Science

Migraine Aura

Originally posted on Mad Art Lab.

Migraines are somewhat mysterious, vicious, angry infiltrators that can cause debilitating pain and a myriad of other symptoms. If you experience migraines you may be nodding your head in agreement right now. But if you don’t suffer from migraines you may be shrugging and saying to yourself, “oh come on, everyone gets headaches.”

But migraines are often much more than just headaches. In fact, migraines are more like electrical disturbances of the brain and nervous system that happen to have a symptom of headache.

Migraine sufferers can experience severe, throbbing or vice-grip-like headaches that last for days and in some cases even weeks. The headaches are often accompanied by nausea and a sensitivity to light and sound along with a disruption of motor skills. I said above that migraines are mysterious because, as of writing this post, there is still no one definitive test that can be given to determine if you have migraines (though genetic work is being done.) It is one of those ailments that you have to describe to your doctor. That description, along with a family history of symptoms is usually what gets you your diagnosis. It is one of the chronic conditions that for many years has been diagnosed on words alone. It is this lack of objective testing that make migraines a darling in the not-so-legit, get-a-medical-marijuana-card, or in other similar alternative medicine practices such as acupuncture or homeopathy. If you can’t even test for it, how can you objectively show if the patient is better? (Answer: you can’t. It’s all based on the subjective reporting of the patient.) But that is a topic for another day. Today, I’d like to direct your attention to one specific aspect of migraines, that over the past few years has been scientifically studied and can be seen- both by doctors and patients. Though patients have seen it for much, much longer indeed.

I am referring to the electrical disturbance that effects the visual cortex and causes what is called the migraine aura. The migraine aura is technically the second stage in the migraine onset though is often the first sign noticed by patients. Many describe the aura as a blinding (literally) multi-colored (though primarily white) spot that grows into an arc that slowly vibrates across the field of vision, causing temporary blind spots. A great description is that of sparkling shattered glass that the sun has been focused upon. The aura on average takes about 30 minutes to travel across what seems to the sufferer to be the eyes (one can see the aura with one’s eyes open or closed) but it is actually an electrical disturbance happening in your brain.

I have heard the aura referred to as a brain storm and I rather like that description. Auras can also be accompanied by loss of feeling on one side of the body and or and a disruption of motor skills. My experience is that it resembles a small temporary stroke where a lot of brain functioning and ability to react is lost for a few hours, or in some cases, days. I have personally experienced a sensitivity to sound, light and in some instances even smells become overwhelming. Patients also report being at a loss for… uh… what… are… those.. things… called.. again? Ah yes patients are often at a loss for words as cognitive ability can diminish for hours and often days after the main stage of a migraine. This is known as the postdrome stage.
Migraine aura diagram
Click on the above image to go to the Mayo Clinic site for a really great video that shows a fantastic animation of the different stages of migraine and how it effects the brain.

Often (and in my experience) as soon as the aura has traveled across the field of vision, the headache and nausea kicks in. Though I have, upon occasion experienced an aura episode without the headache, in most cases it serves as a very bright warning to find a dark space to hide for at least 4 hours-and if you are lucky, to take some migraine medicine.

Since the aura experience is often difficult to describe and I wanted to explain it to my partner, I decided to paint what my migraine auras look like. Below is a photo of a 3ft x 4ft acrylic on canvas representation of a single moment in in time in one of my “brain storms.” The painting shows two frames, one of each eye, if I was looking down at the ground at a beetle. The vibrating blinding arc will stay wherever you gaze, with eyes open or closed and completely covers a spot in your vision. The arc often begins as a tiny dot and grows or will begin on one side of the field of vision and travel across during the 20-30 minute episode. Then, as soon as the blind spot is gone, the headache starts.

migraine art by Amy Davis Roth
Migraine Aura art by Amy Davis Roth. Click to embiggen on Flickr.
 
