Understanding Migraine and Aura

For many, a migraine is synonymous with a debilitating, throbbing headache. However, for a significant minority of sufferers—around one in four—the experience is preceded or accompanied by a neurological phenomenon known as an "aura." This is a temporary sensory disturbance, and its most common manifestation is visual.

The aura is a temporary window into the complex mechanisms of the brain, a sensory experience that can be both bewildering and disorienting. It's a surreal event that can feel like looking through a broken lens, a kaleidoscope, or a funhouse mirror. Understanding these effects is the first step towards managing them and reducing the significant anxiety they can cause. For many, the visual spectacle of an aura serves as a critical warning sign, a signal that a full-blown migraine attack is imminent.

The Visual Hallucinations of a Migraine Aura

The visual aura typically begins gradually and can last anywhere from a few minutes to an hour. It usually starts as a small, sparkling spot or a shimmering zigzag line in the centre of your field of vision, which then slowly expands outwards, often moving from one side of the vision to the other.

Common visual symptoms include:

• Zigzag or 'Fortification' Patterns: These are perhaps the most classic visual aura symptom, often described as shimmering, jagged lines, similar to the crenellated walls of a castle. They can be coloured or black and white and may appear to float across your vision, sometimes pulsating or moving. This pattern, known medically as a scintillating scotoma, is the hallmark of a visual migraine aura.
  

• Flashes of Light or Stars: Sufferers may see bright, flashing lights, sparkles, or stars that can be intensely disruptive and can temporarily obscure their vision. These flashes can be so bright that they are almost painful to look at, even though they are not physically present.

• Blind Spots (Scotomas): As the aura expands, it can create a temporary blind spot or an area of distorted vision. The visual effect may appear as a blank, shimmering patch where you can't see properly. This can make reading or even simple tasks like walking through a room extremely difficult and disorienting.
  

• Blurred or Foggy Vision: The entire field of vision can become distorted or foggy, making it difficult to read, focus, or see clearly. The world can seem out of focus, as if looking through a steamed-up window.
  

• Kaleidoscopic and Hallucinatory Effects: Some people report seeing fragmented or distorted images, colours, or shapes that are not actually there. Objects might appear to shimmer or change in size, creating a truly surreal and unsettling experience.

It's important to note that a migraine with aura usually affects both eyes simultaneously. If you experience visual disturbances in only one eye, it might be a different, rarer condition called a retinal migraine. While both are related to changes in blood vessels, the single-eye effect of a retinal migraine can be a sign of other, more serious conditions and should be checked by a doctor.

The Timeline: A Four-Stage Process

A migraine with aura typically unfolds in a series of stages, and understanding them can help you manage an attack. The entire cycle can last anywhere from a few hours to several days.

1. Prodrome (The Warning Signs): This phase can begin up to 24 hours before the aura and headache. Symptoms are often subtle and can include mood changes (irritability or euphoria), food cravings, neck stiffness, frequent yawning, or fatigue. It's an important early warning that an attack is on its way, and for those who learn to recognise these signs, it can be a critical window to take preventative action.
   

2. Aura: As discussed, this is the neurological disturbance that precedes the headache. It usually develops gradually over 5 to 20 minutes and lasts for less than an hour. The visual symptoms are the most common, but other sensations like tingling or numbness in the face, hand, or arm, or even difficulty speaking (aphasia), can also occur. Sometimes, the aura can even happen without the headache—a phenomenon known as a "silent migraine."
   

3. Headache: The headache phase typically follows the aura. It is often a moderate to severe throbbing pain, usually on one side of the head, and can last from a few hours to up to three days. It's often accompanied by nausea, vomiting, and extreme sensitivity to light (photophobia) and sound (phonophobia). During this phase, even the slightest noise or change in light can feel unbearable, driving sufferers to seek a dark, quiet room.
   

4. Postdrome (The "Migraine Hangover"): Once the headache subsides, many people experience a "migraine hangover." This can last for a day or two and is characterised by a feeling of being 'drained', fatigue, difficulty concentrating, and a general lack of mental sharpness. Some describe it as feeling like a "fog" has settled over their brain.

Triggers and Causes

While the exact cause of migraines with aura remains a subject of ongoing research, it is believed to be linked to a wave of electrical or chemical activity that spreads across the brain's cortex. This phenomenon, known as cortical spreading depression, temporarily disrupts normal brain function, leading to the sensory disturbances of the aura.

Many of the same factors that trigger a regular migraine can also trigger an aura. Identifying and avoiding these triggers is a cornerstone of migraine management. Common triggers include:

• Stress: Both high-stress situations and the sudden relaxation after a period of stress can be a significant trigger.
  

• Sensory Stimuli: Bright or flickering lights (such as from computer screens or fluorescent bulbs), strong smells, and loud noises are well-known culprits.
  

• Changes in Sleep: Too much or too little sleep can disrupt the brain's rhythm and trigger an attack. Maintaining a consistent sleep schedule is often recommended.
  

• Hormonal Fluctuations: For women, changes in oestrogen levels during their menstrual cycle, pregnancy, or menopause are a very common trigger.
  

• Certain Foods and Drinks: Red wine, aged cheese, processed meats, and foods containing certain additives like MSG have all been implicated as potential triggers. Dehydration is also a major culprit, so staying well-hydrated is crucial.
  

• Weather Changes: Fluctuations in barometric pressure, sudden temperature changes, or strong winds can also be a trigger for some people.

What to Do When You Experience an Aura

If you experience an aura, especially for the first time, it can be an unsettling experience. The most important thing is to remain calm and follow a pre-planned course of action:

1. Stop What You Are Doing: If you are driving, pull over safely. If you are working on a computer, save your work and step away. Continuing to engage in complex tasks can worsen the symptoms and increase anxiety.
   

2. Seek a Dark, Quiet Place: Find a quiet, dark room where you can lie down and rest. This can help minimise the sensory overload that often accompanies a migraine and can help to prevent the headache from becoming more severe.
   

3. Take Your Medication: If you have been prescribed acute migraine medication, such as triptans, taking them at the very first sign of an aura can sometimes prevent the headache from developing or significantly reduce its severity.
   

4. Stay Hydrated: Dehydration is a common trigger, so sipping water can be helpful.

It's crucial to consult a GP or neurologist if you experience an aura for the first time, as they will need to rule out more serious conditions with similar symptoms, such as a mini-stroke (TIA) or seizure. While an aura is a classic sign of a migraine, a new or changing pattern of symptoms always warrants medical attention.

Living with migraine with aura requires a proactive approach. Keeping a migraine diary to track potential triggers, understanding your personal symptoms, and working with a healthcare professional to develop a management plan are all vital steps towards regaining control and reducing the impact this challenging condition has on your life.

The visual spectacle of the aura might be disorienting, but with the right knowledge and tools, it can become a predictable signal, allowing you to prepare for the storm and find relief more effectively.