What is the difference between symptoms of migraine with aura and symptoms of migraine with brainstem aura?


Migraine with aura usually involves visual illusions, numbness, and weakness. Migraine with brainstem aura, however, usually involves dizziness, ringing in the ears, increased sensitivity to sound, double vision, and unsteadiness.


“Migraine with aura, the typical aura — the visual, the numbness, the weakness, the trouble with language — is thought to be a brain problem where the problem is in the cortex of the brain, the surface of the brain. Migraine with brainstem aura —the brainstem sits underneath the hemispheres of the brain — the reason we called it migraine with brainstem aura is because of the symptoms that these patients have. They have double vision. They slur their speech, like they’ve had too much to drink. They're unsteady on their feet. They have vertigo. So sometimes there’s a real confusion, whether this is vestibular migraine, which we talked about, or whether this is brainstem aura. Sometimes they have the numbness and tingling, but on both sides of the body.

“So when you see a person like that who has dizziness, ringing in the ears, increased sensitivity to sound, double vision, slurred speech, unsteadiness, that can be migraine with brainstem aura. Again, all those symptoms I just talked about, it's a little wheel now, with fewer symptoms, seven or eight symptoms; you can have one, some, or all of them. There's criteria that we use to diagnose migraine with brainstem aura, but the reason they call it brainstem aura is that most of the time when you have double vision or you slur your speech, or you're unsteady on your feet, that's usually due to a problem inside the brainstem itself, and that's why we refer to it as migraine with brainstem aura.”


Migraine with aura usually presents itself with symptoms such as visual illusions, numbness and/or weakness, and problems with language. Symptoms often displayed with migraine with brainstem aura are double vision, dizziness, ringing in the ears, slurred speech and problems with balance. Those with migraine with brainstem aura can also experience numbness and tingling as well, but it will usually appear on both sides of the body, unlike the unilateral numbness and weakness experienced in a typical migraine aura.

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David Dodick, MD

Professor (Emeritus)
Mayo Clinic, Arizona

David Dodick, M.D., FAAN, is a professor of neurology at the Mayo Clinic College of Medicine and Science in Scottsdale, Arizona. He is the director of the headache program and the sports neurology and concussion program at Mayo Clinic in Arizona. He is an adjunct professor in the department of neurosciences, Norwegian University of Science and Technology. Dr. Dodick is board certified by the Royal College of Physicians and Surgeons of Canada and the American Board of Psychiatry and Neurology (ABPN). He also holds United Council for Neurologic Subspecialties certification in headache medicine and ABPN certification in vascular neurology.

Dr. Dodick has authored more than 380 peer-reviewed publications and authored/edited 10 books. He is the chair of the American Migraine Foundation, chair of the American Academy of Neurology (AAN) Annual Program Concussion Committee, co-director of the American Registry of Migraine Research, chair of the International Registry for Migraine Research, chair of the International Headache Society Global Patient Advocacy Coalition, co-director of the Annual AAN Sports Concussion Conference, president-elect of the International Concussion Society, immediate past-president of the International Headache Society, former editor-in-chief of Cephalalgia, and past-president of the American Headache Society.