Migraine with aura

Migraine is an intense headache that has a neurological origin.

Migraine with aura also causes other symptoms that occur at the same time.

Migraine with aura begins during puberty and regresses around the age of 40 until it disappears completely.
It occurs most often in women, with a frequency of 3:1 compared to men.
Migraine affects 12% of the world’s population.
Migraine with aura occurs in 15% of migraine cases.
Migraine with aura is considered dangerous because it poses a cerebrovascular risk.

What is a migraine with aura and what are its characteristics?

Migraine with aura (or ophthalmic migraine) is accompanied by a neurological symptomatology (affecting the central nervous system) that occurs before or during the migraine attack.

The International Headache Society, i.e. the international organization that brings together most specialists who research the treatment of headaches, refers to migraine as idiopathic or primary cephalgia (headache), i.e. one that occurs without any apparent cause and affects only one side of the skull for a period of between 4 and 72 hours.

The pain is typically pounding or pulsating with the heart rate and of an intensity ranging from moderate to high. With physical activity, sounds, light and also smells, the intensity increases.

The aura is a neurological disorder that arises in the nervous system and manifests itself in visual disturbances, confusion and also more serious symptoms such as loss of strength, speech disorders (aphasia) and strong sensitivity to light.
The aura effects that precede the headache are always reversible. In some cases, an aura may be followed by an asymptomatic (i.e. painless) migraine.
A migraine with aura is almost always indicated by a series of harbinger symptoms that can persist for a few hours and even a whole day before the onset of the aura: anxiety, restlessness, irritability, unusual hunger or thirst. The migraine attacks with aura have an extremely variable frequency, ranging from a few episodes a year to daily attacks. On average, the attacks occur 3 or 4 times over the course of a month.


Let’s examine the symptoms in detail

The severe symptomatology that accompanies the serious cases of migraine with aura can lead to serious functional disability in the patient, which can last even a few days due to the complex phase that accompanies the disease. A disability that gets worse due to the fear of expectation that affects the one who suffers from a severe form of migraine with aura.
The fear of expectation that arises from the fear of an imminent attack and the resulting obstruction.
The symptomatology of migraine with aura is divided into three stages:

The first phase can also begin a day before the onset of pain with a series of the following symptoms:· Psychological harbinger symptoms (prodromal phase), for example, agitation and restlessness accompanied by increased irritability and aggression, as well as abnormal events such as excessive thirst and hunger, fluid retention. 

· Neurological symptoms (aura) that appear after a period of a few hours to a day and are characterized by the appearance of a bright circle of light with jagged and irregular contours, which appear colorful and flickering (scotomas) in the field of vision of both eyes. In some cases, the scotomas may be replaced by flying mosquitoes, as in myodesopsia.

The second phase begins at the end of the aura and consists in the real and actual migraine, the most common symptoms of which are the following:· Pulsating pain of varying intensity in one half of the skull. The areas where they occur most often are the temporal and frontal surfaces above the eye sockets. 

· Nausea.

· Vertigo.

· Diarrhoea. Rarely, but sometimes occurs.

· General lack of strength even with the simplest movements, which increase the intensity of pain.

· State of confusion. That is, a mental state in which thinking is difficult.

· Light intolerance. Light intensifies the symptomatology, while in the dark the symptoms improve.

· Noise intolerance.

· Odor intolerance.

· Temporary loss of consciousness. Occurs very rarely, but can occur with particularly violent attacks.

The third phase begins at the end of the painful phase and shows a series of symptoms that can last for a day or two:Extreme fatigue, frequent urination, loss of appetite.

What are the causes of migraine with aura?

The causes of migraine with aura are still not fully known and there are various hypotheses about it:

  • Heredity, which correlates with the mutation of certain genes. Mutations that have not yet been detected, except in the case of a specific and rare form of familial hemiplegic migraine.
  • Cerebral reduced blood flow. Decreased blood flow caused by narrowed intracranial vessels. This is a hypothesis that has found strong support in recent years. But the modern imaging methods on which the current angiography is based have shown that only some patients have a slight reduced blood flow, which is also so low that it cannot be responsible for the clinical picture. In addition, this reduced blood flow is in many cases not present at all.
  • According to such theories, the aura is caused by “cortical depression” or by the abrupt transition of the neurons of the cerebral cortex from a phase of electrical hyperexcitability into a complete stasis. The brain wave, coinciding with the sudden transition of convulsive electrical activity to stasis (unknown etiology), could provoke the aura and sudden change in blood circulation (maximum in the phase of overexcitation and minimal in the phase of stagnation) and cause the pain.

