How to Know if You Have Migraine with Aura [Updated]

Medical Review by Headache Specialist Dr. Zubair Ahmed

Ever experience strange smells that others don’t detect? Symptoms of an aura aren’t always bizarre visual experiences reminiscent of a Van Gogh painting or an LSD trip.

It’s essential you know which of the 7 Types of Migraine you have by getting an accurate diagnosis. Effective treatment depends on the correct diagnosis that a headache specialist or qualified doc can provide.

About 20% of people with Migraine have Migraine with aura (1). How do you know if you’re one of them? Read on to find out.

What Happens During a Migraine Aura?

Imagine you are sitting at your computer with a pile of work to go through. Suddenly, you feel a little ‘off.’

You can’t focus on your screen, so you rub your eyes. Then you then begin to see floaters and flashes of light. Thinking that you’ve had enough work for the day, you think about grabbing a coffee.

As you stand up, your vision goes black and you can’t see.

You feel tingling in your face and your right arm goes numb. You understandably panic and ask your coworker to help you. You think you might be having a stroke.

That’s what Migraine with aura can feel like: many of the same stroke symptoms, yet only temporary. Despite the fact that aura symptoms disappear, they can be incredibly disabling (and scary) while they’re happening.

Aura and the Brain

“Migraine is a disorder of the brain, and it’s a disorder not just of sensory attention,” said Dr. Peter Goadsby, Director of the NIHR-Wellcome Trust King’s Clinical Research Facility, and professor of Neurology at King’s College London to Migraine Again.

While the causes of Migraine aura are not fully understood, the Mayo Clinic reports that there may be an electrical or chemical cause within the brain (‘>2). These electrical or chemical waves may be responsible for affecting parts of the brain that process certain sensory information and signals, such as vision.

Importantly, some people with Migraine with aura are at a higher risk for developing other medical problems like stroke.

For people with Migraine who have certain other medical conditions like heart or kidney disease, their treatment options may be limited due to medication side effects and risks. That’s why it’s so essential to get an accurate diagnosis of your Migraine type.

Aura is One of Four Phases of Migraine

To recognize Migraine aura, you must first understand the four possible phases of a Migraine attack.

Not everyone will experience all four phases, and not every attack features all four phases.

1) Premonitory (Prodrome) Phase

The premonitory or prodrome phase acts as a warning sign that a Migraine attack is on its way. Symptoms can last for hours to days before the head pain starts. Common symptoms include:

  • Yawning
  • Food cravings
  • Mood changes
  • Increased need for urination.

2) Aura Phase

An aura is a set of symptoms experienced just prior to the onset of a headache. Not everyone with Migraine will experience an aura, but it can be scary for even the most seasoned Migraine warrior.

Many people confuse the symptoms of prodrome and aura since both occur before the acutely painful phase of the attack.

Aura symptoms, which will be discussed in detail below, can include (3):

  • Changes in vision: Visual symptoms like light flashes or zigzags may appear with or without distorted vision. This is called a scintillating scotoma.
  • Sensory Changes: There may be sensory symptoms of facial numbness or tingling and speech changes that make it difficult to speak. Speech difficulties are known as transient aphasia or Migraine babble.

3) Headache or Attack Phase

The headache phase can last for days. Many people experience pain so severe it is debilitating. This phase is characterized by: (4):

  • Headache pain on one or both sides of the head (not everyone will experience)
  • Sensitivity to light, sound, and smell
  • Nausea and/or vomiting

4) Postdrome Phase

The postdrome phase is the recovery period. It’s often called the Migraine hangover, with symptoms similar to a more traditional alcohol hangover.

The postdrome phase often brings fatigue and moodiness. You may even “feel like a zombie.”


More than 90% of Migraine auras come with visual symptoms. The most common visual aura symptoms are flashes of light and temporary vision loss ( ‘>5).

The experience can be frightening, to say the least. Oftentimes, people think there is something dangerously wrong with them. They may even think they’re having a stroke.

Fortunately, aura symptoms clear up in less than an hour for most people.

Just as there are several types of Migraine, there is also more than one type of aura! And you don’t have to experience the headache phase to experience aura.

Typical Aura

A typical aura is the most common type. Typical auras are usually followed by a headache, but not always. A typical aura without headache (TAWH) is possible but rare. TAWH happens in only 3% of women and 1% of men with Migraine( ‘>6).

