Migraine with aura: symptoms, causes and treatment

Visual disturbances are the most common. The Migraine Trust lists blind spots, blurred vision, coloured spots or lines, flashing or flickering lights and zigzag patterns. NHS inform describes sensory aura as numbness or tingling that usually begins in one hand and moves up the arm before affecting the face, lips and tongue, with difficulty speaking and a feeling of dizziness or being off balance as other possibilities. Loss of consciousness is described as unusual.

Timing is distinctive. According to the Migraine Trust, auras usually start gradually over about five minutes and last from five minutes up to an hour, then wear off. NHS inform gives the same pattern, developing over about five minutes and lasting up to an hour. Muscle weakness is a less common aura symptom, and the Migraine Trust says to seek medical advice if it happens for the first time.

• Sight: blind spots, zigzag lines, flashing or flickering lights, coloured spots.

• Sensation: pins and needles or numbness, often starting in a hand and spreading.

• Speech: difficulty finding or forming words.

• Balance: dizziness or feeling off balance.

• Each symptom typically builds up over minutes and clears within an hour.

The Migraine Trust defines an aura as a set of neurological symptoms you may get as part of a migraine attack, neurological meaning connected with the nervous system. The NHS describes it as a warning sign that a migraine attack is about to happen, listing sight problems such as zigzag lines or flashing lights, numbness or tingling like pins and needles, dizziness and difficulty speaking.

Aura is not the same as the headache. For most people it comes just before the main attack, when the throbbing head pain, sickness and sensitivity to light and sound begin. The Migraine Trust adds that some people have aura symptoms throughout an attack or after the headache has started, and that some have aura with little or no headache at all.

The NHS says to call 999 if you or your child have a headache that came on suddenly and is extremely painful, have problems speaking or remembering things, lose your vision or have blurred or double vision, feel drowsy or confused, have a seizure, have a very high temperature with symptoms of meningitis, cannot move or have weakness in the arms or legs on one side of the body or one side of the face, or have recently had a head injury. NHS inform similarly lists paralysis or weakness in an arm or one side of the face, slurred speech and a sudden agonising headache as reasons for 999 or A&E, because they may signal stroke or meningitis.

The NHS also advises an urgent GP appointment or NHS 111 if aura symptoms last longer than 1 hour at a time, if an attack lasts longer than 72 hours, or if you are pregnant or have just had a baby. A first-ever aura at any age, and any aura that is different from your usual pattern, deserves a check.

There is no specific test for migraine. NHS inform says a GP identifies a pattern of recurring headaches together with the associated symptoms, may examine your vision, coordination, reflexes and sensation to rule out other causes, and may suggest a diary. A referral to a neurologist is considered if the diagnosis is unclear or attacks are not controlled by treatment.

For attacks, the NHS lists painkillers such as ibuprofen and paracetamol, medicines called triptans and gepants, and medicines for nausea. The Migraine Trust says that for migraine with aura these should be taken as soon as a headache starts. Prevention options listed by the NHS include beta blockers, antidepressants and epilepsy medicines, acupuncture, relaxation techniques and CBT, and vitamin B2, alongside lifestyle steps such as eating at regular times and drinking less caffeine. Taking acute treatments on too many days can cause medication overuse headache; the NHS says to try not to take painkillers for more than 2 days a week, while NHS inform says not on more than 10 days a month in the long term, so ask your clinician what limit applies to your medicines. This page is informational, and prescribing decisions rest with your clinician.

The cause is not fully known. The Migraine Trust says it is not known exactly what causes aura and that scientists have suggested a slow wave of altered brain activity called cortical spreading depression, which leads to temporary changes in chemicals, nerves and blood flow in the brain. NHS inform says migraine in general is thought to result from abnormal brain activity temporarily affecting nerve signals, chemicals and blood vessels, and that around half of people with migraine have a close relative with it.

Possible triggers listed by NHS inform include hormonal changes, anxiety and stress, tiredness, fasting or low blood sugar, strenuous unaccustomed exercise, alcohol, caffeine, dehydration, bright or flickering lights, strong smells and changes in the weather. Some medicines, including some sleeping tablets, the combined contraceptive pill and hormone replacement therapy, can also trigger attacks. A diary of attacks for a few weeks helps to find any pattern.

The Migraine Trust describes several subtypes. Migraine with brainstem aura has symptoms such as slurred speech, spinning, ringing in the ears, double vision, unsteadiness and fainting, and it is more often first experienced as a teenager or young adult. The charity says that if a first attack of this kind develops after the age of 50, you should speak to your doctor in case tests such as an MRI scan are needed to rule out other causes.

Retinal (ocular) migraine causes visual disturbance in one eye only, such as flashes, blind spots or temporary loss of vision, usually with a headache at the same time or within 60 minutes. It says other serious causes of eye symptoms must be ruled out, that anyone with visual disturbance for the first time needs urgent medical attention, and that sudden vision loss means going to A&E or calling 999. Hemiplegic migraine involves temporary weakness or paralysis on one side of the body.

Silent migraine, or migraine aura without headache, is aura symptoms without head pain. The Migraine Trust says it is more common in older people and in those who develop migraine later in life, and that someone who had typical aura with headache when younger may progress to silent migraine with age. It adds that acute headache treatments will not work for someone who only gets aura, and that there are no treatments specifically for aura alone, so a GP should be consulted.

NHS inform says migraine is linked to a small increased risk of other conditions, including stroke, depression and anxiety disorders. It explains that the risk of ischaemic stroke is increased by the combined contraceptive pill, that medical professionals generally advise women with aura not to use it, and that women with migraine without aura can usually take it safely unless they have other stroke risk factors such as high blood pressure or a family history of cardiovascular disease.

The practical message is not to stop any medicine on your own. If you have aura and take a combined pill, NHS inform advises talking to your GP about alternative forms of contraception. The NHS menopause pages also say that the combined pill is not recommended from age 50, which is another reason to review contraception as you get older.

On the NHS, migraine is usually diagnosed by a GP from the pattern of symptoms, and NHS inform says referral to a neurologist is considered if the diagnosis is unclear or attacks are not controlled by treatment. There is no specific test for migraine. Private neurology appointments follow the same diagnostic approach, and imaging is not routinely needed for typical aura. If aura is new, different from your usual pattern or lasts longer than an hour, get checked promptly whichever route you use.