What Are Migraine Auras? Causes, Symptoms, and Treatments to Know

A migraine aura is a set of physical and visual symptoms that can happen during a migraine attack, usually in the hour before headache pain begins. When having an aura, most people have some combination of  symptoms, such as feeling a tingling sensation and seeing flashing lights. The symptoms usually last for less than an hour and go away completely. 

In general, a migraine aura is harmless. But it can be easy to confuse migraine auras with more serious conditions, such as stroke or eye problems. Knowing what migraine aura is and how it differs from other (more serious) medical conditions, can help you know when you should get help.

What are migraines?

A migraine is a type of painful, recurring headache. It’s often located on one side of the head.  Migraines are sometimes preceded by an aura, but this isn’t always the case. 

People with migraines usually experience a specific pattern in their headaches. This pattern includes a history of at least five migraine attacks, each lasting between 4 and 72 hours when untreated.

Pain from a migraine typically meets at least two of the following characteristics: 

• Occurs on one side of the head

• Has a pulsating quality

• Ranges from moderate to severe in intensity

• Worsens with physical activity

Additionally, migraines are often accompanied by at least one of the following symptoms: 

• Nausea

• Vomiting

• Sensitivity to light or noise 

What is a migraine aura?

Migraine auras are visual and physical symptoms that can occur with a migraine attack — like seeing lights or feeling a tingling sensation in your body. For many people, migraine aura is a sign that headache pain is on the way. But aura can also happen at other times during a migraine attack. And it’s even possible to have migraine aura but never have headache pain.

Between 20% and 40% of people with migraines have auras.

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Migraine aura symptoms

A typical migraine aura usually has at least one or more symptoms. Changes in vision are the most common. In fact, 99% of people with aura will have visual symptoms at some point. Typical migraine aura symptoms include: 

• Blind spots or changes in vision

• Seeing shimmering spots or geometrical shapes

• Seeing wavy or zigzag lines

• Seeing flashing lights

• Tingling (pins and needles) in your arms, legs, or face

• Mixing up words

• Trouble finding words

Symptoms usually take about 5 to 30 minutes to start and spread. The symptoms usually go completely away within an hour. In many cases — but not always — a headache will follow. But pain and aura can also happen at the same time, and aura can even occur with no headache pain at all. 

If you’ve never had them before, these symptoms can be scary. But, fortunately, aura symptoms tend to follow certain patterns. During aura, at least three of the following will be true:

• You have at least one symptom that spreads gradually over 5 or more minutes.

• You have two or more symptoms back to back.

• Each symptom lasts between 5 and 60 minutes.

• You have a headache during or after the aura phase.

• You have symptoms on only one side of the body.

• Your symptoms include visual hallucinations (seeing things that aren’t there).

What causes migraine auras?

Experts don’t know for sure what causes migraine auras. Scientists believe the cause may be cortical spreading depression, a wave-like pattern of electricity in your brain. This pattern changes the blood flow and chemical activity in your brain, which may lead to migraine aura and other symptoms.

Migraine aura treatments

Treatments are the same whether you have a migraine with aura or a migraine without aura. Common migraine medications are:

• Nonsteroidal anti-inflammatory drugs (NSAIDs), like ibuprofen

• Triptans, like naratriptan

• Calcitonin gene-related peptide receptor antagonists (CGRPs), like Ubrelvy (ubrogepant)

• Anti-nausea medications, like ondansetron

• Serotonin agonist, like Reyvow (lasmiditan)

• Dihydroergotamine

Some of these medications work best when taken early. For many people, the aura phase of a migraine attack is a good time to take action.

Unusual types of migraines with aura

There are four other types of migraine with aura. These are all unique types of migraines and are different from the migraine with typical aura described above.

Migraine with brainstem aura (basilar migraine)

People with this condition have unique aura symptoms. This is because their migraine involves the brainstem (the base of the brain). In addition to typical visual and sensory aura symptoms, people with migraine with brainstem aura can also have:

• Double vision

• Trouble speaking

• Ringing in the ears

• Dizziness

• Poor coordination

• Vertigo

Hemiplegic migraine

This is a rare type of migraine where people have noticeable weakness or paralysis on one side of the body. Paralysis on one side of the body is called hemiplegia.

