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What Triggers Migraines With Aura



Migraines With Aura Cause Some Migraine Sufferers To See Geometric Patterns And Shiny Waves Heres What You Need To Know About This Type Of Migraine

The most well-known phase of a migraine is the headache phase. However, for about 10% to 30% of migraine sufferers, the head pain comes with some very distinct warning signs, commonly called an aura.

A migraine aura is a neurological phenomenon most commonly associated with visual disturbances before the onset of a headache. You may see things like zig zag lines, flashing lights, or other visual effects before your migraine begins.

However, some auras may involve sensory symptoms or speech and language disturbances.1,2

Read on to find out more about the causes and symptoms of this common type of migraine and learn how you can get relief when it does strike.

Learn More About Migraine Aura Without Headache Why You Should Visit A Doctor And Available Treatment Options

A small percentage of people with migraine experience an aura that is not followed by head pain. Migraine aura without headache is fairly uncommon and can be hard to distinguish from other visual disturbances, so we reached out to Dr. Kathleen Digre to learn more.

Dr. Digre is a distinguished professor of neurology and ophthalmology and director of the Headache Clinic at the University of Utah. She is also the immediate past president of the American Headache Society and a former president of the North American Neuro-Ophthalmology Society.

Visual Impairments Associated With Migraine Can Happen With Or Without A Headache

“Ocular Migraine” is a term that has been used to refer to a number of migraine subtypes that are characterized by a variety of visual disturbances including visual loss, blind spots, zig-zag lines, or seeing stars. Unlike other forms of migraine, they may occur without any accompanying head pain. It’s not uncommon for a single patient to experience a wide range of visual symptoms. Here’s what you need to know to better understand the migraine subtypes that affect vision.

What Are The ‘red Flags’ That My Visual Symptoms Are Not Due To Migraine

The typical symptoms of a visual migraine are “positive,” meaning that there is something shimmering or sparkling that is disrupting the vision. Migraines are less likely to cause “negative” symptoms of pure visual darkness. An episode of visual darkness typically requires additional evaluation for other conditions, including a “mini-stroke” .

Are There Other Types Of Migraine That Occur In Children And Adolescents

Migraine vs. headache: How to tell the difference

Yes, other types are grouped as either complicated migraine or migraine variants.

Complicated migraines are migraines with neurological symptoms, including:

  • Paralysis or weakness of the eye muscles that keep the eye in its normal position and control its movement. This was previously called an ophthalmoplegic migraine.
  • Weakness on one side of the body. This is called a hemiplegic migraine.
  • Pain at the base of the skull as well as numbness, tingling, visual changes and balance difficulties . This is called basilar migraine.
  • Confusion and speech and language problems. This is called confusional migraine and may also occur after a minor head injury.
  • Migraine variants are disorders in which the symptoms appear and disappear from time to time. Headache pain may be absent. Migraine variants are more common in children who have a family history of migraine or who will develop migraine later in life. Migraine variants include:
  • Paroxysmal vertigo – dizziness and vertigo that is brief, sudden, intense, and recurs.
  • Paroxysmal torticollis – sudden contraction of the neck muscles on one side of the head that causes the head to “tilt” to one side.
  • Cyclic vomiting – uncontrolled vomiting that lasts about 24 hours and occurs every 60 to 90 days.
  • Abdominal migraine – pain in the belly, usually near the belly button . Pain usually lasts 1 to 2 hours.

What Are The Types Of Headaches What Type Of Headache Is A Migraine

There are over 150 types of headaches, divided into two categories: primary headaches and secondary headaches. A migraine is a primary headache, meaning that it isn’t caused by a different medical condition. Primary headache disorders are clinical diagnoses, meaning there’s no blood test or imaging study to diagnose it. A secondary headache is a symptom of another health issue.

What Are The Four Stages Or Phases Of A Migraine Whats The Timeline

The four stages in chronological order are the prodrome , aura, headache and postdrome. About 30% of people experience symptoms before their headache starts.

