What does a migraine aura look like?—A systematic review

Joppeková Ľ. Pinto M.J. da Costa M.D. Boček R. Berman G. Salim Y. Akhtanova D. Abzalbekova A. MaassenVanDenBrink A. Lampl C. European Headache Federation School of Advanced Sciences (EHF-SAS)
December 2025 BioMed Central Ltd

Journal of Headache and Pain
2025 #26 Issue 1

Migraine with aura is a prevalent neurological disorder that affects up to 30% of individuals experiencing migraines. It presents as temporary neurological disturbances, primarily visual, but also includes sensory, speech, motor, and brainstem symptoms. The underlying pathophysiology is closely tied to cortical spreading depression, which initiates neurovascular and inflammatory changes. Epidemiological studies show significant variations in the prevalence of migraine with aura across different demographics, with a more pronounced effect observed among women. Genetic research has identified both common and rare variants that influence susceptibility to migraine with aura, with genome-wide association studies revealing distinct risk loci. Neuroimaging studies indicate structural and functional alterations in cortical and subcortical areas, reinforcing the role of altered brain connectivity in migraine with aura. Additional studies, including various neurophysiological techniques (such as EEG, VEP, or TMS), are needed to potentially identify specific patterns within MA that would help better characterise clinical and electrophysiological phenotypes. Differential diagnosis is essential, as migraine aura symptoms may overlap with a wide range of primarily neurological paroxysmal disorders. While the treatment of migraine traditionally prioritises the headache, there is limited evidence for targeted therapies addressing aura symptoms; further research is warranted. This systematic review offers a comprehensive synthesis of aura types, epidemiology, genetics, pathophysiology, diagnosis, and management of migraine with aura, emphasising areas for future exploration.

Cortical spreading depression , Migraine with aura , Typical aura with headache , Typical aura without headache

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Faculty of Medicine, Masaryk University, Brno, Czech Republic
Neurology Department, University Hospital Brno, Brno, Czech Republic
Neurology Department, Hospital Universitário de São João, Porto, Portugal
Clinical Neuroscience and Mental Health Department, Faculty of Medicine, University of Porto, Porto, Portugal
Neurology, Department of Neurosciences and Mental Health, Hospital de Santa Maria, Unidade Local de Saúde Santa Maria, Lisbon, Portugal
Neurology Department, Military University Hospital, Prague, Czech Republic
Birmingham Neuro-Ophthalmology, University Hospitals Birmingham, NHS Foundation Trust, Birmingham, United Kingdom
Department of Neurology and Experimental Neurology, Charité-Universitätsmedizin Berlin, Berlin, Germany
School of Medicine, Nazarbayev University, Astana, Kazakhstan
Neurology Department, Health Nation Rehabilitation Center, Astana, Kazakhstan
Division of Vascular Medicine and Pharmacology, Department of Internal Medicine, Erasmus MC University Medical Center, Rotterdam, Netherlands
Department of Neurology, Koventhospital Barmherzige Brüder, Linz, Austria
Headache Medical Center Linz, Seilerstätte 2, Linz, Austria

Faculty of Medicine
Neurology Department
Neurology Department
Clinical Neuroscience and Mental Health Department
Neurology
Neurology Department
Birmingham Neuro-Ophthalmology
Department of Neurology and Experimental Neurology
School of Medicine
Neurology Department
Division of Vascular Medicine and Pharmacology
Department of Neurology
Headache Medical Center Linz

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