Part of the Access Doctor migraine treatment guide. Conditions overview: migraine & headache UK.
Migraine with Aura: Symptoms, Types & Treatment UK
A clinically reviewed guide to migraine aura — what it is, the types (visual, sensory, speech, motor), how to distinguish it from a TIA, treatment, and the critical combined contraceptive pill contraindication.
▶ Migraine with aura at a glance
Aura affects 25–30% of people with migraine — focal neurological symptoms that develop gradually over minutes before the headache. Most commonly visual (zigzag lines, blind spots), but also sensory (tingling) or speech disturbance. Key safety point: migraine with aura is a UKMEC 4 contraindication to the combined oral contraceptive pill due to a ~6-fold increase in stroke risk. GPhC pharmacy #9011198.
What Is Aura?
Aura consists of focal neurological symptoms that develop gradually (over 5 or more minutes), typically last 20–60 minutes, and are fully reversible. They occur before or during the headache phase. Each individual symptom within an aura sequence builds, reaches a peak, and resolves before the next begins.
The gradual build-up over minutes is the key distinguishing feature of aura vs stroke. Stroke symptoms are typically sudden. If neurological symptoms appear suddenly, call 999.
Types of Aura
Visual aura (most common — ~90% of aura cases)
- Scintillating scotoma — the classic aura: a flickering, crescent-shaped disturbance with a bright zigzag border (fortification spectrum) that expands across the visual field over 20–30 minutes
- Positive phenomena: flashing lights, bright spots, geometric patterns
- Negative phenomena: blind spots (scotoma), blurred vision, temporary loss of vision in part of the visual field
- Transient monocular vision loss (rare)
Sensory aura
- Tingling (paraesthesia) spreading typically from the fingers up the arm to the face — characteristically unilateral, “marching” spread
- Numbness following the same pattern
Speech and language aura
- Dysphasia (difficulty finding words or naming objects)
- Slurred or disrupted speech
Motor aura (rare — hemiplegic migraine)
Weakness affecting one side of the body. This constitutes hemiplegic migraine, which requires specialist assessment. Triptans and COC pill are contraindicated. Always discuss with a neurologist before using any acute migraine treatment if motor aura is present.
Aura Without Headache (Silent Migraine)
Aura can occur without a subsequent headache — sometimes called “silent migraine” or “acephalgic migraine”. This is more common after the age of 50. Because the visual or sensory symptoms occur in isolation, patients sometimes present urgently fearing a TIA or stroke. The gradual build-up and full resolution within 60 minutes, combined with a prior history of migraine, is diagnostically helpful.
Treatment of Migraine with Aura
Treatment follows the same principles as migraine without aura, with the following considerations:
- Triptans: Effective — take at headache onset (not during aura). Safe in typical migraine with aura. Contraindicated in basilar migraine (aura with brainstem symptoms) and hemiplegic migraine.
- NSAIDs (naproxen 500mg): Effective for mild to moderate attacks. See naproxen for migraine guide.
- Anti-emetics: Often needed alongside acute treatment.
- Preventive treatment: If aura attacks are frequent, see migraine prevention guide.
Critical safety warning — combined contraceptive pill: Migraine with aura is a UKMEC 4 contraindication to the combined oral contraceptive pill (COC). UKMEC 4 means the risks of using the method are unacceptable. The combination increases stroke risk approximately 6-fold. If you have migraine with aura, you must not use the combined pill, patch, or vaginal ring containing both oestrogen and progestogen. Progestogen-only contraception (mini-pill, implant, hormonal IUS) is safe — UKMEC 1. Discuss with your prescriber or GP. See: migraine and the pill →
Get Migraine Treatment Prescribed Online
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View Migraine Treatments →Frequently Asked Questions
What does migraine aura feel like?
The most common aura is visual — a scintillating scotoma: a flickering blind spot with a bright zigzag border that gradually expands across the visual field over 20–30 minutes. Sensory aura feels like tingling or numbness spreading from the fingers up the arm to the face. Each symptom builds gradually, which distinguishes it from the sudden onset of a TIA.
Is migraine with aura more serious than migraine without aura?
Migraine with aura carries a slightly higher stroke risk than migraine without aura, particularly in combination with the combined oral contraceptive pill or smoking. The absolute risk remains low in most people, but the pill contraindication is firm. Migraine with aura does not require different acute treatment — triptans and NSAIDs remain appropriate.
Can I take triptans if I have migraine with aura?
Yes — triptans are appropriate for migraine with aura. Take them at headache onset, not during the aura phase. The exception is hemiplegic migraine and basilar migraine, where triptans are contraindicated.
Why can't I take the combined pill if I have migraine with aura?
Migraine with aura is classified UKMEC 4 (risks unacceptable) for combined hormonal contraception. The combination approximately 6-fold increases ischaemic stroke risk. Progestogen-only contraception (mini-pill, implant, hormonal IUS) is safe and recommended as an alternative.
What is a silent migraine?
A silent migraine (acephalgic migraine) is aura that occurs without a subsequent headache. It is more common in people over 50 and may be mistaken for a TIA. The key distinguishing feature is gradual onset and full resolution within 60 minutes.
References
- NICE. Headaches in over 12s: diagnosis and management. CG150.
- UKMEC. UK medical eligibility criteria for contraceptive use. 2016 (updated 2019).
- NHS. Migraine. nhs.uk/conditions/migraine
Medical disclaimer: This article is for informational purposes only. Prescription migraine treatments require a clinical consultation. Always consult a qualified healthcare professional. In a medical emergency, call 999.