The phases are:

  • Prodrome: The first stage lasts a few hours, or it can last days. You may or may not experience it as it may not happen every time. Some know it as the “preheadache” or “premonitory” phase.
  • Aura: The aura phase can last as long as 60 minutes or as little as five. Most people don’t experience an aura, and some have both the aura and the headache at the same time.
  • Headache: About four hours to 72 hours is how long the headache lasts. The word “ache” doesn’t do the pain justice because sometimes it’s mild, but usually, it’s described as drilling, throbbing or you may feel the sensation of an icepick in your head. Typically it starts on one side of your head and then spreads to the other side.
  • Postdrome: The postdrome stage goes on for a day or two. It’s often called a migraine “hangover” and 80% of those who have migraines experience it.
  • It can take about eight to 72 hours to go through the four stages.

    When Should I Seek Immediate Help Or Contact My Healthcare Provider

    • You are experiencing the “worst headache of my life.”
    • You are having neurologic symptoms that you’ve never had before, including speaking difficulty, balance problems, vision problems, mental confusion, seizures or numbing/tingling sensations.
    • Your headache comes on suddenly.
    • You have a headache after experiencing a head injury.

    Schedule a visit with your healthcare provider if:

    • The number or severity of your headaches increase or your headache pattern changes.
    • Your medications no longer seem to be working or you’re experiencing new or different side effects.

    Treatments For Migraine / How To Reduce Or Get Rid Of Migraine Aura

    Several medications are available to help relieve the pain of a migraine headache . These medications are categorized as abortive treatment and preventive treatment.

    Abortive medications are over-the-counter and prescription drugs that are taken at the first sign of a migraine to stop or reduce pain and other symptoms.

    For sufferers of migraine with aura, these medications should be taken as soon as the aura begins.

    Designed to work quickly to alleviate nausea and vomiting, the sooner these medications are taken, the more effective they are at treating the migraine.

    Abortive medications are varied and can be taken by mouth, skin patch, nasal spray or self-injection.

    Abortive migraine therapy includes prescription triptans, dihydroergotamines and narcotic opioids containing codeine.

    The common OTC pain relievers aspirin or ibuprofen, and migraine relief medications that combine caffeine, aspirin and acetaminophen , also can provide relief.

    Preventive migraine medications are taken daily to prevent migraines from occurring. This therapy reduces the number of attacks, lessens the intensity of pain and prevents the onset of future migraines.

    Preventive migraine therapy includes prescription high blood pressure medications like beta-blockers and calcium channel blockers, antidepressants, anti-seizure medications, and Botox.

    Some migraine sufferers end up taking both abortive and preventive medications for maximum control of their migraine attacks.

    Schedule an exam

    Treating And Preventing A Sudden Increase In Migraine With Aura

    There’s a lot that’s unknown about why migraine with aura or cortical spreading depression develop. It’s unclear at the moment whether impending migraine and blood flow changes itself triggers electrical changes in the brain or whether the electrical changes are the cause of blood flow changes and migraine.

    Migraine Without Aura And Migraine With Aura: Separate Entities

    Whether MA and MWA are part of a continuum or distinct entities has been much disputed . The continuum theory is based on the clinical co-occurrence of MA and MWA, the similarity between MA and MWA during the prodrome, the headache and the resolution phases and the similar therapeutic response. Clinical observations also suggest that one form may transform into the other . However, clinical, epidemiological, pathophysiological and genetic findings suggest that MA and MWA are distinct . The co-occurrence of MA and MWA is no more than a random occurrence . Moreover, headaches in MA are less severe and shorter than in MWA and in MWA a hormonal influence is clearer . In a population-based twin sample it was found that unilateral headache, photophobia and a shorter duration were associated with MA whilst nausea was more common in MWA .

    Dilatation of large inter- and extracranial arteries occurs in both forms during an attack, but regional cerebral blood flow changes are present only in MA . Finally imaging and biochemical studies suggest that these are two distinct entities .

    Gerry J.F. Saldanha, in, 2010

    Treating And Preventing Migraine With Aura Or Retinal Migraine

    For infrequent attacks, medications that target symptoms can be effective, from NSAIDs for pain to anti-nausea medications. Preventative therapies including calcium channel blockers, antiepileptic or tricyclic medications. Quitting smoking is recommended and cessation of oral contraceptives may be advised in certain circumstances. Some options for relief without drugs can include resting your eyes, removing yourself from bright sunlight or other harsh lighting, and taking a break from looking at a screen. As with all types of migraine, try to avoid triggers like stress, dehydration, high altitude, low blood sugar, excessive heat and extensive time spent staring at a screen.

