Migraine Aura Without Headache

If you have seen flashes of light, visual distortions, or bright spots in your visual field, read on. You may have migraines with aura.

Migraine without a headache is possible and common.  What makes it a migraine is the aura, even in the absence of a headache.

The aura can manifest in different ways and at any age. However, it is more common in older people.

 

 

Who gets Migraine with Aura?

According to the Framingham study, 1% to 2% of the elderly experience migraine with aura. Among those with symptoms, 77% experienced migraines after 50 years of age. 42% have no migraine history, and 58% never had any headaches.

A Swedish study reported that it occurs in 13% of the population, and in those with migraines, 37% will have aura without any headaches.

 

 

How Does Migraine with Aura Happen?

During the migraine attacks, the blood vessels of the brain get stimulated with the release of substances. The stimulation constricts the blood vessels and decreases the blood supply. The blood vessels later dilate to cause inflammation around the blood vessels.

At the same time, electrolyte shifts and imbalances lead to “spreading cortical depolarization” and stimulation of the brain to manifests as an aura. Auras can present in different ways. The type of aura will depend on what part of the brain is stimulated.

 

 

 

Types of Migraine Aura

Visual Aura

99% of auras are visual. The following have been described:

• Unformed flashes of light – photopsia
• Fortification spectrum or Teichopsia – a bright zigzag border that looks like an old fortress
• Partial loss of sight or “blind spot” or scotomata are often crescent-shaped
• Visual distortion
• “Heatwaves”
• Double vision or diplopia
• Altered or distorted objects or metamorphosis – “Alice in Wonderland” Syndrome is a distorted image of a part or of the whole body that the person knows is unreal. The body may look bigger, smaller, or distorted. It is rare but common in FaceBook.
• ‘Foggy’/blurred vision or “dimness.”
• Black dots
• Colored dots
• Small bright dots or phosgenes
• Flickering light
• Visual snow
• White spots
• Geometric shapes
• Visual snow
• “Bean-like” forms
• Blindness of one half of the visual field or hemianopsia
• Deformed images
• Tunnel vision
• Movement of stationary objects or oscillopsia
• Mosaic vision
• Fractured objects
• Corona effect
• Objects appear smaller or more distant than they genuinely are – micropsia
• Objects appear larger or closer than they are – macropsia
• Like looking at a negative film
• Visual perception of something not present (objects, animals, and persons) – Complex hallucination

 

 

Neurological Symptoms

• Numbness – none or diminished sensation
• Tingling or paresthesias – This can start from the fingers spread to the upper arms and the face, cross over and travel down the other arm.
• Mild weakness of the limbs. Most common in the hands and arms
• Total Global Amnesia – loss of memory but still able to carry out a conversation and do activities like driving and shopping. Afterward, they cannot recall anything that happened. The pre amnesia memory is intact after the episode.
• Speech problems like slurred speech, expressive aphasia or inability to express themselves properly
• Spinning sensation or vertigo
• Confusion – usually seen in children

 

 

Possible Migrainous Conditions

• Cardiac Migraine – variant type angina or chest pain due to coronary artery spasm
• Cyclic Vomiting Syndrome – severe spells that last for hours and episodic
• Abdominal Migraine – associated with nausea and vomiting and can last from 1 to 8 hours.

Medical conditions that can mimic Migraine with aura

• Mini strokes or Transient Ischemic Attacks
• Stroke (Cardiovascular Accident)
• Eye problems particularly the retina
• Partial Seizures
• Heart attacks

Take-Away Message

If you experience any of the symptoms above, it is best to talk to your doctor. Migraine with aura are generally benign, but other severe conditions must be ruled out.

The next posts will take about the different foods that can trigger migraines. You may be eating them now.

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References:

1. Kunkel RS. Migraine aura without headache: benign, but a diagnosis of exclusion [published correction appears in Cleve Clin J Med. 2005 Aug;72(8):640]. Cleve Clin J Med. 2005;72(6):529‐534. doi:10.3949/ccjm.72.6.529
2. Evans, R. The Clinical Features of Migraine With and Without Aura
   Updates on the clinical features of Migraine, especially Migraine with aura. Practical Neurology. April 2014
3. Viana, M., Tronvik, E.A., Do, T.P. et al. Clinical features of visual migraine aura: a systematic review. J Headache Pain 20, 64 (2019). https://doi.org/10.1186/s10194-019-1008-x

Image credits:

The Brandenburg Gate as seen with four migrainous eyes. By S. Jähnichen – Own work, CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=6668911

Cortical spreading depression By User:S. JähnichenBrain_bulbar_region.svg: Image: Brain human sagittal section.svg by Patrick J. Lynch; Image: Brain bulbar region.PNG by DO11.10; present image by Fvasconcellos. – Brain_bulbar_region.svg, CC BY 2.5, https://commons.wikimedia.org/w/index.php?curid=6049291