If migraine art is interesting to you you may also enjoy this book titled, Migraine Art The Migraine Experience from Within. It has some great illustrations of other people’s interpretations of visual disturbances associated with migraines. I own it and it’s lovely.

If you too are a sufferer of brain storms do feel free to share your experiences below!

 

Some links on information and studies being done on migraines:

 
Genetic Mutation Linked With Typical Form of Migraine Headache
New theory on cause of migraine
Migraine With Aura May Lead to Heart Attack, Blood Clots for Women
Migraine May Permanently Change Brain Structure
What is a Migraine Aura?

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Amy Roth

Amy Davis Roth (aka Surly Amy) is a multimedia artist who resides in Los Angeles, California. She makes Surly-Ramics. She is the fearless leader of Mad Art Lab. Support her on Patreon. Follow her on twitter: @SurlyAmy or on Google+. Tip Jar is here.

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29 Comments

  1. I very occasionally get a visual migraine. I first got one in my late 20s. Mine starts in the centre of my field of vision and slowly expands as a wiggly circle (not disk) until it disappears past the edges of my vision. I am fortunate that so far any pain that follows is mild and short-lived.

    The description in the video is very good.

    1. Same as you I very occasionally get a visual migraine with no pain whatsoever, very lucky it seems! Off centre for me as last time it was curved around my laptop and was growing slowly… Looked a bit like the nexus from star trek but more curved – Amy’s drawing is not far off.
      http://images3.wikia.nocookie.net/__cb20100516231114/memoryalpha/en/images/1/1b/Nexus2371.jpg

      Very luckily all I need to do is find a dark room and close my eyes for a few hours and it always goes away. I remember the first one I got in French class as a kid as it freaked me out – got sent home and my Mum knew exactly what it was. She used to get them as well – but with pain and disorientation/nausea. So I know exactly how lucky I am as they were very debilitating for her. Fortunately hers went with the menopause, not that this is much comfort to women who get them but I understand that is not uncommon. I also hear that psilocybin mushrooms and LSD are being touted as potential treatments. Although it seems extremely preliminary at the moment.

  2. I have migraines that produce much different symptoms.

    For me it will start as a feeling of “visual congestion”, at least that’s how I describe it, my vision will start to look like a a monitor with the brightness turned up and the contrast turned down.
    I will sometime experience a nauseated feeling but not always.
    The migraine will start as a “ripple” in the center of the vision in both eyes and grow until it’s a “C” shaped “tear” over about half of my field of vision making almost any visual task nearly impossible, if I am driving I must pull over (they have a fairly slow onset so that is not usually an issue), and will last from 10 minutes to and hour.
    They are very rarely accompanied by what most people would know as a migraine; no headache, no light sensitivity, and I don’t get the auras as you have described them.
    I have endured a “real” migraine a couple of times (my type is called an ocular migraine and is sometimes referred to as silent because it doesn’t include the pain) and I am grateful for the silent type.
    The first couple of times it was frightening and wholly disconcerting but after talking to my regular doctor and being examined my ophthalmologist they both said that they were mostly harmless.
    I have them a couple of times a month and have learned to live with them, I can’t imagine having to deal with the more painful versions.

    Amy, I am so sorry you have to endure this. I hope they find a way to better combat them.

  3. I get auras and I get headaches with sensitivity to light and sound. But not together. I also woke up one night with a headache so bad I swore if it didn’t stop I’d kill myself. It resolved within half an hour (before the water went cold in the shower).

    Until the first time I saw a visual representation someone had made of an aura, I didn’t know that’s what I had. They’re odd. I’m lucky I don’t get the headaches with the aura, I think. I’m sure they’d be worse than my other headaches.

  4. I’ve only ever had one experience that can be described this way. Five years ago, I woke up to a bright light. I ignored it at first, thinking it was a dream or something. I don’t know how much time passed, but after a while I thought I had fallen back asleep when… pain like I have never felt in my life hit. I tried to get out of bed, but that was hard. When I managed to do it, I stumbled over to my parents’ bedroom and woke them up (actually, I didn’t wake them up… they were already getting set for synagogue; it was a Saturday morning). When they asked what was wrong, I found I simply couldn’t tell them.

