Expert Treatment of Migraine With Aura | Keilor Road Physiotherapy
▫️Written by John Keller
✅ Reviewed by Dr. Jenny Hynes on May 15, 2025
How to manage migraine with aura: Best treatment options in Melbourne
Why choose Keilor Road Physiotherapy for migraine with aura management?
Migraine with aura is not just a simple headache but a complex neurological condition. Characterised by visual disturbances such as flashes of light or blind spots, the aura phase typically precedes the headache stage. While migraines without aura are more prevalent, those with aura are still a significant subgroup of the migraine population, affecting about 25% of people who experience migraines (Goadsby et al., 2017). In Melbourne, there is an increasing demand for effective treatment options. Keilor Road Physiotherapy is proud to offer tailored care for individuals suffering from migraines with aura, using the latest evidence-based treatments to help manage symptoms and improve quality of life.
What is migraine with aura?
Migraine with aura is characterized by temporary neurological disturbances that precede the headache phase, which usually occurs 5 to 60 minutes before the onset of the headache.
Aura Phase: What Happens Before the Headache?
The aura phase is characterised by a variety of sensory disturbances that occur before the migraine headache sets in. These disturbances often involve:
Visual symptoms: The most common aura symptom, experienced by 90% of individuals with migraines with aura, includes seeing flashing lights, zigzag lines, blind spots, or visual distortions which originate from activity changes in the brain's occipital lobe, where the visual cortex is located. These disturbances typically affect both eyes and can involve partial or complete loss of vision, usually in the central visual field. This phenomenon is known as scintillating scotoma (Viana et al., 2019).
Sensory changes: Around 30% of individuals with migraine with aura experience tingling or numbness, commonly in the face or hands, that begins on one side of the body and can spread. This is called sensory aura and may affect speech or motor control in more severe cases (Shankar et al., 2025).
Speech or language disturbances: Approximately 15% of people with migraine with aura report difficulty speaking or understanding speech, which is often referred to as aphasia. This symptom can be particularly alarming, as it can resemble a transient ischaemic attack (TIA) or stroke, but it typically resolves within an hour (Martins., 2007).
The Migraine Headache Phase
The aura phase usually subsides once the headache begins, which is typically followed by severe, throbbing or pulsating pain. The pain is often unilateral (on one side of the head) and can be accompanied by:
Nausea and vomiting
Sensitivity to light (photophobia) and sound (phonophobia)
Increased sensitivity to smells (osmophobia)
Migraines with aura can last anywhere from 4 to 72 hours, although the severity and duration vary significantly between individuals. The pain is typically moderate to severe and can be debilitating, often requiring rest in a quiet, dark room (Goadsby et al., 2017).
Causes and triggers of migraine with aura
The exact mechanisms behind the occurrence of aura in migraine remain only partially understood. However, several theories help explain the phenomenon:
Cortical Spreading Depression (CSD): One of the most widely accepted theories is that the aura is caused by cortical spreading depression, which is a wave of depolarisation that spreads across the brain's cortex, followed by a period of electrical silence. This wave of activity and subsequent inactivity leads to the neurological symptoms experienced as aura. The most commonly affected area is the occipital cortex, responsible for visual processing, which explains the visual disturbances (Costa et al., 2013).
Vascular Mechanisms: Another hypothesis suggests that changes in blood flow due to the spreading wave of neuronal activity could cause the aura symptoms. This wave might lead to vasoconstriction and subsequent vasodilation, resulting in the transient visual disturbances (Dalkara et al., 2010).
Glutamate Activity: Glutamate, an excitatory neurotransmitter, is believed to play a role in triggering cortical spreading depression. Elevated glutamate activity can lead to heightened neuronal excitation and may contribute to the initiation of aura and migraine pain (Hoffman and Charles, 2018).
At Keilor Road Physiotherapy, we focus on the interaction between the trigemino-cervical complex and the brainstem’s locus coeruleus - a fancy way of saying the upper part of the neck. This interaction is crucial as it influences the body's stress response threshold, making individuals more susceptible to aura when under physiological stress. Advanced neuroimaging techniques have confirmed these interactions and underscored the importance of the trigemino-cervical complex in the onset of migraine with aura.
