In the middle of a conversation, a part of the other person’s face disappears. At the edge, a shimmering zigzag line grows, slowly moving across the field of vision. The head doesn’t hurt yet. That usually changes soon. If you recognize this, you probably have a migraine with aura, and the fear that something dangerous is behind it is understandable.
What Happens During an Aura
The aura is a temporary disturbance of brain function that usually begins before the headache, sometimes even during it. It is believed that a wave of reduced nerve activity travels across the cerebral cortex. This explains why symptoms do not appear suddenly but spread gradually. The exact mechanism is not fully understood.
According to the International Classification of Headache Disorders (ICHD-3), a typical aura involves at least one symptom that gradually spreads over five minutes or longer. Each individual symptom lasts between five and 60 minutes and completely resolves. The headache often follows within an hour but can also be absent; in that case, it is referred to as an aura without headache.
How to Recognize an Aura
The most common symptoms are visual disturbances: flickering, jagged lines, bright spots, or a shifting visual field loss. Sensory disturbances are less common. A tingling sensation may then travel from the fingers up the arm to the face. Even rarer are speech disturbances, where words cannot be articulated.
The sequence of symptoms is often a clue. First vision, then tingling, then speech: This progression over minutes is typical for migraines. In contrast, a stroke usually begins abruptly, with deficits appearing immediately at full strength.
When It Is Not a Migraine Aura
Not every flicker originates from the brain. Sudden flashes of light, a swarm of black dots, or a shadow that comes in from the side can indicate a retinal detachment. This is a case for the eye doctor on the same day.
Age also matters. If someone notices flickering, paralysis, or speech disturbances for the first time at 55, they should not assume it is migraine but seek medical evaluation. A brief disturbance in brain circulation (TIA) can look similar and sometimes heralds a stroke.
What Helps During the Aura
The good news: The aura itself is harmless and resolves on its own. There is no medication that needs to be taken against it. Here’s what you can do:
- Stop any activities. Driving, stairs, and machinery are off-limits during this time.
- Sit down or lie down, and go to a quiet, darkened room.
- Check the time. Duration and progression should later be noted in the headache diary.
- Take any prescribed acute medication only as your doctor has explained. The right timing depends on the medication and is determined individually.
Over-the-counter pain relievers are part of the acute treatment for milder attacks. Which medication is right for you can be clarified at the pharmacy or your general practitioner’s office; dosages do not belong in a blog article.
How the Diagnosis Is Made
A blood test or an image does not prove migraine with aura. The doctor will ask about the progression: What came first, how long did it last, what did the flickering look like, did it always occur on the same side? This is followed by a physical and neurological examination, where reflexes, strength, sensation, and eye movements are checked. If the findings are unremarkable and the progression is typical, that is usually sufficient.
It is helpful if you sketch the aura briefly next time or note with your phone what you see and when it starts. People tend to forget surprisingly many details afterward. If you have a companion, ask them to pay attention to your speech and facial expressions.
Preventing Long-Term
If attacks are frequent or significantly limit daily life, preventive treatment may be considered. This is decided by the doctor together with you, especially in the case of multiple attacks per month. Various groups of medications are available, which a doctor prescribes. Do not stop or start anything on your own.
You can also do something without pills. Regular sleep times, regular meals, endurance sports, and relaxation techniques reduce the number of attacks for many. Only your own calendar can provide proof, and that’s exactly what it’s for. More about the differences between headache types can be found in our article Tension Headache or Migraine: How to Recognize the Difference.
Aura and Contraception: A Point for Discussion in the Practice
Migraine with aura is associated with a slightly increased risk of stroke. The risk further increases with smoking and with contraceptives that contain estrogen. Women with aura are usually advised against combined hormonal contraceptives. There are well-tolerated alternatives. Discuss this with your gynecologist and explicitly mention the aura. However, do not stop taking the pill on your own.
When to See a Doctor Immediately
Call emergency services at 112 if:
- Paralysis, speech disturbances, or visual field loss occur suddenly
- The symptoms last longer than an hour
- The aura feels significantly different than usual
- Fever, neck stiffness, or altered consciousness accompany the aura
In any case, visit the practice at the first occurrence of an aura, even if everything is over. The same applies if the aura suddenly lasts longer or occurs more frequently.
Frequently Asked Questions
Is an Aura Dangerous?
The typical aura itself is not. It resolves without leaving damage. The increased risk of stroke mainly affects women with additional risk factors such as smoking or estrogen.
Can I Have an Aura Without a Headache?
Yes. This can happen, especially with increasing age. Since distinguishing it from a TIA is important, the first such case should be medically evaluated.
Should I Get an MRI for Aura?
In typical cases and with an unremarkable neurological examination, usually not. In cases of new or atypical symptoms, the doctor will decide whether imaging is necessary.
Read Also
- Tension Headache or Migraine: How to Recognize the Difference
- Sleep Medicine: Healing for Sleep Disorders and Ways to Restful Sleep
- Stress Management and Burnout Prevention: Ways to More Well-Being in Daily Life
This article is for informational purposes only and does not replace medical advice.
Sources
- Headache Classification Committee of the International Headache Society (IHS): The International Classification of Headache Disorders, 3rd edition (ICHD-3). Cephalalgia 2018;38(1):1–211.
- DGN and DMKG: Guidelines for the Treatment of Migraine Attacks and Prophylaxis of Migraine (AWMF-Register-No. 030/057).