Here’s How Migraine With Aura Can Affect Your Vision, Muscles, and Speech

You might think the world is divided neatly into two groups—people with migraine and people without. Rarely are things that simple, though, and migraine is no exception. There are actually a number of different migraine types, and the two main ones are “migraine with aura” and “migraine without aura.”¹ These two groups can further be divided into several subtypes, Nauman Tariq, MD, the director of the headache treatment program at Atrium Health Neurosciences Institute Charlotte, tells SELF.

Aura is characterized by visual, sensory, and speech disturbances—and you can have migraine aura with or without a headache, migraine with brainstem aura, hemiplegic migraine, and retinal migraine, per the American Migraine Foundation. “We used to lump all of these migraines into ‘complex migraine’ but now they are further categorized based on the symptoms they cause,” Dr. Tariq explains.

That’s good news for migraineurs since being diagnosed properly is the key to getting the right treatment. That said, the different types of migraine with aura can be a little confusing. Here’s everything you need to know, including the symptoms they cause and how to get relief.

It’s important to understand what migraine is in the first place. Migraine isn’t just a headache—it’s a neurological disease that affects about 12% of people in the U.S., the majority of whom are people assigned female at birth. Most people with migraine (around 80 to 85%) have migraine without aura, which is characterized as a throbbing or pulsing sensation, usually on one side of the head, that gets worse with physical activity, bright lights, loud sounds, and strong smells, according to the Cleveland Clinic.

Migraine with aura is less common, affecting around 15 to 20% of people with migraine. In addition to head pain and sensitivity to light, sound, or smells, migraine with aura symptoms includes visual, sensory, motor, or speech symptoms that usually warn that a migraine attack is coming. Per the International Classification of Headache Disorders, migraine with aura can be further divided into the following subtypes:²

• Migraine with typical aura—with or without a headache: Typical aura includes visual, sensory, or speech symptoms but no motor (that means muscle) weakness. This type of migraine can come with or without head pain.
• Migraine with brainstem aura: This type of migraine has aura symptoms that originate from the base of the brain (brainstem) or both sides of the brain at the same time. It’s typically associated with pain at the back of the head on both sides, according to the National Center for Advancing Translational Sciences.
• Hemiplegic migraine: An extremely rare type of migraine, hemiplegic migraine is characterized by experiencing weakness on one side of the body (hemiplegia) along with typical migraine symptoms.
• Retinal migraine: Sometimes called ocular migraine, this type of migraine causes visual disturbances that occur in only one eye before head pain begins.

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Migraine with aura can cause an array of symptoms, from visual disturbances like seeing zig-zags or stars to sensory changes such as numbness or tingling. The symptoms of each type of migraine with aura can overlap, but here are the typical signs of each one, according to the American Migraine Foundation:

• Migraine with typical aura—with or without a headache: “For 90% of patients, their aura is visual such as seeing spots, lights, zig-zags, kaleidoscope-like patterns, or even losing vision temporarily,” Dr. Tariq says. The other 10% of people can have sensory symptoms, such as numbness or tingling in the face, body, and hands, or speech issues like slurring or being unable to say the right words. All of these issues usually resolve within an hour and can precede or occur simultaneously with a migraine headache.
• Migraine with brainstem aura: In addition to typical aura symptoms, this type of migraine can cause vertigo, ringing in your ears, double vision, impaired hearing, unsteady movements, and even a diminished level of consciousness. All of these symptoms are fully reversible, meaning they won’t last forever.
• Hemiplegic migraine: Weakness on one side of the body (called hemiplegia) is the primary symptom. This type of migraine can also cause typical aura symptoms—vision changes, speech issues, etc.—as well as vomiting or nausea, and sensitivity to light and sound. Symptoms can last for hours or, in rare cases, weeks, but they will go away at some point. That said, because these symptoms can mimic a stroke or other major neurological conditions, it’s best to see a doctor right away to rule out something more serious.
• Retinal migraine: This type of migraine is characterized by visual symptoms in one eye only, including seeing twinkling lights, losing partial vision, and temporary blindness. These symptoms may last for up to an hour and usually precede head pain.

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The same things that can trigger migraine without aura can also cause migraine with aura, Dr. Tariq says, and they can vary quite a bit from person to person. Common migraine triggers include:

• Hormonal changes during your period
• Stress
• An erratic sleep schedule
• Bright or flashing lights, loud sounds, and strong odors
• Intense exercise
• Weather changes
• Certain medications
• Skipping meals
• Certain foods, such as aged cheeses or cured meats
• Certain beverages, such as alcohol or drinks with too much caffeine

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Your doctor will get a detailed history of your health and ask you questions about your migraine symptoms in order to make a diagnosis. “We make sure your symptoms aren’t due to something else, such as an eye condition or transient ischemic attack, which is a precursor to stroke,” Dr. Tariq says. It’s important to differentiate symptoms like eye floaters from actual migraine aura too.

To do this, your doctor may recommend an eye exam to make sure your visual symptoms aren’t being caused by an eye issue. In addition, you may need to have a CT scan or MRI of your brain to rule out other neurological conditions. Your doctor will also ask how long your symptoms typically last. “Up to 90% of auras last from 5 to 60 minutes—if your symptoms don’t fall within this time frame, we start to question whether it’s really aura or something else,” Dr. Tariq notes.

