Migraine aura is a transient neurological event that typically precedes or accompanies a migraine headache. Symptoms often involve visual disturbances, such as shimmering zigzag lines or temporary blind spots, but can also include sensory changes like tingling or numbness, or difficulty with speech. This phenomenon is linked to a wave of electrochemical activity slowly spreading across the brain’s surface, known as Cortical Spreading Depression (CSD). Since immediately stopping an established aura is challenging due to this underlying biological wave, strategies focusing on acute management and long-term prevention are the most effective path.
Immediate Steps When Aura Begins
Upon recognizing the onset of aura, non-pharmacological, self-care actions are the first line of defense to lessen the severity of the attack. Moving immediately to a dark, quiet environment is recommended, as sensitivity to light and sound is a common feature of migraine attacks. Closing your eyes and resting or taking a nap can help the nervous system settle and reduce external stimulation.
Applying a cool compress or ice pack to the forehead or neck provides a soothing effect and helps manage the ensuing pain. Engaging in deep breathing exercises or relaxation techniques, such as biofeedback, can assist in dealing with the stressful situation and limit the attack’s progression. Hydration is also important; drinking plenty of water at the first sign of symptoms can help avert the full development of a headache.
Acute Medications for Aura Management
Acute medications aim to stop the migraine attack once it has begun, working best when taken at the earliest sign of symptoms. Over-the-counter Nonsteroidal Anti-inflammatory Drugs (NSAIDs), such as ibuprofen or naproxen, are effective for managing milder attacks and should be taken as soon as the aura starts or the headache phase begins. These medications help prevent or diminish the subsequent headache that typically follows the aura.
For more severe attacks, prescription abortive medications are necessary, including triptans and newer Calcitonin Gene-Related Peptide (CGRP) antagonists (gepants). Triptans, such as sumatriptan, work by blocking pain pathways in the brain and constricting blood vessels. However, triptans are generally recommended once the headache phase begins, not during the aura itself, as they are not specifically indicated for aura treatment.
CGRP antagonists (e.g., ubrogepant or rimegepant) are approved for acute treatment and can be taken for migraine with or without aura. These drugs block the activity of the CGRP protein, which plays a role in migraine pain. The effectiveness of any acute medication hinges on prompt administration; waiting until the headache is severe reduces the ability to provide complete relief.
Strategies for Reducing Aura Frequency
Since stopping an aura once initiated is difficult, the most effective long-term approach involves reducing the frequency of attacks through preventative strategies. Identifying personal triggers is a foundational step, often involving maintaining a detailed headache diary to track factors like diet, sleep patterns, stress levels, and environmental changes. Avoiding common migraine triggers such as certain foods, alcohol, or irregular sleep schedules significantly decreases the incidence of attacks.
For individuals experiencing frequent or severely disabling attacks, daily prophylactic medications are prescribed to reduce overall migraine burden. These preventative options come from several drug classes, including beta-blockers (e.g., propranolol and metoprolol) and anti-seizure drugs (e.g., topiramate). Beta-blockers are among the most widely used prophylactic treatments and are effective for many patients.
CGRP monoclonal antibodies (e.g., erenumab or fremanezumab) are injectable medications that target the CGRP pathway. These are generally considered for patients who have not responded well to at least three other preventative medications. Other preventative options include calcium channel blockers, which may be helpful specifically for migraine with aura, and antidepressants like amitriptyline.
Recognizing Serious Aura Mimics
Certain symptoms can mimic a migraine aura but may indicate a more serious underlying condition, such as a transient ischemic attack (TIA) or stroke. While migraine aura symptoms typically develop gradually over several minutes and resolve within an hour, stroke symptoms often appear suddenly. Sensory changes in a migraine aura, like zigzags of light, are described as “positive” symptoms, whereas a stroke may cause “negative” symptoms, such as a complete loss of vision in one eye or profound weakness.
Specific “red flag” symptoms require immediate medical evaluation, even with a known history of migraine with aura. These symptoms include the sudden onset of the “worst headache ever,” persistent motor weakness or paralysis on one side of the body, or new aura symptoms after the age of 50. If you experience any neurological symptom that is new, different from your typical aura, or does not resolve quickly, seeking emergency medical care is necessary to rule out serious conditions.