Aura: Symptoms, Causes and Treatment
An aura is a temporary neurological phenomenon that occurs before or during a migraine attack or epileptic seizure. Typical signs include visual disturbances, tingling, or speech difficulties.
Things worth knowing about "Aura"
An aura is a temporary neurological phenomenon that occurs before or during a migraine attack or epileptic seizure. Typical signs include visual disturbances, tingling, or speech difficulties.
What Is an Aura?
The term aura refers to temporary neurological symptoms that occur before or during certain medical events – most commonly before a migraine attack or an epileptic seizure. The symptoms are caused by temporary changes in the electrical activity of the brain and usually resolve within 20 to 60 minutes without causing lasting damage.
Causes and Underlying Conditions
An aura occurs in association with several neurological conditions:
- Migraine with aura: The most common form. A wave of electrical activity spreads across the cerebral cortex (known as cortical spreading depression), causing temporary neurological disturbances.
- Epilepsy: An aura can occur as a warning signal before an epileptic seizure, triggered by abnormal electrical discharges in the brain.
- Transient ischemic attack (TIA): In rare cases, similar symptoms may arise from brief disruptions in blood flow to the brain.
Symptoms
Aura symptoms vary depending on which part of the brain is affected. They are generally grouped as follows:
Visual Aura Symptoms
- Flickering lights, zigzag lines, or flashes of light (known as fortification spectra)
- Blind spots (scotomas) in the visual field
- Distorted or blurred vision
Sensory Aura Symptoms
- Tingling or numbness, often in the hands, arms, or face
- A spreading tingling sensation that moves from one body part to another
Motor and Speech Aura Symptoms
- Muscle weakness or coordination problems (as seen in hemiplegic migraine)
- Difficulty speaking or finding words (aphasia)
Other Aura Symptoms
- Confusion or disorientation
- Auditory disturbances or sounds
- Unusual smell or taste sensations (particularly in epilepsy)
Diagnosis
Diagnosis of an aura is primarily based on the medical history and the description of symptoms provided by the patient. Additional investigations may include:
- Neurological examination: Assessment of reflexes, coordination, and sensory perception
- EEG (electroencephalogram): Measurement of brain electrical activity, especially when epilepsy is suspected
- MRI or CT scan: Imaging studies to rule out structural brain changes
It is important to distinguish a migraine aura from a stroke or TIA, as the symptoms can be similar but require different treatments.
Treatment
Treatment of an aura depends on the underlying condition:
Migraine with Aura
- Acute therapy: Pain relievers such as ibuprofen or paracetamol, as well as migraine-specific medications (triptans), although triptans are generally not recommended during the aura phase itself.
- Preventive therapy: Beta-blockers, valproate, topiramate, or monoclonal antibodies targeting CGRP can help reduce the frequency of attacks.
- Lifestyle measures: Regular sleep, stress management, adequate hydration, and avoiding known triggers.
Epilepsy
- Antiepileptic medications such as lamotrigine or levetiracetam
- In certain cases, surgical procedures or neuromodulatory therapies
When to See a Doctor
If aura symptoms occur for the first time or suddenly change in character, medical advice should be sought promptly. The following warning signs require immediate medical attention:
- Aura symptoms that last longer than one hour
- A sudden, severe headache
- Accompanying symptoms such as vision loss in one eye, loss of speech, or signs of paralysis
References
- International Headache Society (IHS): The International Classification of Headache Disorders, 3rd edition. Cephalalgia, 2018.
- Olesen J. et al. - The Headaches, 3rd edition. Lippincott Williams & Wilkins, 2006.
- Hadjikhani N. et al. - Mechanisms of migraine aura revealed by functional MRI in human visual cortex. Proceedings of the National Academy of Sciences (PNAS), 2001.
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