Feeling occasional headaches after a stressful day is already frustrating enough, but migraines are on a whole different level. If a doctor has diagnosed you with migraine, you have likely endured a profound and intense level of chronic headache and discomfort. 

‍Migraine is a complex disorder that involves the brain and nerves, far exceeding only "head pain.” It can affect your mental health and senses and cause various symptoms that can affect your ability to function well on a daily basis. 

In fact, about one-third of people with migraine experience aura, which is a set of neurological symptoms that occur before or during a migraine attack. Migraine with aura generally causes you to experience visual and sensory symptoms, i.e., changes in vision and sensation on one side of your body. On rare occasions, some people experience aura symptoms that affect movement and balance (called motor symptoms), e.g., muscle weakness. 

Learning about migraine with aura, including its causes, triggers, types, duration, and symptoms, can help you make sense of what you feel when you’re having a migraine episode and also figure out when to seek immediate medical attention. 

What is migraine with aura?

Think of a migraine with aura as getting a sensory “heads-up” that a migraine attack is coming. Shortly before the headache hits (about 10-60 minutes before), you might notice speech difficulties or unusual changes in physical feeling and vision, such as seeing patterns, spots, or bright lights that aren’t really there. These symptoms are known as aura. While they commonly show up before the headache, they can sometimes appear during or even after the headache has already started.

For people who experience this type of migraine, aura is typically the second phase of a migraine attack, following the first phase, called the prodrome. But the aura phase may not occur in every migraine attack they experience. 

Migraine auras are temporary, and they typically develop gradually. But, if you’re experiencing auras for the first time, it may be difficult to tell whether they came on gradually or suddenly. 

Types of migraine with aura

Migraine with aura can present in different ways, leading to different experiences. According to the International Classification of Headache Disorders, 3rd Edition (ICHD-3), types of migraine with aura include:

• Migraine with typical aura (with or without headache)
• Migraine with brainstem aura
• Migraine with atypical aura (hemiplegic and retinal)

Migraine with typical aura

Most people who have migraines with aura experience the typical form. It mainly causes vision symptoms such as flashes or white spots, but it can also affect your speech and physical sensations, causing, for instance, a tingling or the feeling of needle pricks on your skin. 

These warning symptoms usually develop gradually, last for less than an hour, and fade away before or shortly after the painful phase of the migraine attack starts. 

Migraine aura without headache

You may experience the symptoms of a migraine with typical aura without having a headache afterwards. This is also called silent migraine. It is more common in some older adults and in people with a history of migraine with aura.

Migraine with brainstem aura

Migraine with brainstem aura is slightly less common. Unlike typical migraines that mostly cause temporary changes to vision, this one involves symptoms linked to your brainstem (the base or lowest part of the brain). 

The brainstem is heavily involved in controlling many activities of the central nervous system, including motor control. While disorders linked to the brainstem typically cause physical motor weakness and paralysis, a key thing to know about migraine with brainstem aura is that it won’t cause such symptoms or make you lose muscle control. 

Migraine with brainstem aura will cause at least two of these symptoms:

• Vertigo (an intense feeling of dizziness, like you are spinning)
• Hearing loss or hearing problem, e.g., ringing in the ears
• Fainting feeling
• Poor muscle coordination (such as shakiness)
• Double vision
• Speech problem, e.g., slurred speech 

Migraine with atypical aura

People don’t usually experience hemiplegic and retinal migraine auras. Both forms are incredibly rare. 

Medical experts consider hemiplegic migraine to be hereditary. The symptoms can mimic stroke, causing weakness on one side of the body, including the face and limbs. However, unlike stroke, the symptoms are temporary. Still, it is important that you don’t dismiss symptoms that present as one-sided weakness, as this may point towards a life-threatening issue like stroke. Seek immediate medical attention instead.

Retinal migraine aura, on the other hand, causes repeated, reversible visual disturbances, such as flashes, blind spots, or temporary vision loss in one eye only. However, this migraine aura type is rare, and it's unlikely that you experience it. If you experience vision loss, it is best to reach out to your doctor right away for proper evaluation. 

Common migraine aura symptoms

Migraine aura symptoms are temporary and are reversible. They are also distinct and vary widely from person to person, so your experience with this migraine phase may differ from someone else's. Among the most common symptoms people report are seeing zigzag patterns, flashes of bright light, foggy vision, and small blind spots. 

That said, migraine aura symptoms can be categorized as follows. 

