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What Is a Migraine Aura Like?

  • Medical Author: Ronald Braswell, MD
  • Medical Editor: Joseph Carcione, Jr.; DO, MBA

Ask a Doctor

Sometimes I get headaches so bad that I seem to see stars, like in cartoons. I’m worried these images may be symptoms of an optical migraine. What is it like to have an ocular migraine aura?

Doctor’s Response

Aura is experienced by of some migraineurs (people who get migraine headaches). Aura is defined as focused symptoms that grow over 5-15 minutes and generally last about an hour. In most cases, the migraine headache follows the aura. However, the two events can happen at the same time, or the aura may develop after the headache starts. With aura, visual symptoms are most common and include the following:

  • Negative scotomata (blurred or absent areas in the vision field), tunnel vision, or even complete blindness
  • Positive visual problems, the most common of which consists of an absent arc or band of vision with a shimmering or glittering zigzag border: This is often combined with photopsias (a sensation of lights, sparks, or colors due to electrical or mechanical stimulation of the ocular [eye] system) or visual hallucinations that may take various shapes. This is a highly characteristic syndrome that always occurs before the headache phase of an attack and is specific to a diagnosis of classic migraine. It is called a "fortification spectrum" because the jagged edges of the hallucinated arc resemble a fortified town with bastions around it.
  • Photophobia
  • Photopsia (uniform flashes of light) or simple forms of visual hallucinations that occur commonly with positive visual phenomena

Migraine headaches typically occur on one side of the head and cause throbbing pain, but the features often vary. Migraineurs often experience a bilateral event, meaning that the pain can be felt anywhere around the head or neck.

Early symptoms are experienced by a majority of migraineurs. Forewarning of a migraine may occur hours to days before a headache event. Although the specific symptoms vary, they tend to remain the same for a given individual over time. These warning symptoms may include the following:

  • Photophobia, phonophobia, osmophobia (sensitivity to light, sound, and/or smells, respectively)
  • Lethargy (weariness, fatigue, lack of energy)
  • Mental and mood changes - Depression, anger, joy
  • Polyuria (urinating often and in large amounts)
  • Soreness and stiffness of neck muscles
  • Anorexia (diminished appetite, aversion to food)
  • Constipation or diarrhea

Motor symptoms like hemiparesis (weakness on one side of the body) and aphasia (poor or absent understanding and/or production of speech, writing, or signs) may occur but much less frequently.

Some people have auras only, without headaches. Treatment is usually unnecessary once the diagnosis is recognized and the migraineur reassured about it. If the aura always occurs on the same side, the risk of brain tumor or other abnormality is greater than in persons with routine headaches.

Typical headache characteristics are as follows:

  • On one side of the head in a majority of migraineurs
  • Slow onset (lasting 4-72 hours)
  • Described as throbbing or pulsing pain but can evolve into a continuous ache or bandlike pattern

Other associated symptoms include nausea, vomiting, paleness, and light-headedness.

For more information, read our full medical article on migraines.

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References
"Pathophysiology, clinical manifestations, and diagnosis of migraine in adults"
UpToDate.com
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