Synopsis
Identify a typical visual aura, distinguish retinal and cerebral emergencies, and manage established migraine without overlooking atypical visual symptoms.
- Typical aura is fully reversible, develops gradually over at least five minutes and lasts five to sixty minutes.
- Visual aura may include spreading zigzags, shimmering edges, spots or a missing area, and can occur without headache.
- A cortical aura affects visual space represented in both eyes, although the patient may initially describe it as one-eye trouble.
Key red flags
A first or changed visual episode with persistent loss, focal weakness or sudden severe headache requires urgent assessment for a secondary cause.
Investigation priorities
Determine whether the event fits a typical reversible aura or needs urgent alternative assessment.
Management branches
The event is abrupt, persistent, strictly monocular with ischaemic features or accompanied by acute neurological red flags.
- Arrange immediate emergency assessment for ongoing visual loss, stroke features or thunderclap headache and record symptom timing.
- If a resolved event is suspected to be a TIA, use the urgent TIA pathway rather than waiting for another episode.
Key medicines
Sumatriptan tablets for established migraine headacheFor adults covered by the cited tablet SmPC, take 50 mg orally at headache onset; some require 100 mg. If there was an initial response followed by recurrence, a further dose may be taken after at least two hours, with a maximum of 300 mg in twenty-four hours. Do not repeat for the same attack if the first dose did not work. In mild-to-moderate hepatic insufficiency, consider a lower 25–50 mg dose.