Triggering factors for the aura

Some behaviors can trigger attacks of migraine with aura:

  • Allergies and food intolerance. Of particular importance is celiac disease or gluten intolerance. Those who suffer from a migraine with aura are 10 times more likely to have celiac disease. In addition, many celiac patients with aurami graines experience complete relief from headaches on a gluten-free diet.
  • Nutrition. Foods containing tyramine, monosodium glutamate, nitrates, aspartame and alcohol. Tyramine is an amino acid found in red wine, nuts, aged cheese, liver, yeast, sausages, canned fish, chocolate, bananas, avocados, plums, tomatoes, eggplant, cabbage, etc. Glutamate is mainly contained in bouillon cubes. Nitrates are the most important preservatives in sausages. Aspartame is a sweetener and is found in all sugar-free and sweetened foods.
  • Both physical (extraordinary physical exertion or intense sports activities) and mental stress.
  • Lowering blood sugar. Occurs, for example, when skipping a meal.
  • Hormonal fluctuations in women. Menstrual cycle, contraceptives, menopause.
  • Cigarette smoking.

Difficult diagnosis of migraine with aura

Diagnosis is complex. There are special centers for diagnosis and treatment of cephalgia. This requires a thorough analysis of the patient’s medical history and clinical appearance.

A detailed diary of the course of the disease is crucial for this initial phase of diagnosis. In the diary it is necessary to carefully record all the following elements, which are important for the doctor to better understand the symptoms of the disease:

  • List of all disorders you suffer from, even if they do not seem to be related to the disease. Describe exactly when and how the symptoms occur, their intensity, duration and whether there is a remedy that alleviates the disorders.
  • List with the beginning and duration of all diseases from which one suffers.
  • List with the essential information about his life and habits, psychological problems, causes of stress, etc.
  • List of medications and supplements taken, as well as their dosage.

The specialist will make a suspected diagnosis based on the symptoms and this information. This suspicion must be confirmed by some clinical analyzes to exclude diseases with similar symptoms. Therefore, it is necessary to:

  • Magnetic resonance imaging of the brain. In order to determine the tissue status and to be able to exclude possible tumors.
  • To study the proper functioning of the intracranial vascular system.
  • Echography of the carotid arteries. To detect any constrictions.
  • Transcranial Doppler sonography. Indicates the presence of microembolisms indicating a perforating foramen ovale or PFO. Cardiac abnormality, which creates a connection between the right and left atrium, thus causing the formation of blood clots, which can then reach the brain.
  • Encephalogram.

Treatment of this type of migraine

Treatment of migraine with aura provides for drug therapy, which affects both the symptoms and prevention.

Drug therapy to treat the symptoms includes the administration of painkillers. The most common are nonsteroidal anti-inflammatory drugs NSAIDs (acetylsalicylic acid, ibuprofen, etc.), which reduce inflammation and pain. Another category includes the triptans (sumatriptan, rizatriptan), which stimulate serotonin receptors.

Preventive treatment of migraine helps to prevent possible attacks. Their mode of action is not always known.
They belong to the category of cardiovascular agents: beta-blockers and calcium channel blockers; antidepressants such as SSRIs selective serotonin reuptake inhibitors; Anticonvulsants such as gabapentin.

Since there is no special treatment protocol for migraine with aura, there are a number of natural treatment measures, but they are applied with dubious results. The only certainty is that almost none has greater efficacy than a placebo. The only effective natural remedies are massage therapy and relaxing techniques, acupuncture and regular intravenous magnesium therapy.

How long does the migraine last? Prognosis

Usually, the disease does not cause serious complications, but in some rare cases, narrowing of the cerebral veins can lead to cerebral ischemia.
With the right treatment measures, the migraine can often be stopped before the symptoms develop. Otherwise, the duration varies, from a few hours to 2-3 days.

Migraine with aura in pregnancy and lactation period

A migraine with aura can worsen due to the hormonal failures, if not even start in pregnancy. During pregnancy and lactation, it is important to discuss therapy with the gynecologist and doctor, because some of the medications needed for treatment could be harmful to the fetus or to the newborn during lactation.

Read more: