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Stanford headache specialist demystifies migraine auras

I have close friends who get debilitating migraines so I knew a bit about auras, which are sensory disturbances that often precede migraine headaches. But experiencing one myself was still quite frightening.

It snuck up on me: I was happily reading a novel in bed when a spot on the page became blurry, even when I closed one eye. It quickly expanded in size, turning into a flickering, zig-zag pattern. After checking online and guessing that I probably had a migraine aura, I tried to go to sleep — and that’s when it really got weird. Suddenly I saw the geometric pattern in color moving across my field of vision, even when I had my eyes closed.

Luckily, my aura lasted less than 30 minutes, so I was eventually able to go to sleep. I was also very happy to avoid the unbearable headache pain common in migraines. But my experience inspired me to learn more about auras.

According to Stanford neurologist Nada Hindiyeh, MD, about 30 percent of people that suffer from migraines get an aura before their headache pain. However, migraine auras can also occur without a headache. This used to be called an ocular migraine, but it is now classified by the International Headache Society as a “typical aura without headache,” she said.

“Aura is a term used to describe focal neurological disturbances that precede a migraine headache and typically develop over a 5 to 60 minute period and last less than an hour. The most common neurological symptoms include visual changes,” said Hindiyeh, who works at the Stanford Headache Clinic. “During a visual aura, people may describe a blind spot in part of their field of vision, sparkles or stars, colored spots, zig-zag lines, flashes of light or tunnel vision.”

A migraine aura is thought to be initiated by a phenomenon in the brain known as cortical spreading depression — a self-propagating wave of electrical silence in which cortical neurons stop firing and go quiet. This starts a chain of reactions in the brain that causes the symptoms of a migraine attack, Hindiyeh explained.

A long list of factors can trigger migraines, she said, including stress, changes in sleep patterns, hormonal changes in women, skipping meals, and eating certain foods and beverages such as highly processed foods and excessive caffeine.

“Migraine symptoms can change throughout a person’s lifetime. Attacks of migraine aura without a headache are more common as migraine sufferers get older,” Hindiyeh said. “However, if you are older than the age of 40 and develop a migraine with aura for the first time, you should be evaluated by a neurologist. If needed, you may then be referred to a headache specialist.”

And it turns out I'm not the only one who finds auras frightening. “Having an aura can be quite a scary experience," Hindiyeh said. "Talk to your doctor about what steps to take when you do have one, such as pulling over if you’re driving, taking deep breathes, lying in a dark room or taking specific medication. That way you have an action plan in place and are prepared when an aura comes on.”

Hindiyeh said she has focused her research and practice on migraines because she believes it to be an underdiagnosed and undertreated disease. “Migraine affects 36 million people nationwide and is the seventh leading cause of disability worldwide. These statistics are staggering. I felt that this was a field in neurology where I could hopefully provide care for many patients, and raise awareness about this disabling disease.”

Previously: New imaging study investigates role of dopamine in migraine attacksHeadache 101: On migraines, pain medicine and when to visit a doctor and Director of Stanford Headache Clinic answers your questions on migraines and headache disorders
Photo by r. nial bradshaw

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