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Migraine With Aura

Ramin Ansari MD
Medically reviewed by Ramin Ansari
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Ramin Ansari MD
Medically reviewed by Ramin Ansari

Migraine with aura is a disorder that presents with repeated episodes of reversible local neurological symptoms (aura), usually increasing over 5-20 minutes and lasting no more than 60 minutes.

Aura is a term that doctors understand as follows:

  1. Visual impairment. It can be lines, lights, spots, flickers. In severe cases, loss of vision. All manifestations are reversible.
  2. Sensory disturbances. It seems that goosebumps are crawling through the body, the person feels tingling, there may be areas of numbness. All this is also reversible.
  3. Speech disorders also go away with an attack.

Migraine headaches with and without aura proceeds in the same way. A person feels a throbbing pain, usually in one half of the head. It often concentrates on the eyeball. The pain increases with movement, sound, and light stimuli. It can last from 4 hours to 3 days. At this time, it is impossible to lead the usual way of life. A person wants to be left alone in a dark and cool room, freezing, hiding under a blanket. Typically, patients describe the pain as “bursting,” “splitting,” “about to burst,” “each sound is like a hammer on the head.” And even after an attack, the consequences persist. The person is apathetic, tired, and broken. You can recover for more than one day.

Migraine headaches

Differences from migraine without aura

Differences from migraine without aura

Migraine without aura is called “classic migraine“. It affects about 80% of patients. Migraine without an aura manifests itself as a throbbing pain at one point. It is not preceded by any visual, auditory, or sensory impairment. Sometimes people do not even understand that this is a migraine but think that they just have a headache. For this reason, patients do not go to the doctor, which is fraught with consequences.

You have a classic migraine if the following symptoms are present:

  • 5 episodes of pain;
  • the attacks last 4 to 72 hours if the medication is not taken;
  • the pain is pulsating, focused on one side of the head. The forehead, the neck may hurt, and then – the face or the back of the head;
  • with any physical activity, the pain gets worse;
  • fearful of light, sounds and voices.

What are the characteristics of migraine with aura?

Aura is about 20% of patients. But only a few say that it occurs with every attack. The most common symptom of the aura is visual disturbances. Less commonly, sensory disorders (tingling, numbness, goosebumps). Aura symptoms are classified as positive and negative. In the first case, something is felt, and in the second, the field of vision falls out or the hands go numb. Another property of the aura is dynamism, a gradual increase in symptoms, and then their gradual decline. Usually, the aura is replaced by a headache, but sometimes the aura appears on its own.

Migraine headaches with aura are characterized by the following features:

  1. Two episodes of migraine without aura.
  2. The presence of an aura for 1 hour or more before the onset of pain. In this case, the following neurological symptoms appear:
  • visual disturbances – photophobia, blinking, black spots in the field of view, flickering arches, lines, zigzags, misperception of objects in the field of view;
  • sound disturbances, mainly intolerance to any sounds;
  • speech problems;
  • sensory disturbances – tingling, burning, numbness, etc.;
  • violation of motor abilities, for example, a sharp weakening of the muscles on one side of the body.

Causes of migraine headaches

Factors that worsen the course of migraine

The mechanisms of development of migraine are not fully understood. Hereditarily determining dysfunction of vasomotor regulation serves as a predisposing factor for the development of the disease. Approximately 70% of migraine patients have close relatives with a history of migraine-like headaches.

There are two groups of factors influencing the course of migraine: worsening the course of migraine in general and provoking an attack.

  1. Factors that worsen the course of migraine

In a patient with migraine headaches, factors such as emotional stress, frequent consumption of alcoholic beverages, and other environmental influences can cause a prolonged (over several months or years) deterioration in the course of the disease in the form of an increase in the frequency and/or intensity of attacks.

In patients with migraines, provoking factors increase the likelihood of attacks; usually, their effects are manifested in less than 48 hours. Despite migraine triggers have been well studied in several epidemiological (for example, the effect of menstruation) and clinical (the effect of aspartame, chocolate, etc.) studies, in each case, it is not always easy to establish a direct causal relationship between a provocateur and a migraine attack.

2. Factors provoking migraine aura:

  • dietary: hunger, food irregularities, certain foods (chocolate, cheese, nuts, alcohol (red wine), creams, yogurt, chicken liver, avocados, citrus fruits, bananas, soups from concentrates, fried pork, sausages, pizza, coffee, cola, tea);
  • hormonal: menstruation, ovulation, estrogen replacement therapy, taking oral contraceptives;
  • psychological: emotional stress, anxiety;
  • depression, tiredness;
  • weather changes;
  • exercise stress;
  • lack or excess of sleep at night;
  • stuffiness, odors (smell of perfumery);
  • visual stimuli (flickering or bright light);
  • cold;
  • noise;
  • stay on top.