Symptoms of aura may vary from person to person, but there are some symptoms that show up again and again.

Visual Symptoms

Visual symptoms of aura are temporary, but they can be disabling. Some examples include(7):

  • Zigzag floating lines or spots
  • Vision loss or changes
  • Flashes of light
  • Blind spots called scotomas

Check out this video showing the different kinds of visual disturbances that can happen with aura:

The Misunderstood Aura:  It’s Not Just Visual

Ever wonder where the strange, colorful imagery from “Alice in Wonderland” comes from?

Yes, author Lewis Carroll lived with Migraine. And as for Vincent van Gogh’s squiggly paint lines and distorted colors – he, too, battled Migraine attacks.

That may perpetuate the perception that auras are strictly visual – but they aren’t. You can have Migraine with aura and never experience visual symptoms.

Sensory Changes

Aura can also involve sensory symptoms like(8):

  • Facial and/or limb numbness
  • Difficulty speaking
  • Weakness
  • Altered body image (see Alice in Wonderland Syndrome)

Alice in Wonderland Syndrome

Another, more rare symptom of Migraine with aura is a phenomenon called Alice in Wonderland Syndrome (AWIS), named after Lewis Carroll’s popular character.

People with AIWS may feel as though they are larger or smaller in relation to their environment. Feelings of being out of proportion relative to other people or things is a telltale sign of this symptom.

Migraine Aura Can Mimic a Stroke

Symptoms of Migraine with aura can feel like a stroke because some of the symptoms overlap:

  • Headache
  • Blurry vision
  • Confusion
  • Unilateral numbness/weakness.

However, strokes tend to be rapid and sudden, whereas a Migraine typically takes a bit of time to reach its peak. A Migraine attack also has warning signs.

The Difference Between a Migraine Attack and a Stroke

Strokes are typically one-time events and symptoms. Migraine attacks can occur more often, even daily, and symptoms are not permanent. In addition to the rapid onset of stroke symptoms, face droop is a tell-tale sign that you may be having a stroke and not a Migraine attack.

Most importantly, know your risk of stroke and talk to your doctor so no confusion is present if a stroke does occur.



Migraine with Brainstem Aura

In addition to the typical aura symptoms, some people experience what is called a brainstem aura (basilar artery migraine) with its own set of symptoms, like: (’>9):

  • One-sided visual changes, numbness, and tingling of face and limbs
  • Slurred speech
  • Vertigo
  • Ear ringing or changes in hearing
  • Double vision
  • Uncoordinated muscle movement
  • Unsteadiness
  • Changes in cognition (decreased)


Visual Aura with Migraine

Unfortunately for many people with Migraine, getting accurately diagnosed proves challenging. All too often, people present to their doctors with symptoms of Migraine only to be diagnosed with another condition.

In many cases Migraine is misdiagnosed as sinusitis, causing patients to miss out on proper Migraine treatment and relief (’>10).

In fact, more than half of people with Migraine never actually receive a Migraine diagnosis. Given the lack of headache specialists in the United States, it is not surprising.(’>11).

With only 500 certified headache specialists to treat more than 39 million people with Migraine, the chances of being misdiagnosed by a primary care physician, ENT provider, gynecologist, or neurologist are high.

When Migraine is properly diagnosed, doctors use a classification system known as the International Classification of Headache Disorders or ICHD-3, to distinguish between different Migraine types.


Once you’re correctly diagnosed with Migraine with aura, it’s essential to find a treatment that works for you. There is currently no treatment that specifically targets the aura phase of an attack.

Available treatments address symptoms of the attack as a whole and/or try to stop the attack entirely. Some medications and devices are FDA-approved for Migraine, others are approved for Migraine with aura, and some are approved for both.

Most people with Migraine treat their symptoms during an attack. If your attacks are frequent, it’s highly recommended to add preventive treatments to stop them before they strike.

Reduction in frequency and severity of Migraine attacks is the primary goal for prevention. However, when an attack strikes, you may need acute medication to treat it.

Be warned: not all Migraine medications are safe for everyone (12). It’s vital to talk to your headache specialist about the best plan for you.

