Aura Migraine

Migraines are not just a bad headache, they are a neurological condition characterized by recurring, moderate to severe headaches, often accompanied by nausea, vomiting, and sensitivity to light and sound. It’s more than just a bad headache; it’s a complex condition with a range of symptoms that can vary greatly from person to person. Migraines can be debilitating, impacting daily life and causing significant disability. 

Migraines are 3 times more common in women (people with uteruses), and are often tied to the menstrual cycle.

  • If you mostly get migraines when you are in PMT or Menstruating, then you probably have the low Oestradiol version (try oestradiol contraceptives)
  • If you mostly get migraines mid cycle or the week before menstruating, then you likely have the high Oestradiol version (avoid oestradiol contraceptives)
  • If you mostly get migraines when you are exhausted and or have just pushed yourself hard, you probably have low neurotransmitter migraines (try Sertraline, Agomelatine, Clonidine and or ADHD medications).
  • If your migraines seem to have no particular pattern, then your migraines are likely not related to hormones or fatigue, so best to consider a neurologist

For men and Trans-men (by hormones), your migraines may be due to low testosterone, or when you are low on neurotransmitters (check out the third option in the above list).

A blood test can check your hormone levels before you try any hormone medications.

Aura Migraine Symptoms

Aura Migraine is one of the most common referenced migraines, but unlike the title, it is not just about seeing a glow about someone. The comprehensive symptoms of Aura Migraine are:

  • Visual (what you see)
    • Common
      • Flashes of bright light
      • Foggy or blurry vision
      • Zigzag lines
      • Blind spots (scotoma)
      • Partial loss of vision
      • Small, bright dots
      • A field of vision that looks like a heat wave or water
      • Colored spots
    • Occasional
      • Trouble judging distances
      • Fractured vision, like looking through broken glass
      • Visions of things that aren’t there (hallucinations)
      • Tunnel vision
      • Short-term blindness
  • Body
    • Upset stomach or vomiting
    • Hot flashes and chills
    • Stuffy or runny nose
    • Dizziness or spinning (vertigo)
    • Sore neck or jaw
    • Sensitivity to light, sounds, smells, touch, or motion
    • Muscle weakness
    • Prickling, tingling, or numb feeling in your arm or leg, which gradually travels up your limb and can spread to your face or tongue. 
  • Cognitive
    • Confusion
    • Dysphasic (speech)
      • Trouble finding words or speaking (aphasia)
      • Mumbling
      • Slurred speech

Prior to the Aura Migraine, you may notice these tells (different to normal you)

  • Crave certain foods
  • Energy
    • Feel hyper
    • Feel aggressive
    • Be tired and yawn more
  • Feel stiffness, especially in your neck
  • Toileting
    • Need to pee more often
    • Constipation or diarrhea

You will notice that these symptoms are indicators that you forgot to eat, forgot to rest or didn’t balance your brain’s neurotransmitters correctly (which often means medications if this is regular for you).

There are three types of Aura Migraine

  • Oestrogen High Aura Migraine
  • Oestrogen Low Aura Migraine
  • Not related to Oestrogen Aura Migraine
    • Often to pushing yourself when you are out of neurotransmitters (mostly Dopamine)

Treatments

Food and Rest

Frequently migraines can be brought on by poor sleep, overwork and poor nutrition.

  • Sleep
  • Rest
    • When we have pushed ourselves too hard, we deplete our system resources of available biological chemicals such as neurotransmitters and blood sugar, to readily use. Resting allows our body to synthesis more from core ingredients for us to use. The Migraine is trying to signal to you that you are resource depleted.
  • Eating
    • In Rest above, you need to rest to create more ingredients, aka fuel, for your body to use. These aren’t synthesised from nothing. It is important to eat to bring those basic building blocks in to your body. A Migraine can indicate that you haven’t got those basic building blocks, or you have run out of quickly available blood sugar for the demand that your current activity is asking for – so go an eat something.
    • What to eat is a matter of understanding nutrition, which we have talked about elsewhere.
    • Water is rarely the problem, but sometimes it is
      • If your lips feel dry and slightly cracked, if your mouth is dry, if your skin feels less elastic; then you are likely low on water, go and drink some.
        • All water based liquids are good, including coffee, tea, soda water and juice – but tap water is best (if you are in a council controlled western world)
      • Excess consumption of water can cause headaches. You only need around 1 to 1.5 L per day, unless your doctor says otherwise.

Once these basics have been ruled out, it is time to look at medical interventions.

Common Medications

The most common treatments for migraine are:

  • Regular pain relief
    • Paracetamol
    • Ibuprofen (works better), or if your taking these regularly, Celebrex (doesn’t irritate the stomach
  • Triptans (serotonin targeting medication)
    • SSRI (Select Serotonin Reuptake Inhibitor)
    • Serotonin Agonist (to make more Serotonin)
  • Antiemetic (reduces nausea and vomiting)
    • These often work by targeting Serotonin receptors in the intestinal tract

Common supplements that might help

  • Sublingual magnesium citrate can help with aura symptoms before the pain kicks in
    • Ask your GP to see if this is suitable for you
  • Vitamin C
  • Vitamin B group
    • Ask your GP for a blood test to check that your levels aren’t high or low, not just B12

However, it is also important to consider rest, eating, dopaminergic medication and hormones.

Oestrogen, Testosterone and Migraine

A quick and easy way to address Aura Migraines is to try adding some Oestradiol or Testosterone (which breaks down to Oestradiol in ‘men’) if your body is low (easily tested with a blood test) “Estrogens, Migraine, and Stroke”, 2004.