    But I didn’t have to. Both my dad and my brother suffer from them often. Usually they are mild, I think because both of them are very, very good at catching them right at the beginning, so their medicine works.

    Dad could tell right away, and while I was failing to say anything at all to Mom, Dad was already getting the medicine. They both put me back in bed and we didn’t go in to synagogue that day. Mom, Dad, and my brother all took care of me.

    Now I get headaches quite often, and have for my whole life (I actually have one right now, but it’s really mild, and I’ve already taken something for it), but this incident has been the only time I ever experienced anything like it.

    I do want to comment on the marijuana-prescription thing you noted, though… when done right, that isn’t for the migraine specifically, but for the pain and nausea. Marijuana is rather well-known as a pain-reliever (both scientifically and I can say that from personal experience, as well), which is why it’s prescribed for people with migraines, cluster headaches, and so on, as well as a good reliever of nausea, which is why it’s often prescribed to patients on chemotherapy. It’s not meant to actually cure the migraines in any way… just help with the symptoms. And many times the symptoms are only subdued while the patient is high. It’s one of those things that really requires more testing.

    I hate being anti-Drug War and pro-legalization, because sometimes it means I share a voice with crackpots and gullible people. But there is science to back up SOME of the less ridiculous claims of medical marijuana advocates (it’s clearly not the wonder drug that will cure ALL THE THINGS!, obviously)… more needs to be done, of course, but that can’t happen while the federal government is still stuck in the 1920’s on how it views marijuana (among other things).

    1. Just for the record I think marijuana should be legalized. I just also think that the process to obtain it legally in California is a bit of a joke. I also think that like a lot of other herbs and alternative medicines, there is a lot more myth and magic and a lot less fact surrounding the products and their uses. I have actually been wanting to do a post on the topic and will try to do so in the coming weeks.

      1. I recently read this in the textbook, “Neurology and General Medicine” regarding neurologic complications of marijuana:

        Two recent reviews summarize case reports point –
        ing to a possible relationship between marijuana use
        and cerebrovascular ischemia and infarction.152,153 The
        mechanism by which marijuana could produce cerebral
        ischemia in young adults without other predisposing
        conditions is unclear, but vasospasm seems to be the
        most likely mechanism, as vasoconstrictive effects of
        THC have been documented in animals.154

        Although case reports are not the equivalent of a double blind placebo controlled trial, they are valid pieces of scientific evidence that are used for more accurate prospective studies. With that in mind and with your skeptic cap on, would you want to legalize a drug for migraines which could in turn possibly yield a devastating stroke among young adults? Would you want to treat one neurologic disorder resulting in an even worse neurologic disorder? If hypothetically, cigarettes reduced the migraine frequency, would you smoke? I’m all for decriminalizing this and other drugs (which would likely result in less abuse). Indeed, the street drug and formerly the date rape drug Sodium Oxybate is now used for the treatment of narcolepsy. The vasoconstricting triptan drugs to abort migraines (eg. Imitrex) carry a risk for cardiovascular and cerebrovascular sequelae. But those drugs are prescribed to patients who do not have any contraindications (eg. coronary artery disease, transient ischemic attacks) and they have gone through the proper prospective studies before being blessed by the FDA. Also, it is imperative for a physician to discuss the potential vascular side effects (eg. stroke and heart disease) when prescribing triptans. if there is now case reports of stroke among young adults who take marijuana, should there not be similar scientific studies that assess safety before being prescribed? I’d personally like to see Neurologist Steve Novella’s take on all this.

        1. Personally, I don’t hope to see the legalization of marijuana for the treatment of any condition in young adults. I just think it should be available in the same way alcohol is available. For adults only, in controlled environments. Unless the science proves me wrong, I see pot as a recreational drug that appears (from what I have seen) to be less damaging than alcohol in that respect. I definitely do not advocate using any unproven alternative medicine to treat any condition, especially one that can impair function like marijuana can.

