Part 4: Migraine Aura—More Than Just Visual Disturbances
"I get ocular migraines."
It's a phrase clinicians hear all the time.
The problem is...it's usually not correct.
One of the most misunderstood aspects of migraine is the concept of aura. Many people assume aura simply means "seeing flashing lights," while others use the term ocular migraine to describe any visual disturbance that occurs before or alongside a headache.
Modern migraine research tells a much more interesting story.
Migraine aura isn't simply an eye problem—it's a temporary neurologic event occurring within the brain.
Understanding that distinction changes how we think about migraine and helps explain why some patients experience symptoms that extend far beyond vision.
What Is a Migraine Aura?
A migraine aura is a temporary neurologic disturbance that typically develops gradually over several minutes and usually lasts between 5 and 60 minutes.
Only about 30% of people with migraine experience aura, meaning most migraine patients never develop one.
Although visual symptoms are by far the most common, aura can affect many different parts of the nervous system.
Aura Isn't Always Visual
When most people think of aura, they picture flashing lights or zig-zag lines.
Those are certainly common, but they're only one type of aura.
Migraine aura may also include:
numbness or tingling
difficulty finding words
temporary speech disturbance
weakness affecting one side of the body
dizziness or imbalance
double vision
ringing in the ears
cognitive symptoms “zoning out”
In other words, aura is not defined by what symptom occurs.
It's defined by where that symptom originates—in the brain.
"Ocular Migraine" Is Usually the Wrong Term
One of the biggest misconceptions is the phrase ocular migraine.
Most patients who use this term are actually describing visual aura.
Visual aura originates in the occipital cortex, the part of the brain responsible for processing vision. Although patients often feel like the disturbance is occurring in one eye, it is actually affecting the visual fields of both eyes because the problem lies within the brain—not the eye itself.
A true retinal migraine is something entirely different.
Retinal migraine is a rare condition involving temporary visual loss or visual disturbance affecting only one eye. Because several serious eye and vascular conditions can produce similar symptoms, retinal migraine is considered a diagnosis of exclusion and warrants appropriate ophthalmologic evaluation. Ruling out a stroke or other vascular events is an important part of the diagnostic process.
Can You Have Aura Without a Headache?
Yes.
In fact, some patients experience typical aura without headache, meaning the neurologic symptoms occur, but the headache phase never follows.
For patients, this can be incredibly unsettling.
Many worry they're having a stroke or another neurologic emergency, especially if the symptoms occur for the first time later in life.
Recognizing this migraine subtype helps clinicians educate patients while also knowing when further medical evaluation is appropriate.
So What Causes Aura?
Researchers believe migraine aura results from a fascinating phenomenon known as cortical spreading depression—a slow-moving wave of altered electrical activity that travels across the surface of the brain.
As this wave passes through different regions of the cortex, it temporarily disrupts normal neurologic function, producing the symptoms patients experience.
Exactly how this process unfolds—and why it occurs in some migraine patients but not others—is one of the most fascinating areas of migraine research today.
We'll take a closer look at cortical spreading depression in a future article.
Clinical Pearl
Patients will often insist that their visual disturbance occurred "in one eye."
Instead of asking,
"Which eye?"
Try asking,
"If you close one eye, do you still see it? What about the other eye?"
Many patients discover the visual disturbance is actually present regardless of which eye is closed, suggesting the phenomenon is occurring within the brain rather than the eye itself.
Sometimes, a single question can completely change how a patient understands their migraine.
Key Takeaways
Aura is a temporary neurologic event, not simply a visual disturbance.
Visual aura is the most common type, but aura can also affect sensation, speech, balance, and movement.
Most people who say they have an "ocular migraine" are actually describing migraine with visual aura.
Retinal migraine is rare and affects vision in only one eye.
Aura can occur with or without a headache.
Cortical spreading depression is believed to be the underlying mechanism behind migraine aura.
Suggested Reading
Continue Rethinking Migraine
This is Part 4 of the Rethinking Migraine series.
Next Article → Part 5: The Electrical Storm Behind Migraine Aura
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If you are looking for continuing education credits on this topic, consider my Migraine Series: A Clinical Guide for Acupuncturists available through Net of Knowledge!
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