Types and symptoms of migraine aura

Types and symptoms of migraine aura

Let’s consider the main types of auras and how they appear.

  1. Visual or ophthalmic

This aura is called “classic migraine“. With it, visual images appear – flashes of light, curved or straight lines, flickering objects, white or golden figures, spherical images, etc.

Symptoms develop over 5-30 minutes. The positive ones can be replaced by the negative ones. The duration of the aura can be up to 1 hour. The image usually appears in the center of the field of view. It gradually increases and goes to the periphery. Behind it remains a scotoma – a dark, “blind” area. Pain comes during the aura or within an hour after its appearance. When the attack ends, any violations go away without consequences.

2. Retinal

With this aura, scotomas or blindness in one eye occur. Symptoms persist for up to 1 hour.  This is a rare type of aura. There is an assumption that the symptoms appear in connection with a spasm of the central retinal artery of the eye. In most patients, retinal migraine attacks alternate with migraine attacks with or without a classic aura migraine.

3. Auditory

Auditory auras are hallucinations with sound. Tinnitus may occur and patients sometimes hear music or voices. Doctors associate this aura with epileptic activity in the cerebral cortex, in its temporal region.

4. Speech

It manifests itself as a speech disorder because it affects the speech centers of the brain. Before the onset of pain for several minutes, it is difficult or impossible for the person to speak. It can cause rearrangement syllables in words, letters, and repeat the same thing. At the same time, the consciousness is pure.

5. Vestibular

This is an aura in the form of movement disorders – dizziness. Quite a common occurrence that can be hidden and explicit. In the second case, the person is “rocked” even with small loads. In the first, violations can be detected only within the framework of the survey. 

According to the ICD, there are 2 forms of vestibular migraine:

  1. Basilar – is rare, mainly in adolescent girls. The attack begins with visual disturbances, followed by dizziness, tinnitus, impaired sensitivity, etc. Then, in 25% of cases, confusion occurs. Neurological symptoms persist for 20-30 minutes, then pain in the back of the head comes. Without treatments for migraine, throbbing pain may persist for 2–3 days.
  2. Paroxysmal vertigo of young children (benign). It occurs in children 1-4 years old. It manifests itself in short – from several seconds to several minutes – attacks of dizziness. The child loses stability, becomes anxious, vomiting appears. He may turn pale and sweat profusely. There is no headache. Attacks can recur over months or years.
  3. Vegetative
  4. Often such auras are manifested by a sensation of heat, chills, coldness, trembling, the face and neck may turn red or pale. Goosebumps can run, and even hairs will rise on the skin. During an attack, pupil size may change asymmetrically. This attack is usually part of a complex attack, rather than an independent occurrence.

Diagnostics, treatment, and prophylaxis of migraine aura

Diagnostics, treatment, and prophylaxis of migraine aura


It is necessary to address such a problem with a neurologist. The doctor should rule out cysts, swelling, encephalitis, and vascular pathologies that cause similar symptoms. Therefore, a neurological examination, CT, or MRI of the brain is carried out, the patient is sent for a consultation with an ophthalmologist to examine and determine the visual fields.

An EEG (electroencephalography) is mandatory, which provides information about the functional activity and characteristics of the biorhythm of the brain of a particular patient. Based on the EEG results, the doctor chooses medications for therapy.

Treatments for migraine

Treatments for migraine are based on eliminating pain and making it happen as rarely as possible or go away altogether. NSAIDs or specific medications, most commonly triptans, may be used. Intravenous fluid therapy is also used to treat migraines. The effectiveness of pain relief is directly proportional to the time of taking the drugs. You can stop an attack when it has just begun. At the peak of the attack, the pills almost do not help, because, with migraine gastric stasis in the intestine, the absorption of any substances is very difficult.

Alternative treatments for migraine are physical activity, exercise therapy, physiotherapy, psychotherapy. Massaging the neck area is especially helpful because muscle spasms in this area can trigger an attack. Recently, migraines have been successfully treated with injections of botulinum toxin type A. Injections make remission longer, and in some cases relieve pain for a long time.

Prophylaxis of migraine aura

 Prevention consists in taking medication prescribed by a neurologist every day for a certain time. This medicine will not act on the symptoms, but on the cause of the disease, preventing attacks from developing. However, drug prophylaxis is not indicated for everyone. It is prescribed if:

  • the number of attacks – up to 8 per month or 2 per week;
  • specific anti-migraine drugs – Zomig, Relpax, and other triptans don’t help;
  • it is impossible to take triptans and analgesics due to contraindications;
  • the patient has hemiplegic migraine, a rare hereditary disorder that leads to stroke.



  • Why are migraines dangerous?

According to the expert, migraine adversely affects the work in the trigeminal nerve system, which leads to vasodilation of the dura mater of nerves, the occurrence of non-infectious inflammation, and its edema. As a result, the person has an intense and throbbing headache.