Risk factors for migraine with aura
The risk of developing migraine with aura is influenced by various genetic and environmental factors:
Genetics: Family history plays a significant role in the development of migraine with aura. Around 70-80% of individuals with migraines report a family history of the condition, indicating a strong genetic link (Goadsby et al., 2017). Specific genes, such as CACNA1A (calcium channels), are associated with migraines, affecting how the brain reacts to triggers (Shankar et al., 2025).
Hormonal Changes: Hormonal fluctuations significantly influence migraine occurrence, particularly in women. Estrogen levels, dropping during menstruation, pregnancy, or menopause, can increase migraine frequency (Sacco et al., 2012). Menstrual migraines, often linked with aura, are common among women in their reproductive years.
Age: Migraine with aura typically affects individuals between 20 and 40 years of age, with women being three times more likely to experience it than men (Goadsby et al., 2017). The frequency of migraine with aura tends to decrease with age, especially after menopause in women (Sacco et al., 2012).
Environmental and Lifestyle Factors:
Stress is one of the most common triggers for migraines with aura, along with sleep disturbances and dietary factors such as alcohol and caffeine (Shankar et al., 2025).
Bright lights, strong smells, and weather changes can also trigger episodes, suggesting the influence of environmental factors on migraine onset (Shankar et al., 2025).
Best migraine with aura treatment Melbourne.
How to manage migraine with aura: Best treatment options in Melbourne
Managing migraine with aura requires a combination of preventive and acute treatments. In Melbourne, patients have access to a range of options including medications, physiotherapy, and lifestyle changes.
1. Preventive treatments
Preventive treatments aim to reduce the frequency and severity of migraines.
Medications
Beta-blockers (e.g., Propranolol) reduce the frequency of attacks by stabilising blood pressure.
Anticonvulsants (e.g., Topiramate) help prevent cortical spreading depression (CSD) associated with aura.
Antidepressants (e.g., Amitriptyline) regulate serotonin levels to reduce migraine occurrence (Shankar et al., 2025).
Botox injections are effective for chronic migraines, reducing both pain and aura frequency (Shaterian et al., 2022).
Lifestyle Modifications
Sleep hygiene and stress management are crucial for preventing attacks. Regular sleep patterns and relaxation techniques reduce migraine frequency.
Dietary changes: Identifying and avoiding triggers such as caffeine, alcohol, and processed foods can help prevent migraines.
2. Acute treatment for migraine with aura
Acute treatments aim to reduce pain and symptoms when a migraine occurs.
Pain Relief Medications
NSAIDs (e.g., Ibuprofen) are used to reduce pain and inflammation early in the migraine.
Triptans (e.g., Sumatriptan) are the go-to treatment for moderate to severe migraines, acting on serotonin receptors to alleviate pain (Goadsby et al., 2017).
Anti-nausea medications help reduce associated nausea (Shankar et al., 2025).
Oxygen Therapy
Inhalation of pure oxygen can reduce the severity of migraines by decreasing vasodilation, a key factor in migraine pain (Shankar et al., 2025).
3. Physiotherapy for migraine with aura
Physiotherapy is a highly effective treatment for migraines with aura, especially when neck dysfunction or poor posture contributes to attacks (Carvalho et al., 2020)
Manual Therapy
Techniques like spinal mobilisation and soft tissue massage reduce neck and shoulder tension, helping prevent migraine onset.
Postural Education
Improving posture through targeted exercises can prevent strain on the neck and upper back, reducing migraine triggers.
Cervicogenic Headache Treatment
For those with neck-related migraines, muscle strengthening and stretching exercises help alleviate symptoms.
4. Complementary therapies
Acupuncture and Cognitive Behavioral Therapy (CBT) are complementary therapies that help reduce migraine frequency by addressing stress and tension (Bae et al., 2020).
When to seek professional help for migraine with aura
Migraine with aura can often be managed with self-care, but there are critical times when professional intervention is necessary to ensure proper treatment and avoid complications (Shankar et al., 2025)
- If Migraines Are Frequent or Severe
If you experience migraines with aura more than two to three times a month or if the severity increases, it’s time to seek professional help. Frequent migraines can indicate the need for preventive treatments and further assessment of your condition.
