What migraine with aura is
Mayo Clinic describes migraine with aura, once called classic migraine, as a recurring headache that strikes after or at the same time as nervous system symptoms called aura. The NHS explains that migraine causes attacks with a throbbing headache, often on one side, feeling or being sick, and sensitivity to light and sound, and that some people get warning signs known as aura.
Mayo Clinic explains that aura is thought to be caused by an electrical or chemical wave spreading across the brain, called cortical spreading depression. The area it crosses determines the symptoms. These waves can occur with normal nerve function and do not harm the brain. Treatments for migraine with and without aura are usually the same.
Visual aura and other aura symptoms
Mayo Clinic explains that visual symptoms are the most common, tend to start in the center of the field of vision and spread outward, and usually affect both eyes. They may include:
- blind spots (scotomas), sometimes outlined by simple shapes
- zigzag lines that gradually float across the field of vision
- shimmering spots, stars or flashes of light
- changes in vision or temporary vision loss
Other aura symptoms can include tingling in one hand or one side of the face that may spread slowly and turn into numbness, numbness of the tongue or mouth, speech or language difficulty, ringing in the ears or hearing loss and, less often, weakness. The NHS also lists dizziness. Symptoms in only one eye may indicate other causes, including retinal migraine, and should be examined by a professional.
The phases of an attack
The NHS explains that early symptoms, such as feeling very tired and yawning, food cravings or thirst, mood changes, a stiff neck or passing urine more often, can begin hours or up to 2 days before the head pain. Aura usually follows, typically within an hour before the headache, and should not last longer than 1 hour. Mayo Clinic notes that aura can also happen at the same time as the headache.
The headache phase, with throbbing pain, nausea and sensitivity to light and sound, usually lasts between 4 hours and 3 days, according to the NHS, and some symptoms can continue after the pain stops. Attack frequency varies widely, from several times a week to much less often. See also our guide to vestibular migraine, a different type centered on dizziness.
Aura without headache
Mayo Clinic explains that, rarely, aura happens without a headache following it, usually in people over 50. Because aura without headache can resemble other conditions, a professional may recommend tests to rule out more serious causes, such as a transient ischemic attack (TIA, a temporary interruption of blood flow to part of the brain).
Aura symptoms that appear for the first time, especially later in life, should therefore be assessed rather than assumed to be migraine.
Triggers and patterns
Mayo Clinic and the NHS list common triggers:
- stress, anxiety and tiredness
- too much or too little sleep
- skipping meals or irregular eating
- alcohol, especially wine, and too much caffeine
- bright lights, loud sounds, smoke or strong odors
- some foods, including processed foods or those with additives
- menstruation and other hormonal changes, and lack of regular exercise
Triggers differ between people. Both sources recommend a headache diary to identify personal triggers. Migraine is more common in women and in people with a family history of migraine; the NHS notes that attacks often improve with age and, in women, after menopause.
How it is diagnosed
Mayo Clinic explains that there is no specific test to diagnose migraine with aura. A professional bases the diagnosis on your symptoms, medical and family history and a physical examination, looking for repeated headaches with features such as one-sided, throbbing pain, temporary visual disturbances, nausea and sensitivity to light and sound.
Depending on the situation, assessments may include an eye examination by an ophthalmologist to rule out eye problems, and CT or MRI scans, which are usually not needed but may be used if symptoms are not typical or the examination shows something unusual. A neurologist can rule out other brain conditions.
Aura vs stroke or TIA: warning signs
Mayo Clinic advises seeing a professional immediately if you have new symptoms such as temporary vision loss, speech or language difficulty or weakness on one side of the body, to rule out serious conditions such as stroke. It also advises seeing a professional if your headache pattern changes or your headaches suddenly feel different. People with migraine with aura have a mildly increased risk of stroke.