          1. Ah, now that’s different. Like alcohol, you take this drug at your own risk and you pay the consequences of causing harm to yourself and to others (eg. drunk driving). And a different set of laws “in controlled environments” would have to be implimented. For example, in regards to alcohol, according to the FAA a pilot’s last drink has to be 12 hours before the flight. Personally, I wouldn’t board that plane until there is definite proof that the pilot’s blood alcohol level is zero and no clinical evidence of intoxication/withdrawal. For marijuana, blood THC metabolites have an elimination half-life of 20 hours and in the fat, it is 10 to 13 days. I don’t want to be high in a plane when a pilot is high. If you’re a pilot who likes to get high then you should fry–in jail!

          2. “Personally, I wouldn’t board that plane until there is definite proof that the pilot’s blood alcohol level is zero…”

            Zero? Absolutely zero?! Really?

        2. Proving, of course, that it really requires more study. But there’s a lot of information out there:
          http://norml.org/component/zoo/category/recent-research-on-medical-marijuana

          http://www.nashuatelegraph.com/news/1011407-469/the-science-of-medical-marijuana-is-hard.html

          http://www.cmcr.ucsd.edu/

          http://www.cnn.com/2013/08/08/health/gupta-changed-mind-marijuana/

          http://medicalmarijuana.procon.org/view.timeline.php?timelineID=000026

          For the record, ragdish, I’m not posting these links to “prove you wrong”. a) I don’t think there’s enough information out there to say either way, and b) I’ve read those papers as well and they do present some troubling aspects of marijuana. I’m following the science on this aspect of marijuana very closely (both papers I believe are undergoing more peer review… as I understand it).

          This will also be the last post I do on it without Amy’s… erm… blessing, I guess?… because I don’t to drag this wonderful post on migraines off topic into a marijuana flame war… except to say that I do support the idea of medical marijuana, as long as it’s scientifically viable, proven to work, and fully approved, as opposed to being peddled as snake-oil, which is how it’s being done right now.

          Why do so many medical advocates have to be anti-science?

          Why?

          It’s so damn frustrating!

  5. I’ve had migraines since my early 30s. I get one about twice per year, with pain, nausea and light aversion, but no aura. (It is rather as I imagine a hangover to be, but I’ve never been drunk, so I can’t compare directly.) I’ve thrown up on a couple of occasions. Unmedicated, it takes about 4 hours. I feel fine once it is over (indeed, I often feel quite good, appreciating the lack of pain.)

    Whenever I get a headache, I’m in fear. Is this just a headache, or is it the start of a migraine? Is that nausea I’m starting to feel a symptom, or just psychosomatic caused by my fear of it being a migraine?

    Medication at best shortens the duration. I’m not 100% sure it does anything, but I’m not about to risk not taking it.

    My migraines are horrible, yet I am well aware that I am very much at the mild end of what they can do.

  6. Interesting. I have migraines with aura but with no pain or nausea (if I try to read while the aura is going on then yes, that will cause a headache due to eyestrain). It starts with dissociation, then an hour or so later my depth perception drops out like someone has switched it off. Then I start to get creamy halos around points of light and everything becomes bright. Mine are triggered only by lack of sleep, and sleep in a dark room is the only thing that cures them.

    I had one recently for the first time in two years, and my depth perception took four days to completely return to normal. Not helpful with my commute, particularly.

  7. I very occasionally get an aura that’s like what you describe, a dot or something, but more often it’s just increased sense sensitivity. The big cue that I’ve got a migraine coming is when I suddenly feel like I am being attacked by strong scents and that the brightness of everything has been turned up, giving everything that is giving off light (or just reflective) an irritating haze and halo of light. In fact I had one a few weeks ago that, it wasn’t the worst, but it out lasted my pain med and woke me up, where I then proceeded to have to move as swiftly as I could to the toilet.

