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Migraine with Aura

A migraine with aura is different from a “normal” migraine, as it is preceded by disturbed sensory perception. This may include disorders of the sense of smell, visual disturbances, acroparaesthesia as well as neurological symptoms, speech disorder and paralytic symptoms. The symptoms of aura normally disappear once the migraine hits.

Migraine with Aura

What is a Migraine with Aura?

Migraines are not just a headache. A migraine includes a headache (migraine headache), but is usually accompanied by further symptoms like nausea, vomiting and light as well as noise sensitivity. A migraine with aura is a special type of migraine. Here, “aura” refers to a distortion of perception which precedes a migraine attack. The symptoms of an aura are, for example, a visual disorder, a disorder of the sense of smell and other neurological impairments. For a long time it was assumed that the brain doesn’t suffer any damages from the symptoms of aura. However, current results revealed that there might be long-term effects.1

Who is Affected by the Pain?

Migraine is a „woman’s disease”. Approximately 12 to 18% of women suffer from migraines, while only 6 to 8% of men are affected. The reason for that are the fluctuating hormone levels in women, also causing menstrual migraines. This special migraine form appears around menstruation. Women who are on the birth control pill often suffer from migraines during the hormone-free week, because the estrogen level drops during that time.2 About 30% of women with migraine experience the type with aura.3

Symptoms of Migraine with Aura

A migraine with aura includes several of the following symptoms:4

  • Headache
  • Nausea and vomiting
  • Extreme light and noise sensitivity
  • Disturbances of the stereoscopic vision, blurred vision to the point of partial loss of sight
  • Tingling or numbness of extremities
  • Disturbed sense of smell

Visual Disturbances as Special Symptoms

The visual impairments (e.g. sparks or flashes), which appear before the migraine attack arrives, should be given special consideration:

Symptoms Migraine with Aura

The picture illustrates the visual disturbances of a migraine with aura, from the top left clockwise: fortification (zigzag lights in the shape of a fortification), partial loss of vision, negative scotoma (area of lost or depressed vision, surrounded by an area of less depressed or of normal vision), positive scotoma (additional structures within visual field).

Hormonal Contraception as a Migraine Trigger

It is not quite clear yet what causes migraines. Besides, the symptoms vary from person to person. Identifying and observing trigger factors of migraine attacks can be helpful. Such trigger factors are e.g. stress, lack of sleep, irregular meals, certain weather conditions etc. Migraines can also be one of the side effects of the pill.5

Migraine with Aura and Contraception

If you suffer from migraine with aura, you should choose your contraception method carefully. Depending on the type of contraception, the risk of suffering a stroke might be increased. Natural contraception has no side effects and could be the perfect alternative. The WHO recommends that women with migraines older than 35 years should refrain from taking the birth control pill. The recommendation for women suffering from migraine with aura is not to take the pill at all.6 According to the German Migraine and Headache Association (DKMG) the absolute stroke risk is slightly higher in women suffering from migraine with aura, depending on the progress of the migraine. Smoking and other risk factors also increased the risk of stroke for aura migraineurs.7


The German Stroke Foundation’s (Deutsche Schlaganfall-Gesellschaft) recommendation for women who suffer from migraine with aura is to avoid the combination of smoking and the pill as the risk of stroke was then increased by a tenfold.8 Furthermore, if more than 2 risk factors like diabetes mellitus, obesity or high blood pressure apply, it was best to refrain from hormonal contraception.9,10

How to Treat Migraine with Aura?

There is no royal road to mastering migraines and its symptoms. There are recommendations to stop taking hormonal contraceptives, especially if they were prescribed against menstrual migraines. By surpressing menstruation, these hormones cause the menstrual migraines to disappear. However, the continuous intake of hormones might also worsen headaches and other symptoms related to migraines. The rule of thumb is: As long as you can’t get your headaches under control, you should refrain from hormonal contraception.11 If you suffer from further risk factors apart from migraine with aura, you should consider coming off the pill and look for alternative contraception methods.

Keeping a Migraine Diary

In order to make out the triggers for migraines with aura, it can be very helpful to keep a migraine diary. You should keep track of the following:

  • When did the attack happen?
  • How long did it last?
  • How intense was the headache?
  • What did you do right before? What did you eat and drink?
  • How did you sleep the night before?
  • What medication did you take?
  • What extraordinary events took place on that day?
  • What was the weather like?

Should you detect recurring patterns after some time, this could be helpful for a diagnosis at your doctor’s.

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1 Rocca, M. A. et al.: Brain Gray Matter Changes in Migraine Patients With T2-Visible Lesions. In: Stroke, Juli 2006. Called up on 21 September 2016 from http://citeseerx.ist.psu.edu.
2 Stürmer, S.: Migräne-Attacken bei Frauen – oft sind sinkende Östrogenspiegel die Ursache. Ärzte Zeitung, 31. Oktober 2008.
3 Evans, R. W.: The Clinical Features of Migraine With and Without Aura. Updates on the clinical features of migraine, especially migraine with aura. Practical Neurology, April 2014.
4 C. Hohmann: Neurologie: Migräne ohne Kopfschmerz. Pharmazeutische Zeitung 11/2011.
5 Göbel, H.: Migräne und Antibabypille – wo liegen Gefahren? Called up on 7 August 2017 from www.swr.de.
6 WHO: Medical eligibility criteria for contraceptive use. Fifth Edition, 2015. Called up on 21 September 2016 from http://apps.who.int.
7 Deutsche Migräne- und Kopfschmerzgesellschaft: Antibabypille bei Migränepatientinnen ohne Aura – kein gesteigertes Risiko für Schlaganfall oder Herzinfarkt! Called up on 21 September 2016 from http://www.dmkg.de.
8 SchĂĽrks, M. et al: Migraine and cardiovascular disease: systematic review and meta-analysis. 2009.
9 Pharmazeutische Zeitung: Kurzzeitprophylaxe mit Hormonen versuchen. Pharmazeutische Zeitung 46/2001.
10 Koch, E.-M.: Neurologische Erkrankungen: Migräne mit Aura. Called up on 21 September 2016 from https://www.mta-portal.de/.
11 Buchholz, D.: Heal Your Headache: The 1-2-3 Program for Taking Charge of Your Headaches. Workman Publishing, 2002, S. 95.

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