    While the symptoms can be disorienting and distressing, they are often short-lived, and almost always reversible. Take some time away from triggers and wait for the symptoms to fade. For more information, visit the American Migraine Foundation’s resource center, which includes content specifically related to Migraine with Aura, Retinal Migraine and more. The American Migraine Foundation is committed to providing comfort and information to people living with this disease. You are not alone: find your support network today.

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    How Are Migraine Headaches Treated In Children And Adolescents

    Did You See It Coming? : Migraine Aura — Migraine Buddy

    Basic lifestyle changes can help control a migraine. Whenever possible, avoiding the known triggers can help reduce the frequency and severity of migraine attacks.

    Biofeedback and stress reduction. Biofeedback helps a person learn stress-reducing skills by providing information about muscle tension, heart rate, and other vital signs as a person attempts to relax. It is used to gain control over certain bodily functions that cause tension and physical pain.

    Biofeedback can be used to help patients learn how their body responds in stressful situations, and how to better cope. Some people choose biofeedback instead of medications.

    Other stress reduction options include counseling, exercising, and yoga.

    Vitamins, minerals, and herbal products. These products have shown some effectiveness in migraine. They include magnesium, riboflavin, and coenzyme Q10.

    Medications. Headache medications can be grouped into three different categories: symptomatic relief, abortive therapy, and preventive therapy. Each type of medication is most effective when used in combination with other medical recommendations, such as dietary and lifestyle changes, exercise, and relaxation therapy.

    Important: If symptomatic relief medications are used more than twice a week, see your doctor. Overuse of symptomatic medications can actually cause more frequent headaches or worsen headache symptoms. This is called rebound or medication overuse headache.

    Abortive medications include:

    • Triptans

    What Is The Outlook For Children And Adolescents With Migraine

    Treatment helps most children and adolescents with migraine. Fifty percent of children and adolescents report migraine improvement within 6 months after treatment. However, in about 60% of adolescents who experience their first migraine as an adolescent, the migraine may continue off and on for many years.

    It should be noted that many of the medications listed in this handout have not been approved by the by the Food and Drug Administration for use in children and adolescents with headaches. This is a common practice in the field of medicine and is called ‘off-label’ prescribing. It is one of the ways new and important uses are found for already approved drugs. Many times, positive findings lead to formal clinical trials of the drug for new conditions and indications.

    Rehabilitation program. Some hospitals and/or other health care facilities offer inpatient headache management programs for children and adolescents; ask your doctor if their facility offers such programs.

    Patients typically accepted into these programs are those who have a chronic daily headache , missed an excessive amount of school, have overused over-the-counter medications, and have headache pain that is controlling their lives. The staff of such programs can include psychologists, pediatric rehabilitation specialists, occupational and physical therapists as well as access to a child psychiatrist. Stress factors are an important focus of this program; not rapid changes in medications.

    References

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    What Symptoms Must You Have To Be Diagnosed With A Migraine

    Migraine with aura . This is a headache, plus:

    • Visual symptoms or vision loss.
    • Sensory symptoms .

    Migraine without aura . A common migraine is a headache and:

    • The attacks included pain on one side of your head.
    • You’ve had at least five attacks, each lasting between four and 72 hours.

    Plus, you’ve experienced at least one of the following:

    • Nausea and/or vomiting.
    • Lights bother you and/or you avoid light.
    • Sounds bother you and/or you avoid sounds.

    What Is Aura In The Eye & What Causes An Aura In The Eye

    Aura in the eye, also called as migraine with aura or classic aura refers to a severe headache, which strikes along or after with various sensory disturbances. Here, the disturbances may include blind spots, light flashes, changes in the vision of a patient or tingling in his face or hand.

    Migraine with aura or aura in the eye problem may result in throbbing pain or a sensation of pulse severely on a particular side of your head. In addition, sometimes, the problem accompanies vomiting, nausea and extreme sensitivity towards the sound and the light.

    Migraine attacks may result in a huge pain for about few hours to 1 or 2 day and may become so much severe that pain disables. Aura or any other warning symptom may take place with or before you face with the headache problem. These include tingling, light flashes and blind spots.

    What Types Of Migraine Occur In Children And Adolescents

    There are two main types. A migraine without an aura occurs in 60% to 85% of children and adolescents who get a migraine. A migraine with an aura occurs in 15% to 30%. In young children, migraine often begins in the late afternoon. As the child gets older, migraine often begins in the early morning.

