Migraine is the most common type of headache, but its symptoms can vary. While some people may experience sudden pain, others may encounter other symptoms, such as vision, speech, sensation, and motor disturbances, typically lasting between 20 to 60 minutes before the painful sensation sets in.

There are two types of migraines: with aura and without aura.

What is a migraine?

Migraine is a disorder of the central nervous system that involves specific neurotransmitters and pain circuits. To diagnose it, the pain must last between 4-72 hours and be characterized by at least two of the following four features:

  • Unilateral localization;
  • Pulsating type;
  • Medium to severe intensity;
  • Aggravation by routine physical activities such as walking or climbing stairs.

Additionally, at least one of the following symptoms is usually present: nausea, vomiting, discomfort with light (photophobia), or pain to noise (phonophobia). 

Migraine: what is aura?

As mentioned above, we recognize two types of migraines:

  • Migraines without auras, which used to be called “common migraines.”
  • Migraines with auras, which used to be called “complicated migraines” or “ophthalmic migraines.”

It is essential to distinguish the two types. The aura occurs immediately before the head pain. It should not be confused with the typical prodromal symptoms of migraine (such as malaise, yawning, fatigue, and altered appetite), which can occur even the day before and affect all migraine sufferers, regardless of whether or not the aura is present. 

Migraines with aura and without aura: the differences

Unlike migraines without aura, migraines with aura are characterized by the presence of one or more central nervous system dysfunctions that manifest before the onset of migraine pain. These dysfunctions can affect various aspects, such as: 

  • Vision
  • Speech
  • Sensation
  • Movement

According to experts, the aura is triggered by an abnormal electrical wave originating from the posterior region of the brain, gradually progressing forward at approximately three millimeters per minute. This wave can cause disturbances in different brain areas, resulting in issues related to vision, speech, sensitivity, and movement. During the aura phase, these disturbances can occur individually or sequentially, appearing one after another.

Each aura symptom typically ranges from 20 to 60 minutes, but in most cases, the entire aura episode lasts for less than an hour. Following the aura, classic headaches usually manifest. 

Aura and visual disturbances

Due to the involvement of the occipital brain region, which is responsible for vision processing, it is standard for aura to present with visual disturbances. This is why terms like “ophthalmic migraine” were used in the past.

Various symptoms can occur at the visual level, including: 

  • “Positive” disturbances, characterized by perceiving something that is not present, such as twinkling lights or wavy lines known as photopsia or phosphenes
  • “Negative” disorders, where a portion of the visual field becomes unobservable or there is blurred vision in a specific area of the visual field

When to refer to the specialist

Specialized neurological examination is always recommended for cases of migraines, both with and without aura. In general, visiting a specialist is recommended when: 

  • The persistent headache occurs with such regularity and intensity that it interferes with daily activities.
  • Other symptoms are present, such as dizziness, visual disturbances, seizures, fever, nuchal rigidity, vomiting, or even slight changes in consciousness.
  • The headache is unresponsive to treatment.
  • There is a history of head injury.
  • The headache suddenly arises with high-intensity

A neurologist is the right person to diagnose the type of headache a patient is experiencing and prescribe the appropriate drug therapy for immediate relief and prevention. In recent times, there have been significant developments in migraine treatment. A new medication called “monoclonal antibodies” has been introduced, proving highly effective in preventing migraines. These drugs can reduce the number of monthly migraine days by up to 70%. Patients can administer the medication themselves through a prefilled syringe that is easy to use and is given as a subcutaneous injection in their thigh. However, these drugs are only prescribed through the NHS by neurologists at regional headache centers.