What Is A Migraine With Aura (Really)?

Probably The Most Dangerous Migraine....

The Short Answer –

A migraine with aura is exactly what the name suggests – an ‘aura’ followed (normally) by a migraine. They are often confused as being one event, but in reality you can suffer an aura without any migraine afterwards because they are two separate events.

Once you understand this, treatment becomes a lot more simple, despite an aura being a very complex event…

Defining The Fuzziness…

An aura is literally a disturbance to your senses such as flashes of light, seeing stars or blind spots.

A ‘migraine with aura’ is any migraine during which you suffer aura before or during the migraine itself. Thankfully, according to DeLange et al (Current Pain and Headache Reports), the symptoms of your aura are ‘fully reversible’ with the right treatment.

However, the first stage to treating a migraine with aura is to understand what the aura is, what causes it, what triggers one to take place and how to treat them successfully.

DO NOT LISTEN TO ANYONE WHO SAYS A MIGRAINE WITH AURA IS THE SAME AS A ‘NORMAL’ MIGRAINE.

Firstly, there is no such thing as a ‘normal’ migraine. There are many different types of migraine.

While they may have similar symptoms and treatments (that is what connects them as ‘migraines’ after all), those who treat them as the same, miss the subtle differences that are key to treating them properly in the first place.

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Why Is The Aura Important?

If you suffer with aura, this may seem a silly question, but I get asked it none the less. Migraines with aura are especially difficult because the sensory disturbances add a further difficulty.

They often come up to one hour before a migraine – but there is no guarantee that you will definitely get the migraine headache itself.

Occasionally, you may suffer just the aura in isolation.

Either way, the sudden loss of vision, blurry vision or shapes/ objects appearing in your vision can make even simple activities nearly impossible.

Furthermore, when the aura comes an hour before a migraine, driving home or even organising your medications may not be possible and emergency assistance from a family member is likely to be essential.

Typical ‘Aura’ Symptoms…

The typical symptoms suffered during an aura not only vary from person to person, but even from day to day. They will normally however be a selection of the basic symptoms listed below…

  • Blind spots
  • Zig zag lines across your vision
  • Tunnel vision
  • Flickering lights
  • Coloured spots/ stars
  • Black dots across your vision
  • Feeling overheated
  • Confusion
  • Memory loss
  • Reduced cognitive behaviour, forgetting how to do simple tasks.
  • Sensitivity to light and sound
  • Feeling of separation from your body
  • Temporary Blindness

Which Type Of Aura Do You Have?

The international Headache Society (Cephalalgia) has classified migraines with aura into 4 key categories –

Migraine With Typical Aura. This is a migraine with an aura that contains sensory, language or (most commonly) visual symptoms BUT NO motor skills issues.

Migraine With Brainstem Aura. This is a migraine with aura that does not contain any motor or retinal symptoms, but does contain at least TWO of the following symptoms –

  • Tinnitus/ ringing in the ears
  • Hearing disruption or impairment (not including ear fullness)
  • Vertigo
  • Slurred speech
  • Double vision
  • Decreased control over bodily movements
  • Decreased level of consciousness
  • ‘Out of body’ experience

Hemiplegic Migraine. This is a migraine in which you suffer motor skills disturbance/ weakness such as the inability to move.

Retinal Migraine. This is a migraine with aura that creates a visual disturbance in just one eye.

The default categorisation for any migraine with aura is the ‘migraine with typical aura’ unless you are specifically showing symptoms from one of the other three categories.

Prevalence of Migraines With Aura….

According to an article in The Lancet, as many as 10% of the world’s population suffer with migraines.

Approximately half of these (5% of the global population) are estimated to suffer an aura before their migraine.

Within these migraines, a Headache Registry Database at the Mayo Clinic referenced in Current Pain and Headache Reports, analysed 2,030 patients and listed the following prevalence of aura disturbances amongst it’s patients –

  • 86% had visual aura
  • 35% had language aura
  • 34% had sensory aura
  • 10% suffered motor aura

Diagnosing Migraine with Aura…

Your doctor can diagnose a migraine with aura simply by discussing your symptoms with you. This may include a basic medical examination and a discussion around your family history.

Other tests (such as eye tests) or even CT/ MRI scans are sometimes used to rule out other potential causes of your pain.

Your doctor should then use what is known as the ICHD-3 definitions to categorise your migraine, but many doctors are still not actually aware of this (ICHD-3 standing for the ‘International Classification of Headache Disorders’).

The Final Word –

A migraine with aura is a double disaster – the pain of a migraine, preceded by the cognitive loss and confusion of an aura.

Having an aura however, does not guarantee that you will suffer a migraine headache afterwards, but they are closely linked and aura is likely to either come before or at the same time, as a migraine.

The typical symptoms too are nothing to be taken lightly – imagine driving a lorry when you start to suffer vision loss….

The potential implications and serious consequences should never be underestimated. If you do suffer migraines with aura, then you need to start a very specialist treatment plan – one that addresses both the migraine and the aura as separate events.

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References Used –

1) The International Classification of Headache Disorders,3rd edition (beta version). Cephalalgia. The International Headache Society.
2) Justin M DeLange and F. Michael Cutrer. (Oct 2014) “Our Evolving Understanding of Migraine with Aura.” Current pain and headache reports.
3) Rigmor Jensen, MD and Lars J Stovner, MD. (April 2008). Epidemiology and comorbidity of headache. The Lancet.

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