- If Symptoms Change or Worsen
A change in the pattern, intensity, or duration of your migraine with aura symptoms is a signal to consult a healthcare provider. If the aura phase lasts longer than usual or if new symptoms emerge, it could indicate a more serious condition.
- If You Experience Neurological Symptoms Like Weakness or Paralysis
If you develop hemiplegic migraine symptoms, such as weakness or paralysis on one side of the body, seek immediate medical help. These symptoms can mimic a stroke and require urgent attention.
- If Over-the-Counter Medications Are Ineffective
If over-the-counter medications no longer provide relief or if you rely on them frequently, it's time to seek professional care. Medication adjustments and stronger treatments may be necessary to manage your migraines effectively.
- If You Have a History of Stroke or Other Vascular Conditions
Migraine with aura slightly increases the risk of stroke, particularly in younger women. If you have a personal or family history of cardiovascular issues, it's important to consult a healthcare provider for a full assessment and risk management.
- If You Experience Sudden or Severe Headache
A sudden severe headache or the “worst headache of your life” warrants immediate medical attention, as it may indicate something more serious, like a subarachnoid haemorrhage or other medical emergencies.
- If You Have Difficulty Managing Daily Life
If migraines with aura significantly impact your work or quality of life, professional help is essential. A personalised treatment plan can help reduce the frequency and severity of attacks, improving daily functioning.
Why choose Keilor Road Physiotherapy for migraine with aura management?
The Watson Headache® approach: A specific treatment for migraine with aura
Our treatment approach is centered around the Watson Headache® Approach, which targets the underlying irritation in the trigemino-cervical complex. This method has been validated through clinical research to reduce the 'noise' that triggers migraine aura, thereby normalizing brainstem function and reducing the occurrence of migraines.
Comprehensive diagnosis and understanding symptoms
Migraine with aura involves specific diagnostic criteria, including:
Recurrent episodes of unilateral and fully reversible visual, sensory, or other central nervous system symptoms.
Symptoms that typically develop gradually and are followed by a headache.
Aura symptoms that spread over more than five minutes and last between 5 to 60 minutes.
At Keilor Road Physiotherapy, we conduct a thorough assessment to accurately diagnose migraine with aura and differentiate it from other headache disorders. This ensures that our treatment plans are tailored effectively to each individual’s needs.
Epidemiological insights and treatment implications
Understanding the epidemiology of migraine with aura is essential for tailoring our interventions. Studies indicate that while aura affects a minority of migraine sufferers, its impact on daily functioning is significant. Our treatment strategies are informed by these insights and are aimed at reducing the debilitating effects of this condition on our patients' lives.
At Keilor Road Physiotherapy, our approach to treating migraine with aura involves a combination of advanced diagnostic techniques and personalized therapeutic interventions that focus on reducing the frequency and severity of migraine episodes. By addressing the physiological triggers and underlying causes of migraine with aura, we aim to improve our patients' quality of life and provide long-term relief from this challenging condition.
Frequently asked questions
Q1: Can migraines with aura be prevented?
Yes, with the right combination of medications, lifestyle changes, and physiotherapy treatments, it is possible to reduce the frequency of migraines with aura.
Q2: What are the most common triggers for migraines with aura?
Triggers include stress, certain foods, hormonal changes, lack of sleep, and environmental factors such as bright lights and strong smells.
Q3: Is physiotherapy effective for treating migraines with aura?
Yes, physiotherapy can help reduce the frequency and severity of migraines by addressing neck tension, posture, and muscle imbalances that may contribute to migraines.
Q4: How is it different from other headaches?
Unlike other headaches, migraine with aura includes a neurological phase (the aura) before the headache pain, which may involve visual and sensory disturbances.
Q5: When should I seek professional help?
Seek help if migraines are frequent, severe, or if symptoms change or worsen, or if over-the-counter medications no longer work. Seek immediate help if you experience weakness, paralysis, or difficulty speaking.
Q6: Can it be prevented?
Yes, through preventive medications (e.g., beta-blockers, anticonvulsants) and lifestyle changes like regular sleep, stress management, and avoiding triggers.
Q7: What treatments work best?
Effective treatments include preventive medications, NSAIDs, triptans for acute attacks, and physiotherapy to manage neck tension.
Q8: Is it hereditary?
