Migraine aura

Migraine aura is a set of transient neurological symptoms that occur before or during a migraine attack, and in some patients, they may even occur without subsequent headache. These symptoms most often involve visual disturbances, less frequently sensory, speech, or motor coordination issues. Aura symptoms develop gradually, intensify over time, and usually resolve spontaneously within 5–60 minutes. From a neurological standpoint, an aura is not a "supplement" to a migraine but rather a separate pathophysiological phenomenon, associated with a temporary functional disturbance of the cerebral cortex. Its recognition is of significant diagnostic importance, as it helps differentiate migraine from other neurological conditions, such as transient cerebral ischemia or focal epilepsy.

Migraine aura – what are the initial symptoms

The initial symptoms of a migraine aura are usually subtle and gradually increasing, which distinguishes them from sudden vascular incidents. They most often have a visual nature but can also involve other neurological functions.

Most common migraine aura symptoms:

flashes of light, flickering points, or zigzag lines (known as scintillating scotoma),
visual field deficits (dark or blurry areas),
image distortion, wavy lines, difficulty in judging distance,
numbness or tingling in the face, tongue, hands (sensory symptoms),
temporary difficulties in speaking or word selection,
less commonly: balance or coordination disturbances.

Characteristic features of the symptoms:

gradually appear (increase over several minutes),
move (e.g., tingling from fingers to forearm),
completely subside without leaving neurological deficits.

For some patients, the aura ends with a typical migraine headache, while for others, the headache is mild or does not occur at all, which can be a source of concern and lead to mistaken suspicions of a more serious neurological condition.

Migraine aura - causes

The primary mechanism of a migraine aura is the so-called cortical spreading depression (CSD), which is a wave of temporary neuronal activity inhibition that moves across the cerebral cortex.

Key elements of the pathophysiology of an aura:

temporary disturbance of neuronal ionic balance,
changes in cerebral blood flow (initial short-term increase, followed by a decrease),
activation of the trigeminovascular system,
release of pro-inflammatory neuropeptides (e.g., CGRP).

Factors favoring the occurrence of an aura:

genetic predispositions (migraine with aura often runs in families),
psychological stress and chronic tension,
sleep disorders and circadian rhythm disruption,
sudden hormonal changes,
certain visual stimuli (flashing lights, prolonged screen time),
fasting, dehydration, sudden blood sugar fluctuations.

It is important to emphasize that a migraine aura is not caused by permanent cerebral ischemia, although its symptoms may resemble it. Despite this, every first episode of an aura or a change in its character requires neurological diagnostics.

Migraine Aura – Treatment

The treatment of migraine aura depends on the frequency of its occurrence, the severity of neurological symptoms, and the temporal relationship with the migraine headache attack. The aura itself, as a phenomenon resulting from spreading cortical depression, is difficult to interrupt once it has started. Proper management can, however, reduce the intensity of symptoms and decrease the risk of developing a full-blown migraine attack.

Immediate management during the aura includes:

reducing sensory stimuli (light, noise, screen stimuli),
resting in a calm, dark environment,
proper hydration,
using pain relief or anti-migraine medication as per medical advice.

Preventive treatment is considered in situations where:

the aura occurs frequently or has a severe course,
neurological symptoms significantly disrupt daily functioning,
the migraine involves severe, recurrent headache attacks.

Prevention may include:

pharmacotherapy affecting neuronal excitability and nerve transmission,
methods regulating the autonomic nervous system function,
lifestyle modification, including normalizing sleep, regular meals, and reducing chronic stress.

It should be emphasized that migraine with aura is considered an independent vascular risk factor, which is clinically significant, among other things, when planning hormonal contraception and assessing overall cardiovascular risk.

Migraine treatment procedures

In patients with migraines, including migraines with aura, procedures with documented impact on the nervous system are increasingly used as a complement to pharmacological and prophylactic treatment. Their goal is not to interrupt a single aura, but to achieve a long-term reduction in the frequency and intensity of migraine attacks.

In clinical practice, the following are utilized:

procedures using botulinum toxin - affecting neuromuscular transmission and pain modulation within cranial and cervical nerves,
manual and physiotherapy treatments - aimed at normalizing the myofascial tension of the neck, shoulders, and skull base, which often constitute significant triggers for attacks,
neuromodulation and biophysical treatments - influencing the autonomic system, improving microcirculation and tissue metabolism in the head and neck area,
therapies supporting nerve regeneration and balance - used within comprehensive chronic migraine treatment programs.

The goals of procedural therapies are:

reducing the frequency of migraine attacks,
alleviating their intensity,
improving the patient's quality of life and functioning between attacks.

The selection of the appropriate method should always be preceded by a thorough medical history and neurological diagnosis to rule out other causes of symptoms and choose a therapeutic strategy suitable for the patient's individual profile.