Aura: Those Zig Zags and Flashes Before a Migraine

Bright dots and zig zags impacting your vision. Tingling on one side of your body. Struggling to express yourself clearly. If you experience any of these symptoms just before migraine pain begins, it’s very likely that you’re dealing with the separate and distinct stage of migraine known as aura.

‍Stages of Migraine 

What exactly is aura? Let’s take a look at all four typical and distinct stages that may occur during a migraine attack: 

• Prodrome/Premonitory Stage: Prodrome symptoms, which occur up to two days before a migraine attack, may cause a variety of symptoms from yawning and a feeling of euphoria, to depression, irritability, and neck stiffness. 
• Aura Stage: The American Migraine Foundation (AMF) describes aura as a set of sensory disturbances — vision changes, flashes of light or bright spots — that occur for 20-to-60 minutes before the start of migraine pain. Aura affects 25-30% of people with migraine.
• Headache/Attack Stage: The attack stage is what most people think of when they talk about migraine. Headache pain can start gradually, worsen over a period of one to several hours, and resolve slowly at the end of the episode. Often affecting just one side of the head, it can range from a dull, moderate level of pain to a severe and throbbing headache. Among other side effects, it may also cause sensitivity to light, noise and smell, as well as nausea and vomiting.
• Postdrome Stage: After pain subsides, the affected person may feel fatigued and moody, or have trouble concentrating for a day or two after the attack. 

Interestingly, not everyone with migraine will experience all of these stages. And people who do experience aura may find that it doesn't necessarily accompany each and every one of their migraine episodes. 

Cause and Symptoms of Migraine Aura

The cause of migraine aura is not yet fully understood. Scientists think it may be due to an electrical wave that moves across the visual cortex in the brain. This movement temporarily alters the blood flow, nerves, and chemicals in the brain, according to The Migraine Trust.

Aura is triggered by the same factors that can trigger an overall migraine episode, such as stress, too much or too little sleep, bright lights, certain foods and medications or, for women, their menstrual cycle.

Migraine aura can affect you in three different ways, according to the Cleveland Clinic:

• Visual: You might see stars, spots, flashes, geometric shapes, or zig zags in your vision, get tunnel vision or lose sight for brief periods. It’s estimated that visual effects impact 90-99% of people with aura.

• Sensory: You may feel tingling or numbness in your hands, fingers, face, or body. About 36 percent of people with aura feel this effect.

• Speech or language: You may temporarily slur or mumble words, or find yourself unable to find the right words. This affects only 10 percent of people with aura.

So…is Migraine with Aura Dangerous?‍

The short answer is no. Although aura can feel alarming, it generally doesn't last long and is not dangerous. But if your aura symptoms manifest abruptly, last over an hour, or don't completely resolve, seek medical attention, says the AMF. Symptoms of aura can be very similar to those of a stroke, so if you suddenly experience aura symptoms and haven’t before, check with your healthcare professional right away.

A related caution: aura can slightly elevate stroke risk, according to the American Heart Association. Research presented at the American Stroke Association’s International Stroke Conference in 2016 found that people who’ve had migraine with aura were 2.4 times more likely to eventually have an ischemic stroke (one caused by a blood clot) than people who’ve had migraine without aura. 

A 2020 study found that ischemic stroke in people with migraine and aura was associated with being young, female, using oral contraceptives, and smoking. So if you have migraine with aura, it's essential for you to lower any risk factors for stroke.

Treating Migraine Aura

So, if you start to experience zigzag lines or flashes of light that tell you a migraine is underway, what’s the best way to treat it? The same way you would treat the migraine pain stage – at the first sign of aura symptoms, take your migraine medication as prescribed by your healthcare professional. 

According to Mayo Clinic, that might include over-the-counter medications like aspirin and acetaminophen, or prescription triptans, dihydroergotamine, lasmiditan, and calcitonin gene-related peptide (CGRP) antagonists. If you also experience nausea or vomiting with migraine, your doctor may prescribe medication to manage that as well.

‍Individualized Treatment for Migraine

Researchers may never find a true cure for aura and migraine — one that works for everyone. But the best way to find a treatment that will work for you is by getting treatment individualized to your unique personal history and DNA.

Mable’s DNA test can provide valuable information about the genetic causes of your migraines, saving you months of experimenting with treatments that ultimately can’t or won’t work for you. Mable also offers you telehealth access to a doctor who will carefully review your DNA results and prescribe medication based on them.

For now, the customized approach you’ll get with Mable may be the closest to a migraine “cure” for you — your most informed, most effective treatment. Ready to get started? Take the Mable quiz.