Visual aura 

Visual auras are temporary changes in sight that occur before or during a migraine attack. These symptoms are the most commonly experienced and happen in up to 98% of migraines with aura. Common visual aura symptoms include:

• Zigzag patterns
• Shimmering spots
• White spots
• Bright or flashing lights
• Blurry (foggy) or distorted vision
• Blind spots (scotomas)
• Partial vision loss
• Small bright dots (phosphenes)
• Movement of stationary objects (Oscillopsia / autokinesis)
• Things looking larger or smaller than they really are

A true aura typically affects both eyes, with visual symptoms often starting near the center of vision and expanding outward. However, you may find it difficult to determine whether it is occurring in both eyes or just one. If so, your doctor may guide you through a simple exercise to help figure out what’s going on, e.g., covering one eye while leaving the other open to see if you notice the aura and doing the same for the other eye. 

Sensory aura

Sensory aura symptoms are the temporary changes in feeling or sensation that you may experience before or during a migraine attack. About 36% of auras are sensory in nature. 

They often start gradually as tingling or pins and needles in the fingers and mouth and may travel up an arm or into the face, mouth, or tongue. You may also experience it as a sensation on only one side of the body. 

Sensory aura can cause:

• Tingling or pins-and-needles sensation
• Numbness in the face, hand, or arm
• Sensations that gradually move across one side of the body

Speech or language aura (aphasic aura)

You may also experience migraine aura that comes with temporary speech or language disturbances, although this happens less frequently. 

Possible symptoms of speech/language aura include:

• Difficulty finding the right words
• Slurred speech 
• Mumbling words
• Trouble understanding language

Since these signs can mimic a stroke, it’s best not to take any chances. If you notice such unusual symptoms, especially if they are happening for the first time, get checked out by a doctor right away.

Motor aura 

Motor aura symptoms involve temporary weakness or difficulty moving a part of the body. You may feel weakness in one side of your face, arms, or legs. Motor aura symptoms are uncommon and are most often seen in people who get hemiplegic migraines.

Why migraine aura happens

Scientists have carried out research over the years to understand why migraines happen. Here are key causes and mechanisms that have been identified:

• Cortical spreading depression (CSP): You can think of this as a widespread disruption of electrical activity in the brain or a wave of abnormal electrical activity moving across the brain. This triggers migraine aura.
• Brain chemical changes: CSP activates a group of nerves, leading to the release of certain proteins, such as Calcitonin Gene-Related Peptide (CGRP), which can trigger inflammatory changes in pain-sensitive protective layers of the brain. This, in turn, contributes to the headache associated with migraine.

These brain changes, while associated with migraines, do not cause permanent brain damage. The type of symptoms you experience will depend on the part of your brain that is affected. For example, a visual aura is associated with activity in areas of the brain that process vision.

Common triggers for migraine with aura

Triggers won’t cause you to develop a migraine with aura, but they can increase the chances of an attack happening if you’re already prone to migraines. Some common potential triggers of migraine with aura include:

• Stress and anxiety
• Hormonal changes
• Sleep disturbances
• Dehydration
• Strong smells
• Bright or flashing lights
• Smoking and alcohol (often red wine)
• Certain foods or additives, such as soy products, MSG, and aged cheeses
• Loud noises
• Fasting
• Caffeine intake
• Weather changes

Triggers vary from person to person. It’s best to listen to your body and keep track of events and any changes so you can determine what may trigger an attack for you. A migraine diary can be helpful and practical for this purpose. In your diary, enter information like when your migraine started, what you ate from about 24 hours before the attack, what you were doing, and where you were when it started.

How long do migraine aura symptoms last?

Migraine attacks occur in four phases: prodrome, aura, headache, and postdrome. Migraine aura symptoms develop gradually over 5-20 minutes and often last between 5 minutes and an hour. 

Those who have migraines without aura will typically experience three phases of migraine progression instead of four. You can also experience aura symptoms without getting a headache afterwards. 

Risk factors: Who is more likely to get migraine with aura?

Anyone, including children, can develop migraines. However, some people may be at a higher risk of developing it. Factors that may influence the likelihood of developing a migraine include:

• A family history of migraine: Research indicates migraine has a strong genetic component, meaning it can be inherited genetically. Relatives of people with migraine are three times more likely to develop it than those without a family history. To be more specific, you are about four times more likely to have migraine with aura, if you have a first-degree relative who has it.
• Sex assigned at birth: Migraines are generally more common in people assigned female at birth (AFABs). About three out of four people who have migraines are AFABs, so it’s no wonder that migraine and women’s health are two closely connected topics. However, those assigned male at birth (AMABs) are more likely to experience migraine with aura, in particular.
• Younger adulthood: People usually start getting migraines around their teenage years, and the prevalence peaks between the ages 20 and 40. This indicates you are more likely to develop them as a young person or early in adulthood than later in life. 
• Hormonal changes: Hormones such as serotonin could also be contributing to migraine episodes. Notably, it appears there is a complex relationship between female sex hormones and migraine. Natural changes in levels of hormones like estrogen and progesterone that come with menstrual cycles, pregnancy, and menopause may explain why migraines tend to affect women more often.

