What Are the Different Types of Migraine Aura?

Migraine with aura can cause various symptoms. Here are the different types of migraine aura and what you can expect if you experience them.

If you have migraine you’re not alone. Approximately 12% of people are affected by migraine, making it one of the most common neurological conditions.

Of the people who have migraine, about 1 out of every 4 also experience what’s called migraine with aura. Migraine with aura is a distinct clinical diagnosis from migraine without aura.

Aura is the umbrella term for the visual, sensory, speech, auditory, or motor symptoms that can occur during a migraine episode. These symptoms often precede or accompany an attack.

While aura can look and feel different for different people, symptoms generally fall into a few different categories. Here, we take a look at what those aura categories are.

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What is an aura?

When someone talks about migraine with aura, they’re referring to migraine episodes accompanied by particular sets of neurological symptoms.

For people who have migraine with aura, the symptoms of aura occur during the second phase of a migraine episode, after the prodrome phase. While not everyone experiences the prodrome phase, those who do tend to have symptoms starting a couple of hours to a couple of days before the migraine attack.

Different types of auras produce different effects on the body. The most common aura symptoms are visual disturbances, sensory disturbances throughout the body, and trouble with speech and language. Other, rarer aura types can also occur, including motor symptoms or symptoms associated with migraine with brainstem aura.

Aura symptoms develop gradually and typically last anywhere from 5 minutes to 1 hour. Symptoms usually occur before the onset of migraine headache pain (also known as the migraine attack phase). It’s also possible for auras to develop after the headache phase has started and occur simultaneously with headache pain.

Headache and other general migraine symptoms usually follow within 60 minutes of the onset of auras. This means that aura symptoms can be a strong indication that a migraine attack is starting.

It’s also possible to experience auras with milder headache than your usual migraine head pain, or even without headache entirely. This is still a migraine episode, just without the headache pain.

It’s important to note that aura symptoms are fully reversible, meaning they go away entirely. The majority of aura symptoms go away in about 1 hour. Some rare motor symptoms may last up to 72 hours.

If symptoms that you thought were related to an aura last longer than an hour, it may be a sign of something else and you should contact your doctor.

People who experience aura don’t necessarily experience it with each migraine episode: it’s possible to have migraine with aura sometimes and migraine without aura other times. And of course, some people with migraine don’t experience aura at all, ever.

What are the different types of migraine aura?

Migraine aura can manifest in several different ways. Visual, sensory, and speech or language disturbances are the three most common types of migraine aura. Rarer types include migraine with brainstem aura, hemiplegic migraine, and retinal migraine.

Some people experience just one aura per migraine episode. Others may experience multiple auras. Auras can happen in succession or at the same time, like a visual symptom accompanied by a sensory symptom. Taken individually, each aura symptom can last up to 1 hour.

For people who experience multiple auras in one migraine episode, the order generally begins with visual, then sensory, then speech and language auras. Clinical studies have, however, noted different orders, so it’s also possible that your aura symptoms won’t occur in the same way.

Keeping in mind that each person can experience aura differently, here’s a breakdown of some of the symptoms you may have with different types of migraine aura.

Visual aura

Visual aura is by far the most common type of aura. Of people who have migraine with aura, over 90% experience visual disturbances in at least some of their migraine attacks.

Visual auras can include the following disturbances in your vision:

• shimmering zigzag lines or bright lines
• bright spots, dots, or stars
• bright flashes or flickers of light
• blurred vision
• blind spots or loss of vision

Visual auras appear, to some degree, in both eyes. The things you see may gradually spread out from a smaller focal point, growing in size. The result can sometimes be a large blind spot with shimmering edges stretched across your vision.

In some cases, you may even experience a partial or total loss of vision for short periods of time. This is called a “scotoma.” However, it’s important to note that your vision will come back as the aura goes away.

People who experience visual aura may occasionally have sensory symptoms as well, particularly in their extremities. They may also experience language aura.

Sensory aura

Sensory aura is the second-most common type of aura that people who have migraine with aura experience, accounting for 36% of migraine cases with aura.