    I don’t take any specific migraine medicine. I find, luckily, that if I’m quick to note a headache that seems to be becoming a bit more than a headache, I can take ibuprofen, lay down in a dark, quiet room, sleep and it will mostly pass me by. I’ll have horrible dreams that include some pain (because migraines are vengeful suckers who will follow you no matter how deeply you sleep), but I’ll otherwise wake up reasonably ok. Fuzzy-headed, usually, and feeling a little blurred around the edges, but quick to return to normal. It just generally takes a chunk of my time with it. If it’s bad enough that nausea goes beyond just feeling like throwing up, it generally takes even longer to recover. Luckily, that doesn’t happen too often.

    My first major migraine lasted about a week when I was 14. I spent a week thinking my head would just explode, not eating anything because it kept coming up. That is my nightmare, that a migraine I’m having might last like that one did, or even longer.

  8. I get very mild migraines a couple of times a year.
    It is typically first visual Aura, which in my case consists of a blurry spot in the center of my vision, so I have to look around it to see anything. this lasts less than an hour, and then I start to feel nausea, and sometimes get a headache.

    Sometimes my aura is not a visual disturbance, but a cognitive. Typically it is kind of like a constant deja vu. Everything i hear, see or think about, makes me feel that I’ve experienced it before. I get the feeling you get when you the right answer to a question, but it is just beyond your grasp, which makes me focus on remembering where I heard, saw or thought that thing before.
    Then I get deja vu about trting to remember where my deja vu comes from – and finally I have to force myself to calm down, then I get deja vu all over again.

    It is a crippling and extremely stressing experience. I know my mind is dysfunctional, but I am unable to stop it. Lying down in a dark room doesn’t help all that much because I then have a hard time not starting on the vicious circle of trying to remember.

    One time, when I was at work I got so stressed that i fainted from the effort. 6 months quarantine from driving a vehicle, an MRI, and a couple of neurologists appointments later no explanation othe than migraines was found.

    The starnge thing is, that close to these crippling attack – and by close I mean up to a year later, even describing the symptoms as I did here, made me nauseous all over again, and I had to focus to not snap into the same state again.

  9. Oh, very cool artwork! I have always intended to put my auras in my watercolor paintings but have not done it yet. This will inspire me!

    My auras are a little different, they have different colors in them and the arc is made up of very small geometric shapes. The auras last for several hours and sometimes longer… then the rest starts up and it lasts for 2 or 3 days. If I could just stay in bed that whole time it would make it easier to get through but of course I have to try and work. Luckily I don’t get the terrible pain, and I can function at least a little.

    My doctor told me that they sometimes treat it with the drug in ergot! I thought that was pretty interesting. I use naproxin for the pain and that works fairly well as long as I take it immediately.

    1. Yes, my auras have very bright different colors too! If I ever paint it again I will try harder to detail the geometric brightly colored squares. Interesting that many people experience such a similar phenomenon!

  10. I used to have the aura and headache every month or two, just like in the mayo video, but without the pre- and post- effects described, although I usually was aware a couple of hours before that one was coming.

    Then, at age 30, in 1986, I had a motorcycle accident on the way home from work, hitting my head on the road pretty hard, but not enough to cause injury, thanks to my helmet. Immediately, I had the biggest and worst migraine of my entire life, but I have never had another one since then.

    It was worth it!

    That immediately throws any genetic explanation out the window for me. It seems it must be a mechanical problem that was fixed in the impact.

    Not necessarily recommending anybody else tries the same technique …

  11. It’s always interesting to see what other peoples’ auras are like. I’ve had visual disturbances only a few times – triangle-y things above and to the left of the center of my field of vision. They’ve always been right before a REALLY bad migraine, so whenever I start to see them, I make sure to finish up what I’m doing in the lab, because I’m probably going home early.

