The migraine aura is the name given to certain recurrent symptoms, which you see in less than 20% of migraine sufferers. They are visual, sensory, motor, and speech disturbances – visual disturbances being the most common.
The aura symptoms usually last from 10 to 30 minutes but not more than 60 minutes. Migraine auras may precede the migraine headache pain or can occur along with it.
What causes migraine aura?
What causes the migraine aura is yet not known. Certain theories are being propagated.
Some believe that the visual disturbances seen in the aura are due to an electrical or chemical wave that passes over the visual cortex of the brain. As the wave passes, visual hallucinations are seen. This electrical wave could be due to exposure to migraine trigger factors.
Others believe that the cause may be the disturbances in the two brain chemicals serotonin and dopamine, which regulate the functioning of the brain.
The cause again could be the migraine trigger factors. This causes the autoimmune system to react leading to an extra flow of immune cells through the blood. The blood vessels dilate to accommodate this extra cell mass.
In order to control the smooth muscles of the blood vessels more chemicals are released, which cause the blood vessels to constrict. The blood vessels dilate and constrict due to these reactions in the brain, which results in a throbbing headache.
Symptoms
The symptoms of migraine with aura usually precede the common migraine symptoms but at times can occur with it. These symptoms are harmless and temporary and go away once the attack has subsided.
Visual disturbances: A migraine headache accompanied by visual symptoms is called ocular migraine. These symptoms cause you to lose normal vision. There could be eye pain. You may see a small area in your visual field called the blind spot or zigzag lines in your visual field. You may also see bright spots or flashes. There could be a partial loss of vision, which is called scotoma. Some people experience blurred or cloudy vision.
Sensory disturbances of aura can occur with visual disturbances or just after. These disturbances are seen as tingling or numbness that travels up your arm and can spread to the face and nose area of the same side and to the tongue. This can last for 10 to 20 minutes. Rarely, the limbs and the face on one side of the body may become weak.
Speech disturbances of the aura are temporary disturbances in speech wherein the speech becomes slurred. This is referred to as a dysphasic aura.
Other Symptoms include loss of appetite, nausea, vomiting, sensitivity to light and sound, irritability, increased sweating, fatigue, and swelling of the face.
Your doctor might diagnose the migraine with aura through your signs and symptoms, your medical and family history, and a physical exam.
He might recommend certain tests to rule out other conditions, such as a transient ischemic attack (TIA), also called the mini-stroke.
These tests might include
An eye examination. A thorough eye exam conducted by an ophthalmologist will help rule out eye problems that might be causing visual disturbances.
Brain CT scan. This imaging procedure produces detailed images of your brain.
Brain MRI. This diagnostic imaging procedure produces more detailed images of your brain.
Your doctor might refer you to a neurologist to complete your nervous system assessment to rule out nervous conditions that could be causing your symptoms.
Treatment of migraine with aura
Medications used to relieve migraine pain work best when taken at the first sign of migraine symptoms. The types of medications that can be used to treat migraine with aura depend on how severe your migraine symptoms are. They include:
Pain killers. These over-the-counter or prescription pain relievers include aspirin or ibuprofen. They should not be taken too frequently because then, they can cause medication-overuse headaches, and ulcers and bleeding in the gastrointestinal tract.Medications that combine caffeine, aspirin, and acetaminophen (Excedrin Migraine) may be helpful against mild migraine pain.
Triptans. Prescription drugs such as sumatriptan (Imitrex, Tosymra) and rizatriptan (Maxalt, Maxalt-MLT) give relief from migraine symptoms by blocking pain pathways in the brain. They are available as pills, injections, or nasal sprays. They are contraindicated in people who are at risk of a stroke or heart attack.
Dihydroergotamine (D.H.E. 45, Migranal). DHE is available as a nasal spray or injection. This drug is most effective when taken immediately at the onset of migraine symptoms for long-lasting migraines that tend to last longer than 24 hours. It can worsen migraine-related vomiting and nausea.DHE is contraindicated in people with coronary artery disease, high blood pressure, or kidney or liver disease.
Calcitonin gene-related peptide (CGRP) antagonists. Ubrogepant (Ubrelvy) and rimegepant (Nurtec ODT) are oral CGRP antagonists newly approved for the treatment of acute migraine with or without aura in adults. Common side effects include dry mouth, nausea, and sleepiness.
Opioid medications. Since opioids are highly addictive, they are used only if no other treatments are effective.
Anti-nausea drugs. These drugs are taken with painkillers when your migraine with aura is accompanied by nausea and vomiting. They include chlorpromazine, metoclopramide (Reglan) or prochlorperazine (Compro).
All the above-mentioned drugs are not safe for use in pregnancy.