If you experience a sensory aura, it means that you feel unusual sensations in your body. These sensations can include:

• tingling
• pins and needles
• numbness

Usually, sensory auras begin in one part of your body, face, or tongue and may slowly spread outward. You can experience sensory auras in small spots or in bigger areas. Numbness may occur following tingling sensations or pins and needles, or it may be the only sensory aura that you experience.

Generally, sensory auras occur on one side of your body at a time. Even if the tingling or numbness spreads, those sensations will still be contained either on one side of you or the other.

People who primarily experience sensory aura symptoms in their extremities almost always have some form of visual aura during at least some of their migraine episodes.

Speech and language aura

Auras affecting speech and language abilities are the third-most common aura type. Of people who have migraine with aura, 10% experience speech and language auras. This type of aura is sometimes also called “aphasic aura.”

Speech auras can impact:

• word recall
• verbal comprehension
• speaking rate
• articulation

Speech auras can also affect your ability to physically form words, meaning the muscles in your lips, mouth, and tongue have a harder time getting your words out. Additionally, fatigue may impact your sentence-to-sentence stamina, and getting through long periods of speech may be more difficult than usual.

People who primarily experience speech and language aura symptoms almost always also have some form of visual aura during at least some of their migraine episodes.

Rare types of migraine aura

Other types of migraine aura can also occur, although these types are much rarer. Here’s what these migraine auras may look like.

Migraine with brainstem aura

Migraine with brainstem aura is a relatively rare type of aura occurring in about 6.6–10% of cases of migraine with aura.

Symptoms of this aura include:

• vertigo
• slurred or slowed speech
• double vision
• tinnitus
• partial hearing loss
• decreased consciousness
• clumsy movements, like difficulties with walking, balancing, or hand coordination

People who experience migraine with brainstem aura frequently experience other, more common aura types, as well. For example, about 1 in 10 people who experience visual auras also get migraine with brainstem aura symptoms.

Hemiplegic migraine

Hemiplegic migraine involves migraine episodes with auras that affect your motor skills. This type of migraine is very rare: research indicates it only occurs in 0.01% of the population.

This type of migraine aura presents as weakness on one side of your body. Symptoms usually start in one hand, before spreading to the arm and face.

Current clinical research suggests that hemiplegic migraine is genetic, meaning you likely don’t have this type of migraine unless someone in your close family also has it.

Hemiplegic migraine is often accompanied by visual, sensory, or speech and language auras.

Retinal migraine

Retinal migraine has very similar symptoms to migraine with visual aura, including bright flashes, shimmering lights, and vision loss. However, retinal migraine has one important difference: any effects on vision appear only in one eye.

Retinal migraine is extremely rare. Older research suggests it affects about 1 out of every 200 people who have migraine (or 0.005% of the population). 2023 research also indicates that this migraine type is rare, but hesitates to use exact numbers since data concerning retinal migraine specifically is very scarce.

The typical type of visual aura is much more common than retinal migraine, and these auras appear, at least to some extent, in both eyes.

Diagnosing migraine aura

Experiencing aura symptoms like visual disturbances, bodily sensations, or trouble with speech and language can be worrisome or frightening, especially if you don’t understand what’s happening.

Your doctor can help you figure out if your migraine diagnosis should include a migraine with aura diagnosis. From there, they can help you adapt treatment and symptom management to address any auras you may experience.

To prepare for conversations with your doctor, try keeping a journal of your aura symptoms to note if and when you experience them. You can include a list of each symptom, when it begins, when it ends, and when (or if) you get headache pain.

If you experience vision changes, drawing what you see can also be a helpful way of identifying your aura with your doctor. If you have trouble with speech and language, recording yourself talking during an episode can give your doctor valuable real-time information.

The takeaway

Some people who experience migraine have migraine with aura, a distinct medical diagnosis that refers to migraine episodes accompanied by certain neurological symptoms.

The most common types of migraine aura present as visual disturbances (such as bright zigzag lines), sensory disturbances (such as tingling sensations), or speech and language disturbances (such as trouble remembering words).

You may only experience one type of aura, or you may experience a combination of auras in succession or simultaneously. Generally, symptoms shouldn’t last longer than 1 hour.

Although aura symptoms may feel unsettling or even frightening as they’re happening, remember that they will go away completely.