    Most of the time, though, my auras are visual, but not in a way that can be drawn or even described very well. The best description that I’ve come up with is that things get extra line-y. The edges of objects – especially straight edges – become really prominent. If I had to represent it visually, I’d probably take a photograph and show it to someone, but stand next to them and outline all of the edges in the photo with my fingers, while saying “HEY! HEY! LOOK AT THE EDGES!” and generally waving my hands around like an annoying jackass. Actually, that could make for an interesting art installation…

    Thankfully, my migraines have never lasted for more than a day, and while they tend to come in clusters, I can be migraine-free for a month or two at a time. They’re also pretty responsive to sumatriptan, if I can take it in time. As an added bonus, when a bad one finally clears, I’m absolutely euphoric for the next few hours. Not exactly an even trade, but at least it’s a little bit less of a “screw you” from my brain.

  12. My youngest daughter had such severe, debilitating headaches our doctor friend conjectured they might be migraines. She recommended we look for triggers. We found that when she had commercial pickles and certain cereals, both containing yellow and/or red dyes she got the headaches. We also found that she responded to Vitamin B6. Now, several years later, at 13, she rarely gets them but if she feels she is even slightly getting a headache she takes an Ibuprofen and that seems to do it. Now she is eating commercial pickles again with no problem. Lousy science but when there is so much unknown you tend to go to remedies and anecdotes.

  13. I get headacheless auras on occasion, and at first I was afraid it was a symptom of something really horrible. like a brain tumour. Now, I’m cool with them. Mine look like someone has sliced out a section of my field of view,scrambled up the pixels and glued them back in again with shimmery glue. Weird things, brains.

  14. I have never experienced the auras, or any of the early warning symptoms, as I wake up with migraines. I skip straight to the sever pain in one temple or the other, sometimes it pulses. When my migraines are really bad this often feels like it reaches to the back of my eye. This is usually associated with an inability to focus. I get extremely light and smell sensitive, as well as being sensitive to high pitched noises and nauseous.

    They last for anywhere from 6 hours to a week or more. In the last 6 months I’ve had my husband and partner threaten to take me to urgent care twice because I have been almost completely unable to function.

    Meds are hit or miss, sometimes they work, sometimes they don’t. Sleep and an ice pack (on the affected temple) work best, but it is so damn hard to sleep with a throbbing pain in my head and an ice pack.

  15. I also get the visual aura, but have only once gotten the headache. Usually for several hours or a day afterwards I feel mentally vague and unable to focus, but that’s it. It’s annoying, but not disabling. The video had a pretty good rendition of what an aura looks like, but not colorful enough. I’ve been looking for a good visual representation of one, and nothing has quite caught it yet.

  16. I usually get a migraine about once a year, they start with a blind spot in my vision. The blind spot must be in the brain because I can close one eye at a time and the blind spot is in both eyes.
    The next stage is the shimmering visual aura, similar to the picture at top of page but sometimes like the embattlements of a castle.
    If I can get some Panadol and rest at this point I can head the migraine off at the pass so to speak, but if I leave it too late, its the full blown headache and feeling sick for a day.
    After the migraine has subsided I also get about 2 to 3 days of a ‘recovering from a hangover’ sort of feeling.

  17. I thought it would be a hoot to read this article while having an aura. Having one right now. Fascinating. Took my butalb/apap/caff. Hope it works. Not looking forward to fog brain. I can blurt out really inappropriate things during fog brain, like yelling at clients for wanting to make minor changes, advising lady friends that I’ve noticed they are getting really old, or fat, and just generally being a butt head for no good reason. I really should stay away from people during and for a bout two days after a migraine. Did I spell all my words correctly? I can’t tell, the screen is disappearing and I can only see the first half of what I type. The shimmering jaggies are sure pretty though. Liked your beetle drawing. Why a beetle though? Do you have beetles crawling around your house? Or are they really cockroaches? Why don’t you clean your floor if you have cockroaches..

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