Hemiplegic migraines can sometimes occur in people with no family history of migraine. They can also be an inherited genetic condition (meaning this type of migraine runs in the family). In addition to typical visual and sensory aura symptoms, people with hemiplegic migraine can have:

• Weakness or paralysis on one side of the body (hemiplegia)

• Fever

• Confusion

• Poor coordination

• Jerky eye movements (nystagmus)

Ocular migraine

Unlike classic migraines, which are associated with severe headaches, ocular migraines cause brief episodes of vision changes of many types. When you get an ocular migraine, you might have vision loss, or see things like flashing lights, blind spots, or zigzags. Ocular migraines typically last less than an hour and get better on their own. This term has sometimes been used interchangeably with retinal migraine, a more specific kind of migraine.

Retinal migraine

A retinal migraine aura is similar to those associated with a classic migraine, but it only causes symptoms in one eye. A retinal migraine aura is usually described as temporary vision loss and is commonly followed by a headache within an hour.

Is a migraine aura dangerous?

Migraine aura is not in itself dangerous. Symptoms start gradually, last less than 1 hour, and go away completely when the aura is over. But migraine aura symptoms can sometimes look and feel like other serious conditions, such as a stroke. It’s important to know when your symptoms are normal and when they could be something potentially more serious.

Is it a migraine or a stroke?

Migraine aura is often confused with stroke. Some aura symptoms can feel very similar to a stroke or a mini-stroke, called a transient ischemic attack (TIA). Examples of these symptoms include:

• Confusion

• Changes in vision 

• Body weakness

• Speech problems

In a migraine aura, however, symptoms tend to start gradually and spread slowly. This is different from a stroke or TIA, where the symptoms are often more sudden.

Knowing the warning signs of a stroke or TIA can help you know when to get help. If you suspect a stroke, remember to act FAST:

• F: FACE – Does one side of the face droop when smiling?

• A: ARMS – Does one arm drift downward when raised overhead?

• S: SPEECH – Is speech slurred or strange?

• T: TIME – Time counts. Call 911 right away if you see any of these symptoms.

Is it a migraine or blindness?

When you have a visual aura with a migraine, the symptoms can be very similar to emergency eye problems, like retinal detachment or optic neuritis. These conditions can cause blind spots and flashing lights, just like migraine aura. But, unlike aura, these symptoms don’t usually stop on their own. Remember: In normal migraine aura, symptoms should go away completely. If you experience new dark spots or lights in one eye, this may be a sign of a medical emergency — especially if they persist beyond 1 hour.

Are migraines a health risk?

People with migraine may be at higher risk for other medical conditions. For example, people who have migraines may be twice as likely to have a stroke at some point in their life. This may be especially true in people who have migraines with aura. The risk of stroke may also be higher for women, smokers, and people who take hormonal birth control pills.

People with migraines are also more likely to have other health conditions. These include cardiovascular disease, high blood pressure (hypertension), and high blood fats (hyperlipidemia). In addition, 60% of people with migraine with aura may have a patent foramen ovale (a small hole in the heart wall). These conditions may all increase the risk of having a stroke or heart attack.

Some people with migraines also frequently use NSAIDs like Advil or Aleve. Using nonaspirin NSAIDs for a long time may also increase the risk of stroke or heart attack.

There are also questions about whether there’s a connection between aura and seizures. In the past, some scientists have said that aura could potentially cause a seizure. This used to be called migralepsy. However, there doesn’t seem to be any clear evidence that aura can cause a seizure. It’s more likely that some seizure disorders could have headaches as a symptom.

Finally, people who have migraines with aura may be at risk for depression, anxiety, and suicide. In one large study, women who have migraine aura were more likely to have depression and/or anxiety when compared with women without it.

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Written by:

Sarah Gupta, MD

Sarah Gupta, MD, is a licensed physician with a special interest in mental health, sex and gender, eating disorders, and the human microbiome. She is currently board certified by the American Board of Psychiatry and Neurology.

Edited by:

Karla Robinson, MD

Karla Robinson, MD, is a medical editor for GoodRx. She is a licensed, board-certified family physician with almost 20 years of experience in health through varied clinical, administrative, and educational roles.

Reviewed by:

Farzon A. Nahvi, MD

Farzon Nahvi, MD, is an emergency medicine physician and author of “Code Gray: Death, Life, and Uncertainty in the ER.” He works at Concord Hospital in Concord, New Hampshire, and teaches at the Geisel School of Medicine at Dartmouth.

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