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The exact cause of migraine is unknown but having a family history of migraine seems to be a significant risk factor, according to the Mayo Clinic. People with vaginas are also at a greater risk of migraine (the rise and fall of estrogen during your period can trigger a migraine attack in some people).

Research shows that migraine with aura may be caused by a phenomenon called cortical spreading depression, which is an electrical wave that spreads across the brain, Dr. Tariq says. This is a unique phenomenon to people with migraine (and a few other brain conditions like seizures). Scientists are not sure why this occurs in some people, though it may have something to do with genetic susceptibility, according to a 2018 study published in the Frontiers of Neurology.² It’s even possible that people with migraine both with and without aura experience it, but only those with aura have symptoms. It is still a bit of a mystery, though, as there is also evidence to suggest those without aura do not experience this electrical wave at all.³

If you do get aura symptoms, what you experience depends on the part of the brain the wave reaches, such as the visual, sensory, speech, or movement centers. Waves that reach the visual cortex and cause visual symptoms are the most common type. Don’t worry: These electrical waves do not damage the brain, according to a 2019 study published in The Journal of Headache and Pain.⁴

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Migraine with aura is treated with the same medications as migraine without aura. Known as abortive medications, they stop a migraine that has already started.

Here are some common abortive migraine medications:⁵

• Over-the-counter meds: These include pain relievers, such as NSAIDs.
• Triptans: This class of drugs specifically targets migraine pain, and they can be taken as pills, shots, or nasal sprays.
• CGRP antagonists: These drugs block calcitonin gene-related peptide (CGRP), a protein released in the brain that can cause migraine.
• Lasmiditan: This drug targets a different receptor in the brain—5-hydroxytryptamine (5-HT 1F)—and has been shown to significantly reduce headache pain.
• Dihydroergotamine (DHE): Available as a nasal spray or injection, this drug works best when used to treat a migraine that is already in progress. It shouldn’t be used if you have coronary artery disease, uncontrolled high blood pressure, or severe kidney or liver disease.
• Opioids: If none of the migraine medications above work, opioids may be prescribed in emergency situations (their use is rare since they can be highly addictive and can cause migraine to worsen over time).

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There’s no cure for migraine with aura so you won’t be able to stop symptoms completely, but there are ways to reduce migraine frequency and severity. According to the Cleveland Clinic, your doctor may prescribe the following preventative drugs to take on a regular basis (usually daily or monthly):⁵

• Tricyclic antidepressants: This type of medication has been shown to reduce migraine by keeping serotonin levels steady in the brain.
• Blood pressure medications: Calcium channel blockers may prevent migraine with aura.
• Anti-seizure drugs: These medications can prevent migraine by blocking cortical spreading depression. Do not take them if you’re pregnant.
• CGRP antagonists: These are self-injected monthly or quarterly to reduce the frequency of migraine attacks.
• Botox: Traditionally known as a skin smoother, these injections block pain signals between nerves and your brain. Injections are usually given once every 12 weeks.

There are also lifestyle changes you can make to prevent or reduce your migraine attacks. Per the Mayo Clinic, the following strategies may help:

• Staying hydrated: Drinking lots of water can help keep migraine attacks at bay. Aim for at least 64 ounces a day.
• Learning how to relax: Techniques like biofeedback—where you are hooked up to a machine that monitors your bodily functions, like blood pressure—help you recognize the physical signs of anxiety, and then teach you how to handle stress better. Since stress is a migraine trigger for some people, this technique may help fend off migraines.
• Sticking to a sleeping and eating schedule: Going to bed and waking up at the same time every day and trying to eat meals and snacks on a consistent basis may also help with migraine.
• Exercising regularly: This one is a little tricky because exercise can actually trigger migraine attacks in some people. But one 2018 study published in the Journal of Headache and Pain found that regular exercise may actually prevent migraine attacks for others. The idea is that exercise somehow raises your migraine triggering threshold.⁶

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Migraine with aura can be scary—especially if you’ve never experienced it before. Between the vision changes and strange body sensations, you might think you’re having a stroke or experiencing symptoms of another serious condition. “If it’s the first time you’re experiencing these symptoms, seek immediate help,” Dr. Tariq says. “It’s good to see a doctor right away to rule out a serious health issue and get a proper diagnosis.”

That said, emergency doctors aren’t always experienced with migraine, so after they rule out other conditions, you’ll probably need to see a neurologist, if possible, to get an official migraine diagnosis and determine the best treatment options. There’s no cure for migraine with aura (yet) but there are many ways to manage your symptoms. In other words, there’s relief in sight.

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Sources:

1. Cephalalgia, The International Classification of Headache Disorders, 3rd Edition
2. Frontiers of Neurology, Understanding Spreading Depression from Headache to Sudden Unexpected Death
3. Lancet Neurology, Effects of Tonabersat on Migraine With Aura: A Randomised, Double-Blind, Placebo-Controlled Crossover Study
4. The Journal of Headache and Pain, Spreading Depression as a Preclinical Model of Migraine
5. StatPearls, Migraine With Aura
6. Journal of Headache and Pain, The Association Between Migraine and Physical Exercise

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• Here’s What You Need to Know About ‘Migraine Hangovers’
• We Need to Talk About Migraine Stigma
• This Is What Migraine Really Does to Your Life