Migraine With Aura: Symptoms, Stroke Risk and Treatment
Some migraine attacks come with an aura: short-lived changes in vision, feeling or speech that usually show up before the head pain. Knowing what is typical helps you know when to get checked.
What is migraine aura?
An aura is a set of temporary nervous-system symptoms that most often affect vision. It usually starts shortly before the headache phase, though it can also blend into the headache. The symptoms tend to change and spread as the minutes pass, then fade.
Aura does not happen to everyone with migraine, and it may not happen with every attack. A person can be diagnosed with migraine with aura, migraine without aura, or both. The American Headache Society notes that getting the type right matters, because migraine with aura carries a higher stroke risk and may call for a different treatment plan.
Common aura symptoms
- Visual: spots, sparkles, flashes, stars, zigzag or wavy lines, colored patterns, blind spots, or briefly losing part of your sight. A bright shape may drift toward the center of your vision and leave a dark or gray patch.
- Sensory: tingling or numbness, often starting in the fingertips and moving up the arm, or affecting the face or mouth.
- Speech and language: trouble finding words, or slurred or mumbled speech.
- Less common: changes in smell.
Other forms of aura include motor aura, which causes weakness on one side of the body and is also called hemiplegic migraine, as well as migraine with brainstem aura and retinal migraine.
Aura without headache
Sometimes an aura comes and goes with no headache after it. This used to be called “acephalgic migraine” or “silent migraine.” The American Migraine Foundation (AMF) now prefers the term “migraine aura without headache,” because “silent” can make the experience sound minor. Research on this form is limited.
Prolonged aura
Most auras end within an hour. An aura that lasts longer than 60 minutes, starts suddenly, or does not fully go away needs medical attention, according to the AMF. For people with prolonged aura, a few small studies have tried a nasal spray form of ketamine. This is an off-label use, meaning the medicine is not approved for this purpose, and the evidence is limited.
Aura and stroke risk
Migraine with aura is linked to a higher risk of stroke, especially in women, including women younger than 45. The overall risk is still small: of about 800,000 strokes a year, an estimated 2,000 to 3,000 may be related to migraine.
Steps the AMF suggests discussing with your doctor include:
- Not smoking
- Keeping blood pressure and cholesterol under control
- Keeping a healthy weight
- Reviewing estrogen-containing birth control or hormone supplements, which can raise risk further in people with aura
- Learning the warning signs of stroke
How it is diagnosed
Aura is diagnosed from your description of what happens, how it starts and how long it lasts. Because aura can look like a stroke, timing is an important clue: aura usually builds gradually, while stroke symptoms tend to start suddenly. When aura appears without headache, a doctor may also need to rule out other causes, such as seizures or visual symptoms not related to migraine, including visual snow.
Treatment options
Treatment may combine acute medicine for attacks with preventive treatment to make attacks less frequent. For aura without headache, treatment can be tricky: common pills such as triptans and anti-inflammatory pain relievers often take longer to work than the aura lasts. No medicine is FDA-approved for aura without headache. Small studies and case reports have looked at magnesium, aspirin and lamotrigine. Preventive care, cognitive behavioral therapy and lifestyle changes may also help reduce attacks.
How Dr. Park can help
Dr. Hannah Park is a dual board-certified, fellowship-trained headache medicine neurologist with over 10 years of specialized experience. Migraine with visual aura, prolonged aura and complex aura are among the conditions she treats. Your first visit is a 90-minute consultation with Dr. Park: a full history review, a neurological exam, a diagnosis and a personalized treatment plan.
The practice focuses on targeted injection treatments, such as an occipital nerve block or an SPG block (no needles), rather than a cycle of prescription medicines. See services and fees. Appointments are Monday to Friday, 9 a.m. to 6 p.m.
When to get emergency care
Call 911 or go to the nearest emergency room if aura symptoms start suddenly, last longer than an hour, or do not fully go away; if you have new weakness on one side of the face or body, trouble speaking, or a change in alertness; or if your aura is suddenly different from your usual pattern. Do not assume these symptoms are “just aura.”
Related
Sources
This page summarizes patient information from these organizations, in our own words. It is general education, not medical advice.
- Understanding Migraine With Aura, American Migraine Foundation
- Aura Without Headache or “Silent Migraine”: A Guide, American Migraine Foundation
- Migraine and Stroke: Reducing Your Risk as a Patient, American Migraine Foundation
- Webinar Recap: The Phases of Migraine, American Migraine Foundation
- Migraine in the Emergency Department: When to Go to the ED for Migraine, American Migraine Foundation
- Migraine with Aura, American Headache Society
- Migraine Symptoms, National Headache Foundation
Last updated October 27, 2026.
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