Migraine Aura Explained
What Is Migraine Aura, Really?
Spoiler: it’s not just “sparkly lights.”
Migraine aura is a set of temporary neurological symptoms that occur before - or sometimes during - the painful headache phase of a migraine.
Aura reflects changes in brain activity and is often an early warning that a migraine is beginning. These symptoms are fully reversible and typically resolve on their own within 5-60 minutes.
What’s Happening in the Brain?
Aura is linked to a process called “cortical spreading depression” - a slow moving wave of electrical activity across the brain, followed by a brief period of reduced activity.
As the wave moves through different regions of the brain, it temporarily disrupts their functoin. This is what causes the wide range of neurological symptoms which can include:
Visual disturbances
Numbness or tingling
Speech or language difficulty
Dizziness or balance issues
Weakness
Smell or sound disturbances
Symptoms vary depending on which part of the brain is affected.
How Common is Aura?
About 25-30% of people with migraine are diagnosed with aura. However, many experts believe it is under-recognized, especially when symptoms are not visual.
Types of Migraine Aura
Visual Aura (Most Common)
Occurs when the visual cortex (back of the brain) is affected.
Visual Aura Symptoms:
Crescent that shimmers or is colourful
Zigzag or jagged lines “fortification spectrum”
Flickering or shimmering lights
A Blind spot, dark patch, or multiple spots floating in your vision
Objects that appear blury, wavy, distorted, or fragmented
Sensory Aura
Sensory Aura is characterized by physical sensations that spread gradually across the body, usually in the face, hands, or arms.
Sensory Aura Symptoms:
Tingling or pins and needles that spread slowly from the fingers up toward the face
Numbness in one side of the face, lips, or tongue
A feeling of heaviness or unusual warmth in the affected area
Speech & Language Aura (Aphasic Aura)
Affects communication and can feel alarming
Aphasic Aura Symptoms:
Struggling to find words mid-sentence
Words come out jumbled
Unable to respond clearly
Difficulty reading or writing
Motor Aura (Hemiplegic Migraine - Rare)
Motor aura is rare subtype of migraine characterized by temporary muscle weakness typically on one side of the body.
Hemiplegic Migraine Symptoms:
Weakness or heaviness on one side of the body
Difficulty gripping or lifting objects
Dragging of one leg or arm
Rarely, temporary paralysis on one side
This type of migraine requires higher level medical evaluation and ongoing management
Brainstem Aura (Previously “Basilar Migraine”)
Originates from the brainstem, affecting coordination and sensory processing.
Brainstem Aura Symptoms:
Dizziness or vertigo (a spinning sensation)
Double vision (diplopia)
Ringing in the ears (tinnitus)
Unsteadiness or loss of balance
Difficulty speaking or swallowing
Changes in hearing
Retinal Aura (Ocular Migraine)
Retinal aura affects only one eye, not both visual fields.
Retinal Aura Symptoms:
· Temporary vision loss or blind spots in one eye only (scotoma)
Flickering or dimming vision in one eye (scintillating scotoma)
Important: Always assess new single-eye vision loss or changes with your doctor.
Auditory Aura
Auditory aura affects what you hear and manifests as part of the vestibular migraine in 40% of people with vestibular migraines. Auditory aura is easily confused with other conditions like Tinnitus or Meniere’s Disease, proper medical evaluation is important.
Auditory Aura Symptoms:
Ringing, buzzing, or humming (tinnitus)
Muffled hearing
Phantom sounds
Fullness or pressure in the ear
Sound sensitivity (phonophobia)
Olfactory Aura (Phantosmia)
Olfactory aura is characterized by unpleasant odours with no source. It’s less common and often under-reported.
Olfactory Aura Symptoms:
Smelling smoke, burning, or chemicalls
Metallic or unpleasant odours with no source
Aura Without Headache - Silent (Acephalgic) Migraine
Aura can occure without headache, known as silent (acephalgic) migraine.
This can be confusing and is often misdiagnosed, especially when symptoms are neurological but not painful.
Migraine Without Aura: (Common Migraine)
About 70-75% of patients with migraine do not experience aura.
However, they may still experience premonitory phase hours to days before the headache.
Premonitory Symptoms in Common Migraine:
Fatique
Yawning
Mood changes
Food cravings
Neck stiffness.
Light & sound sensitivity
Changes in digestion
Increase urination
What To Do When Aura Starts
Aura can act an early warning window. While short, it’s an opportunity to act.
A Simple Migraine Response Plan:
Take prescribed medication early.
Reduce sensory input (dim lights, quiet enironment)
Hydrate
Eat if blood sugar may be low
Pause activities requiring focus (e.g. driving) and get somewhere safe
Important: When To Seek Medical Attention
Because aura symptoms can overlap with serious neurological conditions such as stroke
If symptoms are new, unusual, or severe
If they don’t follow your typical pattern
If you’re unsure what you’re experiencing
Seek urgent medical evaluation immediately.