Other factors like socio-economic status and racial descent may also influence the risks of having migraines. People who are experiencing poverty and facing unemployment tend to have a higher likelihood of having migraines. The same is true for people of Native American descent.

How migraine with aura is diagnosed

Getting a clear diagnosis of migraine with aura isn’t always straightforward. This is because the symptoms can look a lot like other conditions. Also, having migraine with aura increases your likelihood of developing other medical conditions, so it can be hard to separate the symptoms. Your doctor will likely want to piece together the full picture to confirm what exactly is going on.

Some medical conditions with similar symptoms as migraine aura include focal epilepsy (a type of seizure that affects only one side of the brain and body), stroke, and other conditions that affect the flow of blood to the brain. 

To be sure and to rule out these other possible conditions, your healthcare provider may use different diagnostic approaches, such as:

• Asking about your symptoms, including how long they last
• Taking your medical history
• Doing a neurological exam (to assess if your brain and nerves are functioning properly)
• Doing an eye examination
• Carrying out imaging tests like MRI and CT scans (not commonly used for diagnosing migraine, but may be recommended if your doctor suspects a different condition is causing your symptoms)

It is very helpful to keep a log of your symptoms and what might be triggering them. This can be the key to a faster diagnosis, as sharing these notes with your doctor makes it much easier for them to pinpoint your specific type of migraine and get you the right treatment faster.

Treatment options for migraine with aura

Migraine is a chronic condition and currently has no standard cure, but your doctor can recommend treatments to help improve your symptoms, stop an attack, and prevent future attacks. Aside from treating the aura symptoms, recommended treatments can also target other phases of migraine. 

Acute treatments

If you’re experiencing a migraine with aura, your doctor may prescribe the following acute treatments for migraine to immediately reduce symptoms like headache and nausea:

• Non-steroidal anti-inflammatory drugs (NSAIDs), e.g., ibuprofen and naproxen
• Triptans (migraine medicines that target pain pathways in the brain)
• Anti-nausea medications
• CGRP antagonists (newer medications that may help stop attacks by preventing activation of specific pain-related nerves in the brain)

Home remedies

Doing the following can also help ease your symptoms:

• Getting some rest/break 
• Getting sleep (best in a quiet, darkened room)
• Ice therapy (placing an ice pack on your forehead)
• Drinking lots of fluid, especially if your migraine is causing vomiting leading to excessive loss of body fluid

Preventive treatments

If you are having frequent, recurring migraines, your doctor could put you on preventive treatments for migraines to help reduce the frequency and severity of your attacks. They may include:

• Beta blockers (medications that block the effects of adrenaline one of the body’s stress hormones)
• Anticonvulsants
• Antidepressants
• Botulinum toxin injections
• Psychotherapy (may be helpful if your migraine attacks are linked to depression or anxiety)
• CGRP monoclonal antibodies (newer preventive treatment)

Possible complications of migraine with aura

Rarely, migraine with aura can lead to complications such as:

• Persistent aura (that lasts longer than a week after migraine headache has stopped)
• Status migrainosus (a severe, disabling migraine attack that doesn’t respond to usual treatment and lasts for more than 72 hours)
• Increased risk of stroke and other cardiovascular conditions
• Migraine-aura triggered seizure (typically occurring within one hour)
• Mental health impacts

When to seek medical care for migraine aura

Migraine attacks can be draining and can affect everyone differently, but the symptoms are usually temporary and often completely resolve after the attack. 

If your symptoms change or you experience something you’ve never felt before, or simply something that feels off, it’s important to check in with a healthcare provider immediately. They can help figure out whether what is happening is part of a typical migraine pattern or something else that needs a closer look. 

Seek immediate medical care if:

• You have aura symptoms that last longer than 60 minutes
• Symptoms include severe weakness
• The headache is so severe that the pupils are very dilated or very constricted
• You experience a sudden loss of vision (especially if it is in one eye only)
• The symptoms are new or unusual
• Symptoms resemble stroke

Frequently asked questions about migraine with aura

Here are quick and helpful answers to some commonly asked questions about migraine with aura. 

What triggers migraines with aura?

Migraine aura triggers vary from person to person. Many people have reported triggers such as stress, loud noises, weather changes (especially extreme or abrupt changes), strong smells, inadequate sleep, certain foods or additives, and hormonal changes. Keeping a symptom diary may help you identify personal triggers.

Can you have aura without headache?

Yes, it is possible to experience aura without headache. This is called a silent migraine, or preferably, migraine aura without headache. It’s fairly uncommon and typically happens when people experiencing migraine aura with headache stop experiencing the headache phase as they get older.

