Diagnosis

If you experience signs and symptoms of aura followed by typical signs and symptoms of migraine, it's likely you have migraine with aura. Your doctor may diagnose the condition on the basis of your medical history and a physical exam.

But if your aura isn't followed by head pain, or the visual disturbances affect only one eye, your doctor may recommend certain tests to rule out more-serious conditions, such as a retinal tear or a transient ischemic attack — a temporary decrease in blood supply to part of your brain — that could be causing your symptoms.

Your doctor may recommend:

  • An eye examination. During this exam, your doctor will use an instrument the size of a small flashlight (ophthalmoscope) to project a beam of light into your eye to examine the back of your eyeball (funduscopy).
  • Computerized tomography (CT). This X-ray technique produces detailed images of your internal organs, including your brain.
  • Magnetic resonance imaging (MRI). This diagnostic imaging procedure produces images of your internal organs, including your brain.

Your doctor may also refer you to a doctor who specializes in nervous system disorders (neurologist) to rule out brain conditions that could be causing your symptoms.

Treatment

There is no specific treatment for the signs and symptoms of aura, but there are ways to treat migraine pain. Treatments and medications for migraine with aura are similar to treatment for migraine without aura.

Pain-relieving medications

Medications used to relieve migraine pain work best when taken at the first sign of an oncoming migraine: for example, as soon as you notice signs and symptoms of a migraine aura beginning.

Types of medications that can be used to treat migraine pain include:

  • Pain relievers. Over-the-counter or prescription pain relievers, such as aspirin or ibuprofen (Advil, Motrin IB, others). When taken too long, these may cause medication-overuse headaches, and possibly ulcers and bleeding in the gastrointestinal tract. Migraine relief medications that combine caffeine, aspirin and acetaminophen (Excedrin Migraine) may be helpful, but usually only against mild migraine pain.
  • Triptans. Triptan medications (Imitrex, Maxalt, others) are prescription drugs used specifically for migraine because they block the pathways of pain in the brain. They can relieve many symptoms of migraine, and can be taken as pills, shots or nasal sprays. They may not be safe for anyone at risk of a stroke or heart attack.
  • Ergots. Ergots (Migergot, Cafergot) are another family of drugs used for migraine. They're most effective when taken shortly after the start of migraine symptoms, and in migraines that tend to last longer than 48 hours. Side effects of ergots can include medication-overuse headaches and worsening of migraine-related vomiting and nausea.
  • Opioid medications. For migraine sufferers who can't take triptans or ergots, narcotic opioid medications (especially those that contain codeine) may be helpful. To avoid addiction, these are usually used only if no other treatments are effective.
  • Anti-nausea drugs. These can help if your migraine with aura is accompanied by nausea and vomiting. Anti-nausea drugs include chlorpromazine, metoclopramide (Reglan) or prochlorperazine (Compro). These are usually taken along with other medications.
  • Glucocorticoids. A glucocorticoid (prednisone, dexamethasone) is sometimes used along with other medications to provide better pain relief. Because of side effects, glucocorticoids should not be used frequently.

People who have auras that last a long time should not take ergot medications, as they may reduce blood flow to the brain.

Preventive medications

Medications can help prevent frequent migraines, with or without aura. Your doctor may recommend preventive medications if you're having frequent, long-lasting or severe headaches that don't respond well to treatment.

After a few weeks of taking them, preventive medications can help you have fewer migraines and help treatments work more effectively when you do have a migraine.

Preventive medication options include:

  • Blood pressure-lowering medications. These include beta blockers such as propranolol (Inderal LA, Innopran XL, others), metoprolol tartrate (Lopressor) and timolol (Betimol). Calcium channel blockers such as verapamil (Calan, Verelan, others) can be helpful in preventing migraines with aura.
  • Antidepressants. Amitriptyline, a tricyclic antidepressant, has been found effective in preventing migraines. Because of the side effects of amitriptyline (such as sleepiness, weight gain and more), sometimes other antidepressants are prescribed.
  • Anti-seizure drugs. Valproate (Depacon) and topiramate (Topamax) may help you have less frequent migraines, but may cause side effects such as dizziness, weight changes, nausea and more.
  • Botox injections. Injections of onabotulinumtoxinA (Botox) about every 12 weeks can help prevent migraines in some adults.

Stress management and lifestyle

You may be able to soothe migraine with aura pain with the self-care techniques that can be used for migraine without aura:

  • Cognitive behavioral therapy (CBT). This technique teaches you more-appropriate ways to deal with stressful situations, and may help reduce the number of migraines you have. CBT may be combined with another strategy called learn to cope (LTC). LTC involves slowly exposing you to common headache triggers to help you become less sensitive to them.
  • Get a healthy amount of sleep. Don't sleep too much or too little. Set a consistent sleep and wake schedule that you follow each day and night.
  • Relax when symptoms start. When migraine aura symptoms start, head to a quiet, dark room and rest with an ice pack (wrapped in a towel or cloth) placed at the back of your neck.

Clinical trials

Explore Mayo Clinic studies testing new treatments, interventions and tests as a means to prevent, detect, treat or manage this disease.

Preparing for your appointment

If you're experiencing temporary visual or sensory disturbances, see your family doctor or a general practitioner. In some cases, you may be referred to a doctor who specializes in nervous system disorders (neurologist).

Here's information to help you get ready for your appointment and to know what to expect from your doctor.

What you can do

  • Keep track of your symptoms. One of the most helpful things you can do is keep a headache diary. Write a description of each incident of visual disturbances or unusual sensations. What are they? When did they happen? How long did they last? What followed them? Did something seem to trigger them? A headache diary may help your doctor diagnose your condition.
  • Write down key personal information, including any major stresses or recent life changes.
  • Write down questions to ask your doctor.

For migraine with aura, some basic questions to ask your doctor include:

  • What's the likely cause of my symptoms?
  • What tests, if any, do I need?
  • Is my condition likely temporary or chronic?
  • What treatments are available? Which do you recommend?
  • What are the alternatives to the primary approach you're suggesting?
  • I have other health conditions. How can I best manage them together?
  • Are there dietary restrictions I need to follow?
  • Is there a generic alternative to the medicine you're prescribing?
  • Are there written materials I can take with me or websites you recommend?

Don't hesitate to ask other questions you have.

What to expect from your doctor

Your doctor is likely to ask you a number of questions, including:

  • When did you begin having symptoms?
  • What types of visual symptoms or other sensations do you have?
  • How long do they last?
  • Are they followed by a headache?
  • If you have headaches, how often do you get them and how long do they last?
  • How severe are your symptoms?
  • What, if anything, seems to improve your symptoms?
  • What, if anything, appears to worsen your symptoms?
May 05, 2016
References
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  2. Headache: Hope through research. National Institute of Neurological Disorders and Stroke. http://www.ninds.nih.gov/disorders/headache/detail_headache.htm?css=print. Accessed April 18, 2013.
  3. Cutrer MF, et al. Pathophysiology, clinical manifestations, and diagnosis of migraine in adults. http://www.uptodate.com/home. Accessed March 21, 2016.
  4. Bajwa ZH, et al. Acute treatment of migraine in adults. http://www.uptodate.com/home. Accessed March 21, 2016.
  5. Bajwa ZH, et al. Preventive treatment of migraine in adults. http://www.uptodate.com/home. Accessed March 21, 2016.
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  7. Gooriah R, et al. OnabotulinumtoxinA for chronic migraine: A critical appraisal. Therapeutics and Clinical Risk Management. 2015;11:1003.
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