    Migraine Aura Causes: Symptoms Treatment And Remedies

    An aura caused by migraine, silent or an ocular migraine usually involves some kind of troubles with vision. This blurry vision or flashes of light usually affect both eyes at the same time. The difference between this type of aura and the classical one is that most of the time it is not accompanied by the throbbing pain in the temples.

    However, patients usually suffer from a lot of other irritating symptoms that usually last for an hour or so. These symptoms are not serious; however they can affect the quality of the patient’s life. Read on to learn more about migraine aura causes.

    An ocular migraine with blurred vision affects both eyes and can cause troubles with reading, writing, driving and working on a computer. A retinal migraine is another type that usually affects only one eye and is a much more serious condition.

    A Closer Look At The Different Types Of Migraine Aura

    According to the American Migraine Foundation, only about 25-30 percent of individuals with migraines experience auras. Doctors and researchers are often puzzled as to why auras and migraines go together, yet not everyone who gets migraines experiences auras along with them. For those who do experience auras, they’re often the ‘warning sign’ that a migraine attack is imminent.

    What are auras? What types of migraines come with auras? How do you treat migraines with auras? Here’s a closer look at the answers to those questions and more.

    Epidemiology And Natural History Of Chronic Migraine

    Migraine with and without aura occurs in approximately 12% of the adult population of the United States.14 Epidemiological studies from other occidental populations are relatively consistent with this prevalence marker.15 Japanese populations have a somewhat lower prevalence of migraine, as do those in South-East Asia, Africa, and the Middle East.16 However, primary headache disorders are by far the most common neurological condition in the world for which medical consultation is sought.2 Despite the prevalence of primary headache disorders, they are also one of the most misdiagnosed and undermanaged medical conditions on the planet. This is likely due in part to rapidity of changes in the medical understanding of migraine, failure to define and develop newer migraine-specific therapies, and confusion over the relationship of migraine to other primary headache diagnoses.

    J. Eric Piña-Garza MD, Kaitlin C. James MD, in, 2019

    What Is The Best Way To Treat A Migraine With Aura

    Migraine with aura linked to clot

    When aura symptoms begin, it can be helpful to move into a quiet, dark room and close your eyes.

    Placing a cold compress on your forehead or the back of your neck may also help ease ensuing migraine pain.

    Like other types of migraine, treating a migraine with aura involves a combination of medications. These include medications for both prevention and relief of symptoms.

    Preventive medications that may stop migraine attacks from occurring include:

    • antidepressants, such as amitriptyline
    • blood pressure medications, like beta-blockers or calcium channel blockers
    • anti-seizure drugs, such as

    Medications for symptom relief help decrease the severity of an oncoming migraine attack. They’re typically taken as soon as the symptoms of an aura develop.

    Examples of some of these medications are:

    It’s also a good rule of thumb to make an appointment with your doctor for headaches that:

    • happen frequently and last from hours to days
    • disrupt your daily activities
    • occur frequently when you used to be headache-free

    If you’re concerned about your migraine and don’t already have a primary care provider, you can view doctors in your area through the Healthline FindCare tool.

    What Medications Are Used To Relieve Migraine Pain

    Over-the-counter medications are effective for some people with mild to moderate migraines. The main ingredients in pain relieving medications are ibuprofen, aspirin, acetaminophen, naproxen and caffeine.

    Three over-the-counter products approved by the Food and Drug Administration for migraine headaches are:

    • Excedrin® Migraine.
    • Advil® Migraine.
    • Motrin® Migraine Pain.

    Be cautious when taking over-the-counter pain relieving medications. Sometimes overusing them can cause analgesic-rebound headaches or a dependency problem. If you’re taking any over-the-counter pain medications more than two to three times a week, report that to your healthcare provider. They may suggest prescription medications that may be more effective.

    Prescription drugs for migraine headaches include:

    Triptan class of drugs :

    • Sumatriptan.
    • Butterbur.
    • Co-enzyme Q10.

    Drugs to relieve migraine pain come in a variety of formulations including pills, tablets, injections, suppositories and nasal sprays. You and your healthcare provider will discuss the specific medication, combination of medications and formulations to best meet your unique headache pain.

    Drugs to relieve nausea are also prescribed, if needed.