  • How does a migraine headache start?

If you have stereotypical symptoms before a migraine attack, such as transient visual disturbances (flickering lines before the eyes, loss of visual fields), numbness of a part of the body, a feeling of “tingling”, a change in consciousness, then you may be suffering from a migraine with aura.

  • How does migraine and migraine aura arise?

The human brain consists of nerve cells – neurons. At the onset of a migraine attack, a wave of electrical excitation arises that travels along the brain from the back of the head towards the forehead. Scientists call it Leo’s Pervasive Depression. This wave travels at a speed of 2-3 mm per minute.

  • What are the prescriptions for migraine relief?

Regardless of their type, two types of drugs are used for migraines- specific and non-specific. Specific ones are designed specifically for this disease, affect the mechanism of development of an attack, and are aimed at stopping it. Nonspecific drugs are used to relieve pain. These are analgesics and non-steroidal anti-inflammatory drugs.

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Edward Medina
Edward Medina
15:34 30 Jun 22
Just such an amazing staff that makes you feel like part of their family. I’ve been going there for over 5 years now... and each visit I get the very best care and treatments that I have ever received in the 20+ years that I’ve been dealing with severe debilitating migraines. Since i started seeing them the number of my migraines has dropped from 15-20 a month to 2-3 every 3 month. I highly recommend them …they will change your life!read more
Daneisha Johnson
Daneisha Johnson
22:20 19 May 22
Dr. Askari was very kind and explained everything so I could understand. The other staff were nice as well. I would... have gave 5 stars but I was a little taken aback when I checked in and had to pay 600.00 upfront. I think that should have been discussed in a appointment confirmation call or email just so I could have been more
Jean Cooper
Jean Cooper
16:54 29 Apr 22
I love the office staff they are friendly and very helpful. Dr. JODIE is very caring and understanding to your needs... and wants to help you. I will go back. would recommend Dr. Dr. Jodie to other Patients in a heart beat. The team works well more
Linda M
Linda M
19:40 02 Apr 22
I was obviously stressed, needing to see a neurologist. The staff was so patient and Dr. Ansari was so kind. At one... point he told me to relax, we have time, when I was relaying my history of my condition. That helped ease my stress. I have seen 3 other neurologists and he was the only one who performed any assessment tests on my cognitive and physical skills. At one point I couldn't complete two assessments and got upset and cried. I was told, it's OK. That's why you're here. I was truly impressed, and super pleased with the whole experience!read more
Leslie Durham
Leslie Durham
15:05 01 Apr 22
I've been coming here for about 5 years. The staff are ALWAYS friendly and knowledgeable. The Doctors are the absolute... best!! Jodie Moore is always in such a great mood which is a plus when you are already stressed. Highly recommendedread more
Monica Del Bosque
Monica Del Bosque
14:13 25 Mar 22
Since my first post my thoughts have changed here. It's unfortunate. My doctor and PA were great, but the office staff... is horrible. They never call you back when they say they will, they misinform you, they cause you too much stress wondering what's going on, they don't keep you posted. They never answer the phone. At this point I've left four messages in the last week, and I have sent three messages. Twice from their portal and one direct email. No response. My appointment is on Monday morning at 8:30am, no confirmation on my insurance and what's going on. What the heck is going on, this is ridiculous!I've given up... the stress her office staff has put me through is just not worth it. You can do so much better, please clean house, either change out your office staff, or find a way for them to be more efficient please. You have to do something. This is not how you want to run your practice. It leaves a very bad impression on your more
Ron Buckholz
Ron Buckholz
23:32 23 Mar 22
I was actually pleasantly surprised with this visit! It took me a long time to get the appointment scheduled because no... one answers your phones EVER! After a month, I finally got in, and your staff was warm, friendly, and I was totally impressed! I feel like you will take care of my needs!read more
Steve Nabavi
Steve Nabavi
16:28 16 Mar 22
It was a nice visit. Happy staff doing all they can do to comfort the patients in a very calming environment. You ask... me they are earned a big gold star on the fridge. My only complaint they didn't give me any more
Katie Lewis
Katie Lewis
16:10 10 Feb 22
Had very positive appointments with Jodie and Dr. Sheth for my migraine care. Jodie was so fast with the injections and... has so much valuable info. I started to feel light headed during checkout and the staff was SO helpful—giving me a chair, water, and taking me into a private room until I felt better. Highly recommend this practice for migraine patients, they know what they’re doing!!read more
Joshua Martinez
Joshua Martinez
16:02 10 Dec 21
I was scheduled to be checked and just want to say that the staff was fantastic. They were kind and helpful. I was... asked many questions related to what was going on and not once did I feel as though I was being brushed off. The front desk staff was especially great in assisting me. I'm scheduled to go back for a mri and am glad that I'll be going more
