Migraine with Aura

By: Brooklyn A. Bradley, BS; Medically edited by Dr. Deena Kuruvilla

Migraine with aura is a term that points to a variety of migraine subtypes that can be characterized by visual disturbances. These visual effects may include visual loss, blind spots, or seeing stars [1]. Headache specialists may also refer to this migraine as ophthalmic or monocular migraine [2]. The frequency and duration of ocular migraine is different for every patient. Some patients may have one migraine with aura every couple of months, and others may have it more frequently. 

 

There are two main types of migraine with aura: visual migraine and retinal migraine [1]. Approximately 15-33% of people with migraine experience aura [3]. Aura is defined as symptoms providing a warning of an upcoming attack, such as a migraine. It typically involves visual, sensory, speech, and motor symptoms [3]. Visual aura is the most common manifestation, and is found in over 90% of people who experience aura [3]. With visual aura, the symptoms affect both eyes, while with retinal migraine, the visual loss and other symptoms affect one eye. Retinal migraine is a type of migraine that can cause symptoms in one eye; for example, a patient with retinal migraine may experience twinkling lights, flashes, or temporary vision loss in only one eye during an episode [4]. These visual symptoms have been reported to last between 5 minutes and 1 hour; however, this may vary for each patient. The causes of retinal migraine are unknown; however, neurologists have been able to identify some of the main triggers for this type of migraine. For instance, stress, high blood pressure, smoking, birth control pills, and dehydration are known triggers for retinal migraine and migraine with aura [4]. 

 

Diagnosing migraine with aura typically begins with a referral to an eye specialist and a headache specialist [2]. At the initial visit, your clinician may ask about your current symptoms and order tests to rule out conditions that may have similar symptoms to visual aura. The course of treatment for visual aura varies from patient to patient. For infrequent migraine, clinicians may recommend over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs), which are used to treat mild-to-moderate pain from a wide range of conditions. This drug class includes aspirin and ibuprofen. Some other preventive strategies may include blood pressure medications, anti-epileptic medications, CGRP medications and tricyclic antidepressants [2].

 

Recently, medical devices have been recommended for visual migraine. These self-administered devices aim to deliver electrical stimulation to the forehead or back of the head as a preventive or acute treatment of visual migraine [2]. These devices include Cefaly, Spring TMS, and gammaCore. Cefaly is an FDA cleared, drug free migraine treatment [5]. This device is used for treatment of acute migraine attacks and as a preventive measure for future episodes [5]. Spring TMS is another non-pharmacological treatment used for migraine attacks that has been specifically studied for people with aura [6]. It is an FDA cleared non-invasive device also known as ENeura® sTMS™ mini. This device is a handheld device used for both prevention and as needed treatment of migraine, and involves transcranial magnetic stimulation (TMS) [6]. TMS uses magnetic fields to stimulate nerve cells in the brain to improve symptoms [7]. Lastly, gammaCore is an FDA cleared non-invasive device used for both prevention and treatment of multiple types of headache pain [8]. This device stimulates the vagus nerve via gentle electrical stimulation through the skin. The vagus nerve is involved in the communication between the brain and the rest of the body [8]. GammaCore has been shown to reduce headache days and improve quality of life [8]. Two other devices are FDA cleared for acute treatment – the Nerivio® and Relivion®. The Nerivio device is a wearable migraine treatment that is worn on the upper arm to modulate the body’s pain-regulatory system [9]. The device is able to do this via remote electrical neuromodulation (REN). This drug free and noninvasive device sends signals to the brainstem pain center and releases neurotransmitters that can inhibit pain and relieve migraine attacks [9]. Religion MG is another noninvasive neuromodulation technology to help manage migraine [10]. This device stimulates 2 primary nerve pathways in the brain that are typically associated with migraine, and also targets six nerve clusters across the occipital and trigeminal nerves [10]. 

 

There are some home remedies that can be used to prevent or manage visual migraine. It may help to apply pressure on your temples, lie down in a quiet or dark room, and take over-the-counter NSAIDs to alleviate some of the symptoms related to the headache [1]. Smoking cessation and the modification of oral contraceptives may be recommended as these may increase the risk of stroke or cardiovascular disease  [1]. 

 

Overall, it is important to understand the migraine subtypes that affect vision. Similar to the recommended course for other migraine types, people affected by visual aura should try to avoid triggers like stress, dehydration, and extensive time spent on screen devices. It may be helpful to start a headache diary if you are experiencing symptoms of visual aura, so that your clinician can better understand your episodes. 

 

References:

  1. Ocular Migraines: Understanding & Treating Ocular Migraine | AMF. In: American Migraine Foundation. https://americanmigrainefoundation.org/resource-library/understanding-ocular-migraine/. Accessed 15 Nov 2022
  2. (2021) Ocular Migraines (Causes, Symptoms & Treatment). https://www.visioncenter.org/conditions/ocular-migraine/. Accessed 15 Nov 2022
  3. Lucas C (2021) Migraine with aura. Rev Neurol (Paris) 177:779–784. https://doi.org/10.1016/j.neurol.2021.07.010
  4. Retinal Migraine: Symptoms, Causes and Treatment | AMF. In: American Migraine Foundation. https://americanmigrainefoundation.org/resource-library/retinal-migraine/. Accessed 16 Nov 2022
  5. Homepage. In: Cefaly. https://www.cefaly.com/. Accessed 16 Nov 2022
  6. Team E Migraine Devices: eNeura® sTMSTM mini. In: Migraine.com. https://migraine.com/eneura-stms. Accessed 16 Nov 2022
  7. Transcranial magnetic stimulation – Mayo Clinic. https://www.mayoclinic.org/tests-procedures/transcranial-magnetic-stimulation/about/pac-20384625. Accessed 16 Nov 2022
  8. gammaCore (nVNS): Non-Drug Relief for Migraine & Cluster Headache Pain. https://www.gammacore.com/. Accessed 16 Nov 2022
  9. #1 Prescribed Drug Free Treatment for Migraine. In: Nerivio. https://nerivio.com/. Accessed 9 Dec 2022
  10. Making Migraine Pain Freedom Possible. In: Relivion MG. https://www.relivion.com/. Accessed 9 Dec 2022
Published On: December 9th, 2022