Acute Medications include (Mayo Clinic Staff. Migraine: Diagnosis. (2019, May 31). Retrieved from’>13):

Preventive Medications include (

van gogh's migraine trees


Celebrities are not immune to the effects of Migraine with aura. A few notable Migraine with aura warriors include:

  • Author Lewis Carroll – Famous author of Through the Looking Glass and Alice’s Adventure’s in Wonderland, Lewis Carroll was a well-known person with Migraine. In fact, the size distortions that Alice experiences down the rabbit hole are thought to be related to Migraine and are now called “Alice in Wonderland Syndrome.”
  • Artist Vincent van Gogh – Art enthusiasts have speculated that the halos, swirling patterns, and colors of paintings like Starry Night and Trees in the Garden in Front of the Entrance to Saint-Paul Hospital (right) are representations of van Gogh’s Migraine auras.
  • Artist George Seurat- Famous French post-Impressionist artist George Seurat, well known for the artistic technique pointillism, is said to have experienced Migraine with aura. Some medical researchers even refer to scotoma, or scintillating aura, in Migraine as the Seurat Effect.
  • Actress and Singer Kristin Chenoweth – Migraine warrior, famed actress, and singer Kristin Chenoweth shares her experience with Migraine at the Migraine World Summit. She explains how knowing she wasn’t alone was sometimes the best medicine for dealing with a condition that is largely invisible and often stigmatized.


  • Confirm you have the right diagnosis. Bring a headache diary into your doctor and review ALL your symptoms, even the strange and seemingly unrelated ones. If you’re not confident with your diagnosis, it may be time to see a doctor who is more familiar with migraine or a headache specialist.
  • Act quickly. Think of the aura as your friendly tornado siren. If you know what to look and listen for, you can get to a safe place and sometimes abort an attack before the debilitating headache phase begins. That’ll save you money, time, and a lot of pain. It can allow you to treat early, which experts say is far more effective than waiting.
  • Alert others. Don’t be afraid to ask for help, especially with driving and navigating in public. Friends don’t let friends experience an aura alone. Have an alert plan if you feel an aura coming on, like sending a quick pre-formatted text with instructions to your three closest caregivers.
  • Re-evaluate your treatment plan. If you indeed have migraine with aura, it may not be wise for you to take medications that further elevate your risk of stroke. You and your doctor can create a treatment plan with lifestyle changes that limits your risks.

Once you recognize the symptoms of Migraine with aura, you can better manage Migraine and all the emotions it brings.

Comments? Do you experience any Migraine with Aura symptoms?

Image: Youtube

First published May 11, 2015 / Updated June 2019

  1. American Migraine Foundation. Migraine and Aura. (n.d.). Retrieved from
  2. Mayo Clinic Staff. Migraine with Aura: Overview. (2019, May 30). Retrieved from
  3. American Migraine Foundation. Migraine and Aura. (n.d.). Retrieved from
  4. American Migraine Foundation. Migraine and Aura. (n.d.). Retrieved from
  5. He, Y., Li, Y., & Nie, Z. (2015). Typical aura without headache: a case report and review of the literature. Journal of medical case reports, 9, 40. doi:10.1186/s13256-014-0510-7. Retrieved from
  6. He, Y., Li, Y., & Nie, Z. (2015). Typical aura without headache: a case report and review of the literature. Journal of medical case reports, 9, 40. doi:10.1186/s13256-014-0510-7. Retrieved from
  7. American Migraine Foundation. Migraine and Aura. (n.d.). Retrieved from
  8. American Migraine Foundation. Migraine and Aura. (n.d.). Retrieved from
  9. Migraine with Brainstem Aura (Basilar-Type Migraine). (n.d.) Retrieved from
  10. Al-Hashel, J. Y., Ahmed, S. F., Alroughani, R., & Goadsby, P. J. (2013). Migraine misdiagnosis as sinusitis, a delay that can last for many years. The journal of headache and pain, 14(1), 97. doi:10.1186/1129-2377-14-97. Retrieved from
  11. Al-Hashel, J. Y., Ahmed, S. F., Alroughani, R., & Goadsby, P. J. (2013). Migraine misdiagnosis as sinusitis, a delay that can last for many years. The journal of headache and pain, 14(1), 97. doi:10.1186/1129-2377-14-97. Retrieved from
  12. American Migraine Foundation. Migraine and Aura. (n.d.). Retrieved from
  13. Mayo Clinic Staff. Migraine: Diagnosis. (2019, May 31). Retrieved from
  14. Mayo Clinic Staff. Migraine: Diagnosis. (2019, May 31). Retrieved from
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