Unfortunately, most medical professionals are only aware of the high Oestradiol version of Aura Migraine and the risk of taking Oestradiol with a history of Aura Migraine. This often comes up for humans with a uterus (‘women’) who are seeking some Oestrogen hormone therapy. The risk the doctors are worried about is a slight increase in the risk of stroke. The risk is real, but very small (an increase from 94 per 100,000 women per year to as high as 114 per 100,000 women (in high income countries). Click on “>” in the below Detailed Look for a full explanation, quotes and references.

Detailed Look: The real risk of Oestrogen and Stroke.

A stroke occurs when blood flow to part of the brain is suddenly interrupted, either by a blocked or burst artery. This blockage prevents the brain from receiving the oxygen and nutrients it needs, causing brain cells to die. Strokes are a medical emergency with the potential for lasting brain damage, disability, or even death. This is bad. Trying to work out what the real risk is for adding oestrogen to the mix is difficult due to the many poor quality studies that have been done. For example, the meta study “Risk of Stroke Associated With Use of Estrogen Containing Contraceptives in Women With Migraine: A Systematic Review”, 2017, found that of 2480 records, only 15 studies met the inclusion criteria and only provided 6 “odds ratios” for the relevant population. Of these, no associated risk of combined contraceptive (Oestrogen and Progesterone) and stroke was found. None of the 15 studies looked at the actual amount of Oestrogen and Stroke risk in women, only the stroke risk and or if the person took contraceptive. Only 1 study differentiated risk by presence or absence of migraine aura and found an increased risk in the migraine with aura population and did find a mild increase in risk. Overall the conclusion was “this systematic review shows a lack of good quality studies assessing risk of stroke associated with low dose estrogen use in women with migraine. … The available evidence is consistent with an additive increase in stroke risk with CHC use in women with migraine with aura. Since the absolute risk of stroke is low even in the presence of these risk factors, use of CHCs in women who have migraine with aura should be based on an individualized assessment of harms and benefits.“

The following three paragraphs draws data from “Hormone therapy and the risk of stroke: perspectives ten years after the Women’s Health Initiative trials”, 2013.

Looking at the background level of stroke: “the age-adjusted incidence is estimated at 94 per 100,000 person-years in high-income countries, and 117 per 100,000 person-years in other countries.” A person-year is a unit of measurement used in epidemiological studies. It represents the cumulative time at risk for that many people in one year. For example, for 100,000 people, the expected number of strokes in a high-income country is 94 people, and 117 in low income countries.

The increase in risk for taking Oestrogen: “For women less than 60 years of age, the absolute risk of stroke from standard dose hormone therapy is rare, about 2 additional strokes per 10,000 person-years of use.” That means the number increased by 20 people for the 100,000 people in the above section. This is not large, but it is worth noticing.

It is important to note that the increase in risk was not including for Aura Migraine, just adding Oestrogen based hormones to a person with no note of if the person experienced migraines or not.

As per “Estrogens, Migraine, and Stroke”, 2004:

  • In postmenopausal women, “There are no specific data thus far on the association between migraine and HRT in regard to the risk of stroke.  Thus, migraine in itself is not a contraindication to the use of HRT, which should be decided on a case-by-case basis.”
  • For women younger than 50:
    • Thirty percent are affected by migraine, mostly without aura, which is strongly influenced by estrogens, eg, onset at puberty, menstrual migraine, improvement during pregnancy.
    • Migraine is a risk factor for ischemic stroke, with a relative risk of 3. The risk is higher in migraine with aura and is further increased by tobacco smoking and Oral Contraceptives. [in this study which admits to low evidence]
      • But note the above more up to date studies that show the risk is very low for hormones.
    • The absolute risk of ischemic stroke is very low, and therefore there is no systematic contraindication to Oral Contraceptives use in migraineurs but rather a firm recommendation for no tobacco smoking and for the use of low-estrogen-content pills or progestogens only, particularly in cases of migraine with aura.

Dopaminergic & ADHD Medication

The Dopaminergic System, that is Dopamine, Noradrenaline and Adrenaline, are the most likely next culprits for addressing Aura Migraine Pain. This is because by now you have ruled out anti-inflammatories, serotonin medications, and hormones. This often overlaps with neurological conditions such as ADHD and Autism, but also BPD, Bipolar, PMDD and a few others.

Medications that can address this that are available for your GP to trial, if appropriate, are:

  • Sertraline (increases Dopamine production by a small amount)
  • Fluoxetine (improved the efficiency of Dopamine and Noradrenaline by a small amount)
  • Clonidine (reduces over supply of Noradrenaline and Adrenaline, has an upstream improvement on Dopamine)
    • Especially if you are frequently in flight / fight mode, and or you experience tight face and stomach.
    • Especially if you experience manic or psychosis symptoms (including bipolar)
  • Desvenlafaxine (improves the efficiency of Noradrenaline, has an upstream improvement to Dopamine)

If these aren’t helping, and you have not been diagnosed with ADHD, talk to an ADHD therapist [Book Now] to see if you are ADHD (especially one of the non standard presentations).

Neurologist

If none of the treatments above have worked, it is time to get a referral to a neurologist. The default neurologist works with degenerative brain diseases, so it is important for your GP to refer you to one who specialises in migraines.

Neurologists will consider all of the above, other than hormones and ADHD, and then look at treatments like GCRP and Botox. Prior to this, they should do a few brain scans to ensure that there is not a concern with your brain, skull or sinuses.

This section is left deliberately empty of details as this is now complex medical intervention and you should talk to you processional about that.