Migraine auras are a fantastical part of a migraine. Gifting us with sights unseen by others. And then Bam pain. So they are also a great warning of impending DOOM. There are some auras that are just the most spectacular thing you have ever seen. Amazing what the brain produces as that flux of brain activities presses the wrong buttons. Not to mention the weird sensation. All of a sudden half your face is numb or tingling or both. Or your hearing goes all muffled and all you can hear is the damn tinnitus ringing in it.

It is the type of migraine I was diagnosed with when I was 20 and have had since, although I am chronic now and do also get vestibular migraine. I also have persistent migraine aura, but that is another post.

Let's talk migraine with aura

Here is the criteria for Migraine with Aura:

1.2.1 Typical aura with migraine headache


Typical aura consisting of visual and/or sensory and/or speech symptoms. Gradual development, duration no longer than one hour, a mix of positive and negative features and complete reversibility characterize the aura which is associated with a headache fulfilling criteria for 1.1 Migraine without aura.

Diagnostic criteria:

A. At least 2 attacks fulfilling criteria B–D
B. Aura consisting of at least one of the following, but no motor weakness*:
1. fully reversible visual symptoms including positive features (e.g., flickering lights, spots or lines) and/or negative features (i.e., loss of vision)
2. fully reversible sensory symptoms including positive features (i.e., pins and needles) and/or negative features (i.e., numbness)
3. fully reversible dysphasic speech disturbance
C. At least two of the following:
1. homonymous visual symptoms 1 and/or unilateral sensory symptoms
2. at least one aura symptom develops gradually over ≥5 minutes and/or different aura symptoms occur in succession over ≥5 minutes

3. each symptom lasts ≥5 and

D. Headache fulfilling criteria B–D for 1.1 Migraine without aura begins during the aura or follows aura within 60 minutes
E. Not attributed to another disorder

Yes, it is true that 25-30% of people with migraine experience the aura phase of a migraine. And if you have Migraine with aura, not every migraine will, in fact, have an aura. Apparently, only 20% of the time on average do they have an aura with their attack. Mine seems to have them more than that, but then there are a lot of auras we are talking about here for the brain to choose from. It certainly is a myth that every migraine comes with an aura. Heard that recently. No. There are types of migraine that do not have aura, such as migraine without aura.

Migraine aura

If you think you have auras that last longer than 1 hour remember the phases of a migraine are flexible in duration. You can have an aura last into the headache stage for example. However, this question was in fact studied.

“Background According to ICHD-II, and as proposed for ICHD-III, non-hemiplegic migraine aura (NHMA) symptoms last between five and 60 minutes whereas hemiplegic migraine aura can be longer. In ICHD-III it is proposed to label aura longer than an hour and less than a week as probable migraine with aura. We tested whether this was appropriate based on the available literature.

Methods We performed a systematic literature search identifying articles pertaining to a typical or prolonged duration of NHMA. We also performed a comprehensive literature search in order to identify all population-based studies or case series in which clinical features of NHMA, including but not restricted to aura duration, were reported, in order to gain a complete coverage of the available scientific data on aura duration.

Results We did not find any article exclusively focusing on the prevalence of a prolonged aura or more generally on typical NHMA duration. We found 10 articles that investigated NHMA features, including the aura duration. Five articles recorded the proportion of patients in whom whole NHMA lasted for more than one hour, which was the case in 12%–37% of patients. Six articles reported some information on the duration of single NHMA symptoms: visual aura disturbances lasting for more than one hour occurred in 6%–10% of patients, sensory aura in 14%–27% of patients and aphasic aura in 17%–60% of patients.

Conclusions The data indicate the duration of NHMA may be longer than one hour in a significant proportion of migraineurs. This seems to be especially true for non-visual aura symptoms. The term probable seems inappropriate in ICHD-III so we propose reinstating the category of prolonged aura for patients with symptoms longer than an hour and less than one week” http://cep.sagepub.com/content/33/7/483.abstract

So 12%-37% had auras last longer than an hour. visual aura disturbances lasting for more than one hour occurred in 6%–10% of patients, the sensory aura in 14%–27% of patients and aphasic aura in 17%–60% of patients.

Most people are under the impression that auras are visual. And the majority are. And can include such things as:

  • scotoma: a patch of decreased or lost vision;
  • phosphenes: brief flashes of light across the visual field
  • blurry vision
  • wavy lines: Like looking through heat. Warping lines.
  • And many more manifestations.

Now other non-visual and sensory auras some of which can include:

  • aphasia: the loss of the power to use or comprehend language; both words and numbers
  • allodynia; hypersensitivity to feel and touch (often felt on the scalp and people will say their hair hurts)
  • dizziness: and vertigo
  • confusion:
  • Tingling: hands, feet, face… tingling anywhere.
  • Hiccups
  • Numbness
  • olfactory hallucinations
  • decrease in hearing
  • Auditory hallucinations
Migraine with aura comes with risk factors. We have about double the risk of suffering the most common type of stroke. The risk triples for smokers. And those who smoke and use birth-control are 7 times as likely to suffer a stroke. There is also an increased risk of heart attacks and arterial claudication. There has recently been a study suggesting high risk of heart attacks, more than they had realized initially. And a higher than average suicide risk.

See other migraine aura posts:


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2 thoughts on “Let’s talk Migraine with aura

  1. Interesting, the first part about auras was pretty much how my epilepsy first manifested.

    When I had migraines as a teenager, mine were more like a sudden bolt of lightning. I’d just freeze on the spot wherever I was. Definitely horrible kind of pain, my heart goes out to you 😦 xxx

    Liked by 1 person

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