The NHS advises calling emergency services for a sudden, extremely painful headache, problems speaking or remembering, loss of vision or blurred or double vision, drowsiness or confusion, a seizure, high fever with signs of meningitis, weakness on one side of the face or body, or a recent head injury. It advises an urgent appointment if aura lasts longer than 1 hour, an attack lasts more than 72 hours, or you are pregnant or have just had a baby. Do not wait for symptoms to settle if they are new or different.
Treatment of attacks and prevention (groups, not doses)
The NHS explains that migraine cannot be cured, but treatment can help manage attacks and prevent them. For attacks, options include painkillers such as ibuprofen or paracetamol, taken as soon as symptoms start, medicines called triptans and gepants, and anti-sickness medicines. Mayo Clinic notes that triptans may not be safe for people at risk of stroke or heart attack. Taking painkillers on more than 2 days a week can cause medication overuse headache.
For frequent, long or severe attacks, preventive options include beta blockers, some antidepressants, some medicines for epilepsy, injectable treatments targeting a protein called CGRP and, for some adults, botulinum toxin injections, as well as relaxation techniques, cognitive behavioral therapy and acupuncture. During an attack, resting in a quiet, dark room helps many people. Regular sleep and meals, hydration and less caffeine and alcohol support prevention. Choices and doses are decided with your doctor.
Where the sources differ
Mayo Clinic (September 2025) gives more detail on the mechanism of aura, aura without headache and a wide range of US-approved medicines; the NHS (March 2026) gives clearer thresholds for urgent help, such as aura lasting more than 1 hour, and lists vitamin B2 among preventive options. Medicine availability differs between countries. Some medicines are not safe in pregnancy, and both sources advise talking to a professional before using them if you are pregnant or trying to conceive.
Hormonal changes are a known trigger, and Mayo Clinic notes a mildly increased stroke risk with aura. If you use or are considering hormonal contraception, tell the prescribing professional that you have migraine with aura, and do not change contraception on your own. MediBilbao Salud does not treat migraine; assessment by your doctor or a neurologist is the right step.
In summary
Migraine with aura combines a migraine headache with temporary, gradually developing symptoms, most often visual, that usually last less than an hour. Common triggers include stress, sleep changes, skipped meals, alcohol, caffeine and hormonal changes. Diagnosis is clinical, and tests are used when symptoms are unusual. Treatment includes medicines for attacks, preventive options and lifestyle measures.
For your appointment, a simple timing table helps: for each symptom, note when it started, how it developed, how long it lasted and when the headache began. New aura, aura lasting more than an hour, one-sided weakness, speech problems or a sudden severe headache need urgent or emergency care.
Frequently asked questions about migraine with aura
These answers are general information and do not replace an examination or individual medical advice.
What does a migraine aura feel like?
Most often zigzag lines, flashing lights, shimmering spots or blind spots that spread gradually; sometimes tingling or numbness in a hand or face, dizziness or difficulty speaking.
How long does an aura last?
Usually less than an hour. The NHS advises urgent medical advice if aura symptoms last longer than 1 hour.
Is a migraine with aura a mini stroke?
No, but some symptoms can look similar, and people with aura have a mildly increased stroke risk. New aura symptoms, one-sided weakness or speech problems need prompt assessment.
What triggers migraine auras?
Common triggers include stress, too much or too little sleep, skipped meals, alcohol, caffeine, bright lights, strong smells and hormonal changes. A headache diary helps identify yours.
How is migraine with aura treated?
With medicines for attacks, such as painkillers, triptans or gepants, preventive treatments for frequent attacks, and lifestyle measures. Your doctor chooses options and doses.
When are aura symptoms an emergency?
When they are new or different, last more than an hour, or come with a sudden severe headache, one-sided weakness, speech problems, vision loss, confusion or a seizure.
Sources
- Mayo Clinic · Migraine with aura: symptoms and causes
- Mayo Clinic · Migraine with aura: diagnosis and treatment
- NHS · Migraine
This guide is for general information and does not replace medical advice. How a problem is diagnosed and treated depends on your examination and medical history. If you think you have an emergency, contact your local emergency services.