    All medications should be used under the direction of a headache specialist or healthcare provider familiar with migraine therapy. As with any medication, it’s important to carefully follow the label instructions and your healthcare provider’s advice.

    What Questions Should I Ask My Healthcare Provider

    • Will my child grow out of their migraines?
    • What medications do you recommend for me?
    • What should I change about my lifestyle to prevent my migraine headaches?
    • Should I get tested?
    • What type of migraine do I have?
    • What can my friends and family do to help?
    • Are my migraines considered chronic?

    A note from Cleveland Clinic

    Migraine headaches can be devastating and make it impossible to go to work, school or experience other daily activities. Fortunately, there are some ways to possibly prevent a migraine and other ways to help you manage and endure the symptoms. Work with your healthcare provider to keep migraines from ruling your life.

    Last reviewed by a Cleveland Clinic medical professional on 03/03/2021.

    References

    Whats The Outlook For People With Complex Migraine

    Doctors diagnose an estimated 2 percent of all patients with stroke-like symptoms with migraine, according to a 2019 research review.

    When it comes to complex migraine, it can be difficult to differentiate between the two. However, if you have a history of complex migraine, you may recognize the aura symptoms more easily.

    Your doctor may recommend seeing a specialist called a neurologist to treat complex migraine as their treatment is more complex.

    A neurologist can conduct examinations and prescribe treatments when indicated to address complex migraine symptoms.

    Although doctors don’t use the term “complex migraine” as often, the symptoms this migraine type can cause are alarming. They include:

    • weakness on one side

    Causes Of A Sudden Increase In Migraine With Aura

    Migraine can be difficult to manage and cause debilitating pain. Auras add to the discomfort, causing issues even before a migraine episode starts. On their own, migraine auras are a concern. Studies have shown that the presence of aura in migraine attacks can be a sign of more serious neurological conditions, including a twofold increased risk for ischemic stroke.

    No one exactly knows why auras develop before migraine attacks, but a leading theory is that they’re the result of cortical spreading depression and potentially vascular changes.

    Cortical spreading depression is a phenomenon present in a variety of neurological conditions. A triggering event, either electrical or mechanical, causes a disruption in the brain’s normal electric activity. Neurons power the brain’s signals, but in the case of cortical spreading depression, a wave of depolarization affects electric activity in the brain. Spreading depression can affect one or more regions of the brain.

    Migraine auras may begin in the occipital lobe of the brain — affecting vision — then travel to areas of the brain that trigger headache pain.

    More research is needed to learn exactly how cortical spreading depression and auras are related, but there are a number of triggers that have been linked to both this phenomenon and auras. An increase in these triggers could have the potential to increase the frequency of migraine with aura.

    How Can I Treat Migraines Without Using Medicines

    It is very important to remember that many of the most effective preventive treatments for migraines do not require any medications. Frequent aerobic exercise is an excellent example of an effective way to improve headaches. Other strategies may include better sleep habits, stress reduction, massage, yoga, and acupuncture.

    What Else You Should Know About Ocular Migraines

    An ocular migraine is short-lived and may not be painful, but it can be debilitating – you have to be careful while doing daily activities like driving, reading, or writing. The chance of permanent vision loss due to an ocular migraine is rare but the reduced blood flow for a prolonged time can damage your retina. So it is a good idea to make an appointment with your ophthalmologist to check your condition.

    Since hormones play such a big role in causing migraines, declining estrogen levels as women age and enter menopause is a reason why migraines usually reduce in severity in older women.11

    Transformed Migraine/medication Overuse Headache

    In some patients, migraine progresses to chronic migraine. Acute overuse of symptomatic medication is considered one of the most important risk factors for migraine progression. Medication overuse headache can occur with any analgesic, including acetaminophen or nonsteroidal anti-inflammatory drugs , such as ibuprofen, naproxen, and aspirin. In addition, Bigal and Lipton identified the following associations of medication with progression to chronic migraine :

    • Opiates – Critical dose of exposure is around 8 days per month; the effect is more pronounced in men

    • Barbiturates – Critical dose of exposure is around 5 days per month; the effect is more pronounced in women

    • Triptans – Migraine progression is seen only in patients with high frequency of migraine at baseline

    In the study, the effect of anti-inflammatory medications varied with headache frequency. These agents were protective in patients with fewer than 10 days of headache at baseline but induced migraine progression in patients with a high frequency of headaches at baseline.


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