Migraine with aura means that, in addition to the headache, one experiences visual or sensory disturbances. The aura often occurs before the headache itself but can also appear during the attack. About one-third of all people with migraine have migraine with aura, making it less common than migraine without aura.

The aura is caused by altered activity in the outer layer of the brain, known as the cerebral cortex. This change is likely a wave of reduced electrical activity that starts at the back of the brain and spreads forward across the cortex, accompanied by changes in blood circulation.

Symptoms of aura may include:

Visual disturbances, typically on one side of the visual field, appearing as a flickering, bright, or dark area, sometimes with a zigzag-like pattern. These develop gradually and usually last 20–30 minutes. This is the most common form of aura.

Additionally, symptoms can include sensory disturbances such as tingling in the fingers or face, which can slowly spread over several minutes, for example from the fingers up the arm. This is the second most common form of aura.

In rarer cases, aura can also cause temporary paralysis (for example, in the corners of the mouth), dizziness, and speech difficulties. The aura phase typically lasts less than 60 minutes and is usually followed immediately by the headache.