Your migraine experience may be more then a one-sided, debilitating and pulsating headache. For many of you, it is also associated with a variety of neurological symptoms that can be uncomfortable and/or alarming. Let's review some of the symptoms one may experience during a migraine with aura.
Visual Changes in a Migraine Aura
A classic migraine visual aura is described as an arc of flashing lights that marches across your field of vision and lasts for over 5 minutes and less then 60 minutes. Other migraineurs often describe something more vague such as: sparkles, squiggles, TV static, and halos. Phosphenes, which are the sparks and flashes, and scotoma, which is an area of blurred vision that may or may not have a flickering light in its margin (scintillating scotoma), are the technical terms used when describing a visual aura. The primary cause of a migraine visual aura is thought to be from a mechanism called cortical spreading depression or CSD. CSD is a wave of depressed nerve activity in the brain that sweeps across the cortex. Preventive migraine medications like Topiramate (Topamax) have been found to suppress CSD in the brain, thereby stopping migraine with aura formation.
In addition to a visual aura, people with migraines often describe photophobia, or sensitivity to light. This is due to inflammation of the blood vessels in the meninges, which are protective membranes surrounding the brain and spinal cord. While visual changes can accompany head pain, certain visual stimuli like bright or fluorescent lights can also be a trigger for a migraine.
Sensory Changes in a Migraine Aura
Sensory changes during a migraine may include numbness, tingling, pain, itching, and vibrations and can occur anywhere on the body. Often times, sensory symptoms will spread from one location of the body to the next in a matter of minutes. For instance, if tingling moves from your hand to the same side of your face and then to the shoulder, the first site (hand in this case) will resolve once the tingling affects the face and shoulder. This description can help you and your doctor distinguish a migraine aura from a stroke or seizure. Please note that motor symptoms, such as weakness or heaviness in a limb, are no longer part of the criteria for migraine with aura, according to the International Classification of Headache Disorders 2nd edition (ICHD-2). If motor symptoms are present, the migraine is classified as a hemiplegic migraine.
Language Changes in a Migraine Aura
While not common, speech difficulties may occur during a migraine aura, including difficulty understanding words and word-finding difficulties. This can be especially alarming for a patient, but, fortunately, usually lasts less than 30 minutes.
Now, remember that all of these neurological symptoms are reversible. This is key when differentiating a migraine from other more serious medical conditions like a seizure or stroke.
Other Potential Migraine Symptoms
Dr. Buchholz in his book, Heal Your Headache: The 1-2-3 Program for Taking Charge of Your Pain, describes the variety of other neurologic symptoms patients may experience or associate with their migraines. For example, migraneurs may describe vestibular symptoms such as: vertigo or a vague dizziness or lightheadedness. Similar to visual triggers, movements that provoke dizziness, such as rapid turning of your head or a roller coaster, may trigger a migraine in some patients.
Olfactory changes, or smells, can trigger a migraine or be apart of the attack itself. During a migraine, you may have noticed an increased sense of smell or a desire to avoid a smell. This is called osmophobia and is one of the alternate criteria for diagnosing migraine without aura in the 2nd edition of the International Headache Classification (ICHD-2).
Finally, migraneurs will sometimes report cognitive difficulties, such as memory loss or difficulty concentrating. Psychiatric or emotional disturbances, such as exacerbation of depression and anxiety, or onset of a panic attack, can also occur.
Take Home Points
• A migraine with aura can cause a variety of reversible symptoms including visual, sensory and language changes. You may notice other symptoms such as dizziness or an aversion to certain smells.
• A thorough history and physical examination by your doctor is important during a migraine with aura to differentiate it from other neurologic conditions, such as a stroke.
• If you suffer from migraine with aura, discuss your symptoms with your healthcare provider so she can help you minimize the discomfort of your head pain and/or aura through either pharmacologic or behavioral modifications.
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Buchholz, David & Reich, Stephen G (foreword). Heal Your Headache: The 1-2-3 Program For Taking Charge of Your Pain. New York: Workman, 2002.
Dalkara T, Nozari A, Moskowitz MA. Migraine aura pathophysiology: the role of blood vessels and microembolisation. Lancet Neurol. 2010 Mar;9(3):309-17.
Foroozan R & Cutrer FM. Transient Neurologic Dysfunction in Migraine. Neurol Clin. 2009 May;27(2):361-78.
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The American Headache Society Profiles. 2007. The American Headache Society. 7 Aug. 2013. 2006 Apr;59(4):652-61.