently I am in a new mode, which is giving me new visual auras different from anything I have ever had before,” they wrote. “The newest one was a small spot missing in the center of my vision, making the first two letters of words disappear. It lasted 10 minutes and was followed by another aura of bright wavy lines on the outside of my left eye, which lasted for 15 minutes. This was followed by a full-blown migraine encasing my entire head and both eyes.”

“My visual auras affect a big portion of my vision, so doing day-to-day things is difficult (because I can’t see).”

— A MyMigraineTeam member

Another member noted that the frequency of their migraine attacks with aura ranged from two to three times per month to every one to two months. “Today was hard,” they said. “At around 12:30 p.m. I started getting the usual visual aura that comes with my migraine attacks. My visual auras affect a big portion of my vision, so doing day-to-day things is difficult (because I can’t see).”

Some visual auras can be colorful and appear like hallucinations. People living with migraine sometimes find it difficult to describe their color storm migraine sensations. “I had a particularly nasty migraine this morning, but I also experienced visuals during it,” one member shared. “I won’t call them hallucinations or auras because they weren’t. They were black-and-white pictures, but some areas were filled with a single color. The first visual had bright pink, and the second visual had bright blue, and the colors hurt my eyes!”

Visual auras are like an electrical or chemical wave in the brain. Some members report heightened sensitivity to sound during a visual aura. “If I don’t wake up with a migraine, then before it comes on I feel really achy and sluggish,” one member shared. “I also go blind for about 10 to 15 seconds, but my hearing is amplified at the same time.”

Sometimes, the intensity of the symptoms that accompany an aura can make people think they’re having a more serious problem, like a stroke. “I’m curious to know if anyone else has had Alice in Wonderland syndrome as a visual aura?” one member asked. “It’s intense, and I honestly thought I was having a stroke the first time.”

If you experience a migraine attack that includes visual disturbances or auras, consult a health care provider right away. They’ll examine you to rule out other medical issues, like a stroke or a retinal tear. You may need to see a neurologist, who will consider your medical history when determining your diagnosis. The doctor might also perform an eye exam and an MRI or CT scan to gather more information.

What Causes Migraine With Aura?

Scientists don’t know the exact cause of migraine with aura. However, research shows that severe headaches and migraine attacks with auras can result from:

• Certain medications
• Certain foods and beverages, such as red wine, aged cheese, and chocolate
• Menstruation
• Lack of sleep
• Caffeine withdrawal
• Fatigue

In addition, migraine runs in families. Environmental factors, such as changes in the weather, can also trigger auras. One member wrote, “Ugh, more storms coming our way. Feeling the aura.”

Recent research has uncovered new clues about migraines with aura. Scientists have found that during an aura, the brain releases specific proteins into cerebrospinal fluid (CSF). These proteins then travel to sensory nerves in the head, like those in the trigeminal ganglion, and can trigger pain signals that lead to the intense headaches that follow. This discovery could lead to new treatments for people who don’t respond to current therapies.

Migraine with aura doesn’t have a clear cause, but it can be triggered by factors like certain foods, menstruation, caffeine withdrawal, and fatigue.

Another member shared how stress can trigger their migraine with aura. “Plans were all mixed up today,” they wrote. “Everything I planned for didn’t happen. I feel guilty I didn’t do certain things, and I’m frustrated by others’ actions. All these things always cause me stress, which in turn causes headaches and sometimes migraine.”

Treating Migraine With Aura

There are several treatments available for migraine with aura. Some are the same as those prescribed for migraine without aura.

Over-the-Counter Treatments

Some people find relief from over-the-counter remedies, such as aspirin and ibuprofen, if they’re feeling aura symptoms or a migraine headache.

Prescription Drugs

Triptans are prescription drugs that treat migraine. These drugs can block brain pathways that cause pain. Although triptans were once avoided for treating migraine with brainstem aura, new research shows that triptans can be safe and effective for this type of migraine.

Other medications include dihydroergotamine, available as a nasal spray and an injection. Dihydroergotamine can cause vomiting and nausea, which are migraine symptoms. Anti-nausea medications can help manage these symptoms.

There are also medications that block calcitonin gene-related peptides (CGRP), a type of protein in the nervous system. Anti-CGRP medications include CGRP-R antagonists for short-term treatment and CGRP monoclonal antibodies to help prevent migraine attacks. Examples of drugs in this class include erenumab-aooe (Aimovig), eptinezumab-jjmr (Vyepti), and galcanezumab-gnlm (Emgality).

Neuromodulation

Neuromodulation is a treatment for acute migraines that involves using devices that modify brain activity — either by increasing or decreasing it — often through electrical, magnetic, or temperature-based interventions. These devices may be used to prevent migraine attacks or to stop ongoing attacks.

Types of neuromodulation devices approved by the U.S. Food and Drug Administration (FDA) include:

• Single pulse transcranial magnetic stimulator — These handheld devices use magnetic impulses. Initially approved for treating migraine with aura, these are now also approved to prevent attacks.
• Transcutaneous vagus nerve stimulator — These handheld devices stimulate the vagus nerve, located in the neck. They are used to treat episodic cluster headaches and acute migraine pain.
• Transcutaneous supraorbital neurostimulator — These types of devices use electrical stimulation on supraorbital nerves. They’re approved for treating acute migraine and preventing attacks.
• Noninvasive multi-channel brain neuromodulation system — These headset devices target multiple nerves in the head to treat acute migraine.

These treatments are an option for people who can’t tolerate medications or are concerned about overusing medication. However, their cost can be a barrier for some people.

Preventive Measures

Doctors may suggest some treatments as a preventive measure, including:

• Beta-blockers that reduce blood pressure
• Antidepressants
• Anti-seizure drugs
• CGRP monoclonal antibodies
• Some neuromodulation devices

Finally, onabotulinumtoxinA (Botox) injections have been shown to help prevent migraine attacks in some people with chronic migraine. One member wrote, “I started Botox five years ago. It was amazing. I went almost three years with barely any migraine episodes, and now just this year, they started back up again. But I still think the Botox is helping.”

Talk With Others Who Understand

MyMigraineTeam is the social network for people with migraine and their loved ones. On MyMigraineTeam, more than 84,000 members come together to ask questions, give advice, and share their stories with others who understand life with migraine.

Have you experienced migraine attacks with visual symptoms like auras? What were your symptoms? What treatments have you tried? Share your experiences in the comments below or start a conversation by posting on your Activities page.