How long does migraine aura last?

Migraine aura develops gradually and often lasts 5–60 minutes. If you have aura that persists for a longer period, you should let your doctor know. 

What does migraine aura look like?

A migraine with aura typically presents with visual disturbances like seeing zigzag patterns, shimmering spots, bright or flashing lights, distorted vision, and small bright dots. Occasionally, it may cause changes in sensation and speech, and rarely, muscle weakness.

Are migraines with auras serious?

Migraines with auras cause symptoms that can disrupt daily life and increase the risk of conditions like stroke. It can feel frightening to experience this myriad of changes in vision and bodily sensations. However, they are temporary and mostly reversible. Your doctor can give you a treatment that helps improve symptoms and lower the risk of complications.

Is migraine with aura a ‘mini stroke’?

A migraine with aura is different from a stroke. Its symptoms build gradually and spread. The symptoms are also temporary, with things going back to normal after about an hour. 

A stroke, on the other hand, comes on suddenly, accompanied by typical warning signs of stroke: facial drooping, arm weakness, and slurred speech, along with other signs like confusion and vision changes. Always seek urgent medical care if you experience something like this—especially the first time it occurs. 

Should I go to the ER for migraine aura?

You may not need to seek emergency medical care each time you experience a migraine aura episode. However, it’s advisable to get urgent care if this is your first migraine aura, if you experience vision loss or one-sided weakness, if your symptoms persist for more than an hour, or if you notice symptoms that are unusually different from previous attacks.

Making sense of migraine aura symptoms

If you have a migraine with aura, you might experience more than vision changes—you could also have temporary trouble speaking, hearing loss, or a tingling feeling of pins and needles pricking. Managing all these symptoms while dealing with a severe headache can feel overwhelming. 

Having an expert medical team like Neura Health by your side can make all the difference. A proper medical evaluation can help you understand your condition better, learn how to manage it, and also bring you closer to positive treatment outcomes. Consider booking an appointment with a Neura Health neurologist to discuss your symptoms and next steps.

‍

Sources

1. American Headache Society. Migraine with aura.
2. Lucas C. (2021). Migraine with aura. Revue Neurologique, 177(7), 779–784. 
3. Shankar Kikkeri N, Nagalli S. Migraine With Aura. (2024) In: StatPearls,  StatPearls Publishing
4. American Migraine Foundation. The timeline of migraine attack.
5. American Migraine Foundation. Aura Without Headache or “Silent Migraine”: A Guide.
6. International Classification of Headache Disorders. Migraine.
7. Viana, M., Tronvik, E. A., Do, T. P., Zecca, C., & Hougaard, A. (2019). Clinical features of visual migraine aura: a systematic review. The Journal of Headache and Pain, 20(1), 64. 
8. American Headache Society. Types of aura.
9. American Migraine Foundation. Understanding migraine with aura.
10. National Institute of Neurological Disorders and Stroke. Migraine.
11. National Institutes of Health. Study shows how aura may lead to migraine headache.
12. American Headache Society. Pediatric migraine.
13. Bron, C., Sutherland, H. G., & Griffiths, L. R. (2021). Exploring the Hereditary Nature of Migraine. Neuropsychiatric Disease and Treatment, 17, 1183–1194.
14. Fila, M., Pawlowska, E., Szczepanska, J., & Blasiak, J. (2023). Different Aspects of Aging in Migraine. Aging and Disease, 14(6), 2028–2050. 
15. Joppeková, Ľ., Pinto, M. J., da Costa, M. D., Boček, R., Berman, G., Salim, Y., Akhtanova, D., Abzalbekova, A., MaassenVanDenBrink, A., Lampl, C., & European Headache Federation School of Advanced Sciences (EHF-SAS) (2025). What does a migraine aura look like?-A systematic review. The Journal of Headache and Pain, 26(1), 149.
16. Sutherland, H. G., & Griffiths, L. R. (2017). Genetics of Migraine: Insights into the Molecular Basis of Migraine Disorders. Headache, 57(4), 537–569. 
17. Optometrists Network. 11 causes of blurry vision in one eye.
18. Kamourieh, S., Rozen, T., & Anderson, J. M. (2024). Status migrainosus. Handbook of Clinical Neurology, 199, 413–439. 
19. American Migraine Foundation. Migraine aura without headache.
20. Centers for Disease Control and Prevention. Signs and symptoms of stroke.
21. American Optometric Association. Migraine with aura.
22. American Migraine Foundation. The relationship between migraine and mental health.
23. American Migraine Foundation. What a migraine attack can feel like: Understanding the neurological experience beyond head pain. 
24. American Stroke Association. Brain stem stroke.