Migraine With and Without Aura

Migraine is a complex neurological disease, and one of its most defining characteristics is how differently it can manifest from person to person. One of the biggest distinctions in the world of migraine is the presence or absence of aura. You may have heard the terms "migraine with aura" and "migraine without aura" and wondered what they mean and how they relate to your own experience. It’s important to know that these are not two separate diseases, but rather two different subtypes of the same underlying condition.

This guide is here to offer a gentle and clear comparison of these two common migraine experiences, helping you to better understand your own diagnosis and feel more connected to the broader migraine community.

The Common Denominator: What Both Types Share

At their core, both migraine with and without aura are part of the same family. Both are characterized by the headache phase, which typically involves:

A moderate to severe headache, often described as throbbing or pulsating.
Pain that is often, but not always, on one side of the head.
A headache that is worsened by routine physical activity.
Accompanying symptoms of nausea, vomiting, and sensitivity to light (photophobia) and sound (phonophobia).

Both types of migraine can also include the prodrome (the warning phase before the headache) and the postdrome (the "hangover" phase after the headache).

The Main Difference: The Presence of Aura

The key distinction lies in the aura phase.

Migraine Without Aura

This is the most common type of migraine, affecting about 70-75% of people with the disease. In this type, the headache phase begins without any preceding neurological aura symptoms. A person may still experience prodrome symptoms like fatigue or neck stiffness, but they do not have the specific visual, sensory, or language disturbances that characterize an aura.

Migraine With Aura

This type affects about 25-30% of people with migraine. For these individuals, the headache is preceded by an aura, which we explore in depth in our article on Migraine Aura. An aura is a temporary, reversible neurological disturbance caused by a wave of electrical activity spreading across the brain. The most common type is visual aura, which can involve seeing flashing lights, zig-zag lines, or blind spots. Other types include sensory aura (tingling or numbness) and language aura (difficulty speaking).

Can You Experience Both?

Yes, and many people do. It is very common for a person to have a diagnosis of "migraine with aura" but to only experience an aura with some of their attacks. You might have some attacks that are preceded by aura and others that are not. This is perfectly normal and is just another example of the variable nature of this disease.

Does the Diagnosis Make a Difference in Treatment?

For the most part, the acute and preventive treatments for migraine with and without aura are very similar. The same medications, such as triptans and CGRP inhibitors, are used for both.

The main difference that the presence of aura makes is in providing a clear warning sign. For people who experience aura, it is a definitive signal to take their acute medication immediately, which can often lead to more effective treatment.

One important consideration is that some doctors may be more cautious about prescribing estrogen-containing contraceptives for women who have migraine with aura, due to a slightly increased risk of stroke. This is a conversation you should have with your doctor.

A Final, Compassionate Thought

Whether you experience aura or not, your migraine is real, valid, and deserving of compassionate care. Understanding which subtype you primarily experience can help you to better understand your own body, have more informed conversations with your doctor, and feel a stronger sense of connection to a community that understands. We are all in this together, navigating the different paths of the same complex journey.

Trusted Resources

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