Yes, migraine with aura is often genetic, with a higher risk if you have a family history of migraines.
Q9: Can children get it?
Yes, children can experience migraine with aura, especially during adolescence when hormonal changes occur.
Q10: Are there long-term effects?
While migraines with aura typically don’t cause lasting damage, there is a slightly higher risk of stroke, particularly in younger women.
References
Bae, J. Y., Sung, H. K., Kwon, N. Y., Go, H. Y., Kim, T. J., Shin, S. M., & Lee, S. (2021). Cognitive Behavioral Therapy for Migraine Headache: A Systematic Review and Meta-Analysis. Medicina (Kaunas, Lithuania), 58(1), 44. https://doi.org/10.3390/medicina58010044
Carvalho, G. F., Schwarz, A., Szikszay, T. M., Adamczyk, W. M., Bevilaqua-Grossi, D., & Luedtke, K. (2020). Physical therapy and migraine: musculoskeletal and balance dysfunctions and their relevance for clinical practice. Brazilian journal of physical therapy, 24(4), 306–317. https://doi.org/10.1016/j.bjpt.2019.11.001
Costa, C., Tozzi, A., Rainero, I. et al. (2013). Cortical spreading depression as a target for anti-migraine agents. J Headache Pain, 14, 62. https://doi.org/10.1186/1129-2377-14-62
Dalkara, T., Nozari, A., & Moskowitz, M. A. (2010). Migraine aura pathophysiology: the role of blood vessels and microembolisation. The Lancet. Neurology, 9(3), 309–317. https://doi.org/10.1016/S1474-4422(09)70358-8
Goadsby, P. J., Holland, P. R., Martins-Oliveira, M., Hoffmann, J., Schankin, C., & Akerman, S. (2017). Pathophysiology of Migraine: A Disorder of Sensory Processing. Physiological reviews, 97(2), 553–622. https://doi.org/10.1152/physrev.00034.2015
Hoffmann, J., & Charles, A. (2018). Glutamate and Its Receptors as Therapeutic Targets for Migraine. Neurotherapeutics : the journal of the American Society for Experimental NeuroTherapeutics, 15(2), 361–370. https://doi.org/10.1007/s13311-018-0616-5
Martins I. P. (2007). Crossed aphasia during migraine aura: transcallosal spreading depression?. Journal of neurology, neurosurgery, and psychiatry, 78(5), 544–545. https://doi.org/10.1136/jnnp.2006.093484
Sacco, S., Ricci, S., Degan, D., & Carolei, A. (2012). Migraine in women: the role of hormones and their impact on vascular diseases. The journal of headache and pain, 13(3), 177–189. https://doi.org/10.1007/s10194-012-0424-y
Shankar Kikkeri N, Nagalli S. (2024). Migraine With Aura. [Updated 2024 Feb 29]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK554611/
Shaterian, N., Shaterian, N., Ghanaatpisheh, A., Abbasi, F., Daniali, S., Jahromi, M. J., Sanie, M. S., & Abdoli, A. (2022). Botox (OnabotulinumtoxinA) for Treatment of Migraine Symptoms: A Systematic Review. Pain research & management, 2022, 3284446. https://doi.org/10.1155/2022/3284446
Viana, M., Tronvik, E. A., Do, T. P., Zecca, C., & Hougaard, A. (2019). Clinical features of visual migraine aura: a systematic review. The journal of headache and pain, 20(1), 64. https://doi.org/10.1186/s10194-019-1008-x
Article by
John Keller
Clinical Director | Sports & Musculoskeletal Physiotherapist
John graduated as a Physiotherapist from the Auckland University of Technology with the John Morris memorial prize for outstanding clinical practise in 2003. John has since completed Post Graduate Diplomas in both Sports Medicine and Musculoskeletal Physiotherapy with distinction, also collecting the Searle Shield for excellence in Musculoskeletal Physiotherapy.
Reviewed by
Dr. Jenny Hynes FACP
Clinical Director | Specialist Musculoskeletal Physiotherapist
Jenny sat extensive examinations to be inducted as a fellow into the Australian College of Physiotherapy in 2009 and gain the title of Specialist Musculoskeletal Physiotherapist, one of only a few physiotherapists in the state to have done so.