Migraine with Aura

Diagnosis

A healthcare professional may diagnose migraine with aura based on your symptoms, medical and family history, and a physical examination. The evaluation focuses on identifying a pattern of recurring headaches that are preceded or accompanied by neurological symptoms.

Typical features that support a diagnosis of migraine with aura include repeated headache episodes with the following characteristics:

• Pain on one side of the head

• Pulsing or throbbing head pain

• Temporary visual disturbances or vision loss

• Temporary changes in hearing

• Nausea

• Sensitivity to light and sound

There is no single test that confirms migraine with aura. If aura symptoms occur without head pain, or if symptoms are unusual, your healthcare professional may recommend tests to rule out more serious conditions such as a transient ischemic attack.

Additional assessments may include:

• Eye examination
  A detailed exam by an ophthalmologist can help rule out eye conditions that may cause visual symptoms.

• Head CT scan
  This imaging test uses X-rays to create detailed images of the brain. It is not usually needed to diagnose migraine with aura but may be used if symptoms are atypical or exam findings are unusual.

• MRI scan
  Magnetic resonance imaging produces detailed images of the brain. Like CT scans, it is generally not required unless symptoms are unusual or raise concern for other neurological conditions.

You may also be referred to a neurologist, a specialist in nervous system disorders, to exclude other brain-related causes of your symptoms.

Treatment

Treatment for migraine with aura focuses on relieving pain during attacks and, when needed, preventing future episodes. Management strategies are similar to those used for migraine without aura and are tailored to the severity and frequency of symptoms.

Medicines for relief

Medicines for symptom relief work best when taken at the first sign of an oncoming migraine, often when aura symptoms begin.

• Pain relievers
  Over-the-counter medicines such as aspirin and ibuprofen may help relieve mild to moderate migraine pain. Frequent use can lead to medication overuse headaches and gastrointestinal side effects. Combination medicines containing caffeine, aspirin and acetaminophen may also help in mild cases.

• Triptans
  Prescription medicines such as sumatriptan and rizatriptan reduce migraine pain by blocking pain pathways in the brain. They are available in tablet, injection and nasal spray forms and may not be safe for people at risk of stroke or heart attack.

• Dihydroergotamine
  Available as a nasal spray or injection, this medicine can be effective for migraines that last longer than 24 hours. It is not recommended for people with certain heart, blood pressure, kidney or liver conditions.

• Lasmiditan
  This oral medicine is approved for migraine with or without aura and can significantly reduce headache pain. It may cause dizziness and drowsiness, so driving or operating machinery should be avoided for several hours after use.

• CGRP antagonists
  Oral medicines such as ubrogepant and rimegepant, as well as nasal zavegepant, target migraine pathways and can relieve pain and symptoms like nausea and sensitivity to light and sound. Common side effects include nausea, dry mouth and sleepiness.

• Anti-nausea medicines
  These may be used alongside pain-relieving medicines if nausea and vomiting occur during migraine attacks.

Opioid medicines are generally avoided because of the risk of dependence and medication overuse headaches. Some migraine medicines are not safe during pregnancy, so treatment choices should be discussed with a healthcare professional.

Preventive medicines

Preventive treatment may be recommended if migraines with aura are frequent, long-lasting or severe and do not respond well to symptom-relief medicines. These medicines are taken regularly to reduce how often migraines occur and how intense they become.

Options include:

• Blood pressure–lowering medicines such as beta blockers and calcium channel blockers

• Antidepressants, including certain tricyclic antidepressants

• Anti-seizure medicines that help stabilize nerve activity

• Botox injections given at regular intervals for some adults

• CGRP monoclonal antibodies administered monthly or quarterly by injection

• CGRP antagonists taken orally for migraine prevention

Not all preventive medicines are suitable during pregnancy, so careful medical guidance is needed.

Stress management and lifestyle

Lifestyle changes and stress management can help reduce migraine frequency and severity. When aura symptoms begin, resting in a quiet, dark room and applying a cool cloth or ice pack to the forehead may provide relief.

Helpful strategies may include:

• Using relaxation techniques such as biofeedback or guided relaxation

• Maintaining regular sleep and meal schedules

• Drinking enough fluids to stay well hydrated

• Keeping a headache diary to identify and avoid migraine triggers

Understanding personal triggers such as certain foods, strong smells, loud noises or stress can help you take steps to prevent future migraine attacks.