Migraine with aura is a unique and often perplexing condition that affects many individuals, including Shelly, whose experiences offer a glimpse into the complexities of this neurological phenomenon. In this comprehensive overview, we delve into what an aura is, the different types, typical durations, genetic factors, and potential triggers. We also explore the relationship between auras and other conditions, such as seizures and stroke, and provide guidance on what to do if you experience auras. Whether you’re newly diagnosed or seeking deeper understanding, this guide will equip you with essential knowledge about migraine with aura.
Shelly’s Story:
Shelly is now familiar with her aura. It starts with a flashing dot on the right side of her vision, which becomes larger and turns into squiggly lines. After about 40 minutes, she regains normal vision but gets a pounding headache. Occasionally, she experiences a “big aura,” where she loses her speech and feels confused for about an hour. The first big aura happened during her pregnancy, causing concern for her OBGYN. An MRI showed “little white dots,” but nothing else. Shelly later learned her father also had migraine with aura. She wonders if her son will have it too.
What is an aura?
An aura is a neurological symptom (vision, speech, sensation, motor function) that is caused by a wave of electricity on the surface of the brain. The wave moves gradually and eventually resolves. The aura symptoms often are progressive (though not always), and also resolve.
Are there different types of auras?
Yes. The most typical is the visual aura. People with migraine with aura usually have had many similar (stereotyped) episodes and are able to describe the aura.
Auras can also cause numbness, speech difficulty and even weakness on one side (this is called hemiplegic migraine). It is possible that vestibular migraine is linked to auras. “Confusional migraine,” though not an official term, may relate to auras affecting the language and thinking processes.
What is the typical duration of an aura?
Typically, auras are progressive and last from 5 minutes to one hour. If many different symptoms occur in a sequence, the aura might last longer. Rarely, the aura can be persistent and last many hours, days and even weeks.
Are auras genetic?
Migraine with aura tend to be more genetic than migraine without aura. Many genes are involved. Hemiplegic migraine has been associated with three genes that can be tested. The genes involved in auras influence the ways the neurons work and usually make them more excitable. Some genes cause auras with paralysis.
Is an aura different from a seizure?
Yes. Both involve abnormal brain electrical activity, but auras are slower and typically don’t appear on EEG. Auras usually have a predictable sequence of events and rarely involve loss of consciousness or abnormal movements seen in epilepsy.
Are there triggers for migraine with aura?
It is common for visual auras to be triggered by strong lights, flashing lights or patterns, lack of sleep, exercise, altitude, dehydration… anything that can make the neuron excitable or increase the “metabolic burden.” High estrogen levels (like during pregnancy) could also increase the risk of auras.
Are all auras caused by migraine?
The mechanism of the aura is an electrical wave called cortical spreading depression. The mechanism of the migraine is the inflammation around sensory nerves and the activation of different centres inside the brain. Following the Ping Pong Theory, it may be that a migraine could also trigger an aura, maybe because the migraine inflammation triggers the electrical wave.
Is it possible to have auras with no headache?
Auras can occur without migraines and may be caused by other conditions such as stroke, blood vessel problems, or brain lesions. New auras should always be evaluated by a doctor.
Is it true that auras increase the risk of stroke?
Yes. People with migraine with aura have an increased risk of stroke (3 to 4-times more than the general population). But this risk applies mostly to people below fifty, whose baseline stroke risk is very low. Nevertheless, people with migraine with aura should watch their vascular risk factors, abstain from smoking (everyone should do that anyway) and women should not use high dose estrogen-containing pills. The use of low dose estrogen is controversial. For more information, see our post on contraception and migraine.
What should I do if I have auras?
Auras can be completely benign, but they are still a medical condition. You should be evaluated to determine the need for investigations and treatments.
References
- Charles A. The Migraine Aura. Continuum (Minneap Minn). 2018;24(4, Headache):1009-22.
- Queiroz LP, Friedman DI, Rapoport AM, Purdy RA. Characteristics of migraine visual aura in Southern Brazil and Northern USA. Cephalalgia. 2011;31(16):1652-8.
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