Lee Ashdown was having a peaceful drink in the pub after work when he suddenly couldn’t see half of his friend’s face. I figured I had consumed too much alcohol since I felt bewildered. He hurriedly made his explanations and fled, going directly to bed when he came home.
However, the distorted vision recurred and quickly established a pattern. “It begins as a fuzzy line of light in the bottom corners of both eyes and spreads over my field of vision over an hour,” says the Heathfield, East Sussex, 37-year-old auditor. Then it gradually vanishes into the top corners. This is when the headache begins.”
A few months later, he visited his primary care physician, who diagnosed these symptoms as migraine auras. According to the National Migraine Centre, around 10 percent of the population in the United Kingdom suffers from migraines. A third of these individuals will feel auras. Auras can sometimes arise without a headache; these are referred to as “silent migraines” for those who associate migraines with pain.
Auras can be visual, typically appearing as flashing lights, zigzag patterns, or blind spots, but they can also involve other symptoms such as ringing in the ears, pins, and needles, imagined odors, or aphasia, a temporary loss of the capacity to speak or comprehend people speaking.
Many patients fear they are undergoing a transient ischemic attack (TIA), commonly referred to as a mini-stroke. However, the symptoms of a migraine aura tend to be “positive” (such as flashing lights and tingling skin) and build very gradually, whereas those of a TIA is more likely to be “negative” (such as losing sensation in your hands or vision in one eye) and appear quickly. Rarely, flashing lights can also be a symptom of a retinal detachment; the Royal National Institute of Blind People can provide additional information.
Zoe, now 27 years old, has had migraine auras since she was nine years old. “I get zigzag lines. It’s always the same colors: strong blues, pinks, yellows, and black.” Each aura will last between two and four hours, followed by the onset of severe headaches.
“I also experience pins and needles, difficulty speaking, and loss of sensation in my hands and legs… Sometimes the pain is so terrible that I am unable to walk.” She also experiences tinnitus during these episodes. “I hear buzzing as if bees or wasps are flying about my head.”
Zoe, a court administrator who resides in Leeds and suffers up to twenty migraine auras per month, has experienced difficulties at work due to the amount of time she must take off. (An MRI ruled out alternative causes.) They have also necessitated that she cancel last-minute invitations to friends’ birthday celebrations and miss significant family gatherings. “Not being able to leave the house or do anything takes its toll,” she says. I once struggled with clinical depression.
Cortical spreading depression is the cause of migraine auras; it is a wave of electrical activity that sweeps across the cortex of the brain. Dr. Mark Weatherall, the consultant neurologist at the Stoke Mandeville hospital in Buckinghamshire and chairman of the British Association for the Study of Headache, likens it to “a mini-tsunami, a wave of overactivity followed by a trough of underactivity.”
These occur naturally, primarily in the visual portion of the brain, and are harmless, he explains. “As the wave propagates across the brain’s surface, every area of the visual cortex is struck. The overactivity generates the flashing lights or zigzags, and then there is a period of inactivity during which blind spots appear. Eventually, this will clear.”
According to Dr. Weatherall, the majority of migraine sufferers with auras only need to rest and let them pass. There are no treatments for auras; only medicines for headaches are offered. Over-the-counter medicines such as ibuprofen, paracetamol, and aspirin can be used to treat mild discomfort. According to research, magnesium and vitamin B2 supplements can help prevent migraines, while coenzyme Q10 shortens the duration of an attack and ginger alleviates pain and nausea.
For more severe attacks, your doctor may prescribe triptans, anti-inflammatory drugs, and anti-nausea medication to alleviate pain and nausea. Additionally, beta-blockers, antidepressants, and anti-seizure drugs are used to reduce the incidence of migraines.
Identifying individual triggers can be advantageous. Dr. Dawn Sim, consultant ophthalmic surgeon at Moorfields Eye hospital and co-founder of eye health business MTHK, frequently sees patients with migraine auras who are concerned that they have a visual problem. After performing a comprehensive eye exam to rule out other problems, she sits down with them to determine their triggers.
“Sleep deprivation, caffeine, chocolate, tea, cheese, and red wines… People remark, “Oh, so these are all the nice things in life?” when I list these occurrences. You have to determine your trigger. If excessive consumption or even a small amount of cheese is the cause, you should consider eliminating it from your diet. If [auras] do not cause headaches, they rarely impair people’s life. She sends patients with debilitating migraines to their primary care physician or a neurologist.
“Pork and cheese are my dietary intolerances,” explains Kim Oliver, 50, of Liverpool, who is medically retired from her position as a clerical officer due to migraines. In 2006, she began getting migraine auras. “Within twenty minutes of consuming my favorite foods — bacon, sausage, and paté — I’m out the door.”
In a 2007 US research of more than 1,200 persons with acute migraines, approximately 80 percent of participants cited stress as a significant influence. Women’s hormones, hunger, sleep disorders, odors, neck pain, alcohol, smoking, heat, light, food, exercise, and sexual activity were additional triggers.
Approximately 53% also mentioned that the weather played an influence, which rings true for Oliver. “My worst times are when it’s cloudy and wet,” she explains. It appears to be the most constant trigger for Zoe as well. Her attacks can be triggered if it is “moist or humid, or if it is cold and then becomes hot.” Ashdown concurs, stating, “The only thing I can think of that seems to correspond with receiving these is a severe storm.”
Migraines, and especially migraines with auras, are connected with a modestly increased risk of cardiovascular disease-related death. However, Dr. Weatherall emphasizes that there is no need for alarm. The great majority of migraine sufferers will have no adverse effects. Similarly, he states, “No one has ever conducted research demonstrating that reducing the frequency of migraines reduces the risk of heart disease or stroke.
Ashdown continues to pray for a cure after nearly two decades of suffering and innumerable testing to see whether there are underlying concerns. He has wasted too many days waiting for the migraine auras to fade while resting in a dark room.
“I could find peace with them if I knew when they would occur. It is the uncertainty. I must plan a bachelor party for a pal. What should I do if I acquire one when I’m out? I hope something will be developed one day to prevent them.”