Isabel Ivy
Isabel Ivy
21:42 03 Nov 21
I had such a good experience with Lone Star Neurology, Brent my MRI Tech was so awesome and made sure I was very... comfortable during the appointment. He gave me ear plugs, a pillow, leg support and blanket, easiest MRI ever lol 🤣 My 72 hour EEG nurse Amanda was also so awesome. She made sure I was take care of over the 3 days and took her time with the electrodes to make sure it was comfortable for me! Paige was also a huge help in answering all my questions when it came to my test results, and letting me know her honest opinions about how I should go forth with my more
Leslie Luce
Leslie Luce
17:37 20 Oct 21
The professionalism and want to help attitude of this office was present from the moment I contacted them. The follow... up and follow through as well as their willingness to find a way to schedule my dad was above and beyond. We visited two offices in the same day with the same experience. I am appreciative of this—we spend a lot of time with doctors and this was top notch start to more
robert Parker
robert Parker
16:38 16 Apr 21
I love going to this office. The staff is friendly and helpful. The doctor is great. I am getting the best... neurological tests and treatment I have ever had. The only reason I did not give them a 5 star rating is because it is impossible to reach a live person at the office to reschedule appointments. Every time I have tried to get through to the office it says all people are busy and I am sent to a voicemail. If they could get their phone answering fixed, I would give them a strong 5 more
MaryAnn Hornbaker
MaryAnn Hornbaker
00:26 25 Feb 21
Dr. Harney is an excellent Dr. I found him friendly , personable and thorough. I evidently am an unusual case. ... Therefore he spent a Hugh amount of time educating me. He even gave me literature to further explain my condition and how to follow up. This is something you rarely get from your doctors. So I am more than please with my doctor and his more
Roger Arguello
Roger Arguello
03:05 29 Jan 21
Always courteous, professional. The staff is very friendly and always work with you to find the best appointment time.... The care team has been great. Always taking the time to listen to your concerns and to find the best more
Margaret Rowland
Margaret Rowland
01:12 27 Jan 21
I have been a patient at Lone Star Neurology for several years. Now both my adult daughters also are patients there. I... love Jodie. She is always so prompt whether it is a teleamed call are a visit in the office. She takes the time to explain everything to me and answers all my questions. I am so blessed to have Jodie as my more
Susan Miller
Susan Miller
03:01 13 Jan 21
My husband had an accident 5 years ago and Lone Star Neurology has been such a blessing to us with my husbands care.... Jodie Moore is his provider and she is amazing! Jodie is very knowledgeable, caring, and thorough. She takes her time with you, making sure your needs are met and she is happy to answer any questions you may have. Lone Star Neurology’s patients are very lucky to have Jodie providing their care. Thank you Lone Star Neurology and especially Jodie for everything you have done for us. Jodie, you are the best!read more
Windalyn C
Windalyn C
01:32 09 Jan 21
Jodie is wonderful. She is very caring and knowledgeable. I have been to over a dozen neurologists, and none were able... to help me as much as they have here. Thanks!read more
Katie Kordel
Katie Kordel
00:40 09 Jan 21
Jodi Moore, nurse practitioner, is amazing. I have suffered from frequent, debilitating headaches for almost 20 years.... She has provided the best proactive and responsive care I have ever received. My quality of life has been greatly improved by her caring approach and tenacity in finding more
Ellie Natsis
Ellie Natsis
15:41 07 Jan 21
I have had the best experience at this neurologist's office! For over a year I have been receiving iv treatments here... each month and my nurse, Bobbie is beyond wonderful!! She's so attentive, knowledgeable, caring, and detail oriented. She makes an otherwise uncomfortable experience much more pleasant and definitely puts me at ease! She also helps me with my insurance,ordering this specialty medication and dealing with the ordering process which is no easy feat.Needless to say, she goes above a beyond in every way and I'm so grateful to this office and to Bobbie for all they do for me!read more
Matt Morris
Matt Morris
15:39 07 Jan 21
Let me start by saying that I have been coming here for years. Due to my autoimmune disease, I am in this office... once every three weeks for multiple hours at a time. The office is very clean and the staff very friendly. My only complaint would be there communication via phone. They aren't the best at responding if you leave a voicemail and expect a call back. I understand that this is prob just due to the sheer number of alls they receive daily. What I can say I like the best about the office are the people. Bobby who handles my infusions is great. I never have any issues with her setting up my infusions. She is very quick to reply to messages sent via text and if she were to leave then my whole opinion of the office may change. I also enjoy people like Matt, Lauren, and Jodi. I appreciate all that they do for me and without this team I'm not sure I would be as happy as I am to visit the office as frequently as I have to. Please ensure that these folks are recognized as they are what makes my visit to this office so tolerable :).read more
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