Migraine with Aura

Overview, Causes, & Risk Factors

A migraine is a moderate-to-severe headache affecting one or both sides of the head. An aura is an abnormal sensation which warns that a migraine is coming on.

What is going on in the body?

A migraine begins when cells in the central part of the brain become oversensitive to stimulation. The reason this happens is not known. A migraine trigger causes these cells to suddenly begin firing electrical impulses. This causes a chain reaction inside the brain. The impulses travel through the brain in a wave, similar to the way ripples spread across the water when a stone is thrown into a pond. This spreading electrical impulse causes the release of serotonin and other brain chemicals.

Serotonin causes changes in blood flow to the brain. When an impulse reaches the outermost part of the brain, it triggers the release of substance P and other chemicals. These chemicals contribute to the pain, inflammation, and increased sensitivity. The result is the throbbing pain you feel.

What are the causes and risks of the disease?

A migraine occurs when cells in the center of the brain become overly sensitive to stimulation. Factors that may trigger a migraine include the following:

alcohol

certain foods, including chocolate and some cheeses

change in hormone levels

fatigue

food additives

foods containing tyramine, such as red wine and organ meats

light or noise

too much or too little sleep

weather changes

Symptoms & Signs

What are the signs and symptoms of the disease?

A migraine with aura usually has the following characteristics:

may involve sensitivity to light, sound, and odors

often accompanied by nausea and vomiting

pain usually lasts anywhere from 4 to 72 hours

severity may range from mild to excruciating

typically involves throbbing or pulsating pain on one or both sides of the head

An aura begins 5 to 30 minutes before the headache pain and may involve:

a feeling of numbness or pins and needles in the face or head

changes in hearing and smell

changes in vision, such as tunnel vision or blind spots

difficulty finding the right word while speaking

visual symptoms, such as wavy or jagged lines, dots, or flashing lights

Diagnosis & Tests

How is the disease diagnosed?

Diagnosis of a migraine with aura begins with a medical history and physical exam. Rarely, the healthcare provider may order tests to rule out other problems.

Prevention & Expectations

What can be done to prevent the disease?

An individual can lower the risk for migraine with aura by identifying and avoiding triggers. People who are sensitive to tyramine, for example, should not drink red wine. Medicines used to prevent migraines include the following:

anticonvulsants, such as gabapentin and carbamazepine

beta-blockers, such as atenolol and propanolol

calcium channel blockers, such as diltiazem and verapamil

lithium carbonate

methysergide maleate and methylergonovine maleate

nonsteroidal anti-inflammatory drugs, or NSAIDs, such as ibuprofen and naproxen sodium

other antidepressants, such as trazodone and venlafaxine HCl

selective serotonin reuptake inhibitors (SSRIs), including paroxetine HCl and fluoxetine HCl

tricyclic antidepressants, such as amitriptyline and nortriptyline

What are the long-term effects of the disease?

If the migraines are infrequent and mild, there are few long-term effects. If they are frequent and severe, they can greatly impair a person's ability to function or work. Rarely, a migraine can cause a stroke.

What are the risks to others?

Migraines with aura are not contagious and pose no risk to others.

Treatment & Monitoring

What are the treatments for the disease?

Medicines used to relieve the symptoms of migraine with aura include:

barbiturate combinations, such as butalbital with caffeine and acetaminophen

ergot alkaloids and derivatives, such as ergotamine

isometheptene agents, with combinations of isometheptene

narcotic analgesics, such as codeine and butorphanol

pain medicines, such as ibuprofen and acetaminophen

triptans or serotonin (5HT-1) receptor agonists, such as sumatriptan succinate

Alternative and complementary therapies for migraine with aura include:

acupuncture, a therapy used to relieve pain by inserting thin needles into certain parts of the body

aromatherapy, which uses oils to stimulate pleasant sensations and relieve stress

biofeedback, a process in which a person is taught how to relax when the body starts to show the signs of a headache

chiropractic, which involves manipulation of the spinal bones

anxiety

depression

eating disorders such as anorexia nervosa and bulimia

alcohol and drug abuse problems

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exercise

herbal remedies

hypnosis, which uses suggestion to influence the person's subconscious

relaxation training, which reduces stress and eases emotional strain

stress management

transcutaneous electrical nerve stimulation, or TENS, which relieves pain by stimulating nerves

What are the side effects of the treatments?

Medicines used to treat migraine with aura may cause drowsiness, allergic reactions, or rebound headache. Rebound headaches are caused by regular use of pain medicines.

How is the disease monitored?

The individual may be asked to keep a headache diary to identify triggers and track the success of treatment. Any new or worsening symptoms should be reported to the healthcare provider.