Scintillating Scotoma and Migraine Aura: Causes, Triggers, What to Do and Prevention

Seeing Flashing Lights? It Could Be a Sign of Migraine Aura

Suddenly, you notice zigzag lines, flashing lights or shimmering patterns in your vision. What starts as a small visual disturbance may gradually spread, making part of your visual field harder to see. Then, sometime afterward, a throbbing headache or nausea may begin.

These visual symptoms may be a form of scintillating scotoma, one of the best-known visual symptoms associated with migraine aura.

Migraine is more than just a headache. It is a neurological disorder that can also involve sensitivity to light and sound, nausea or vomiting, and pain that may become worse with physical activity.

Current research suggests that migraine involves a combination of processes in the brain and nervous system, including the trigeminal system and substances involved in pain signaling such as CGRP (calcitonin gene-related peptide).

In this article, we look at how migraine is currently understood, scintillating scotoma and migraine aura, weather and barometric pressure, nausea, dizziness, pain around the eyes, common triggers, everyday management and signs that should be medically assessed.

What Is Migraine?

Migraine is a neurological disorder that can cause recurring headache attacks along with a range of other symptoms.

A typical untreated migraine headache may last for around 4 to 72 hours.

Migraine is often associated with throbbing pain on one side of the head, but the pain can also affect both sides.

Common features may include:

• Throbbing or pulsating pain
• Moderate to severe headache
• Pain that becomes worse with activities such as walking or climbing stairs
• Nausea or vomiting
• Sensitivity to light
• Sensitivity to sound
• Increased sensitivity to smells
• Fatigue or difficulty concentrating before or after the headache

Migraine can feel quite different from person to person. The location and intensity of the pain, associated symptoms and the presence or absence of aura can all vary.

Why Does Migraine Occur? What We Currently Know

Migraine was once commonly described mainly as a “vascular headache” caused by the narrowing and widening of blood vessels in the head.

As research has progressed, migraine has come to be understood as involving more complex neurological processes within the brain and nervous system.

One important part of this process is the trigeminal system, which is involved in sensation in the face and head.

During a migraine attack, networks involving the trigeminal system can become activated. Substances involved in nerve signaling, including CGRP (calcitonin gene-related peptide), are thought to play a role in pain transmission and sensory sensitivity.

Migraine is therefore now understood as a neurological disorder involving both the brain and nervous system, rather than being explained by blood vessels alone.

What Is Scintillating Scotoma?

Some people with migraine experience temporary neurological symptoms called an aura, often before the headache begins.

One of the most familiar forms is a visual aura, which may include scintillating scotoma.

People describe the experience in different ways, including:

• Seeing zigzag lights
• Seeing shimmering or sparkling patterns
• Seeing bright lines or wave-like shapes
• Having part of the visual field become difficult to see
• Seeing visual patterns slowly move or spread

A typical migraine aura often develops gradually over several minutes, with symptoms spreading or moving across the visual field.

According to the International Classification of Headache Disorders, individual symptoms of a typical migraine aura generally last 5 to 60 minutes.

A headache may follow the aura, but some people experience visual aura without a subsequent headache.

Why Does Scintillating Scotoma Occur?

Visual migraine aura is thought to be associated with a phenomenon called cortical spreading depolarization (CSD).

This involves a wave of electrical and chemical changes in nerve cells and surrounding cells that slowly travels across the surface of the brain.

When this activity affects areas near the occipital lobe, which processes visual information, it may contribute to symptoms such as shimmering lights, zigzag patterns and temporary changes in the visual field.

Understanding scintillating scotoma therefore also means considering how the brain processes visual information, rather than focusing only on the eyes.

What to Do When Migraine Aura Begins

Because scintillating scotoma can temporarily affect part of the visual field, the first priority is staying safe.

If you are driving or riding a bicycle, stop somewhere safe and wait until your vision has returned to normal before continuing.

If light or sound feels uncomfortable, resting in a quiet room with softer lighting may feel more comfortable.

Bright computer screens, smartphones and strong indoor lighting can also feel unpleasant during an aura, so taking a break from screens may help reduce sensory stimulation.

If you have been prescribed migraine medication, use it according to the instructions given by your healthcare professional.

Triptans are generally recommended early in the headache phase rather than during the aura alone. Follow the timing and dosage instructions provided by your prescribing clinician.

When to Seek Medical Advice for New or Unusual Visual Symptoms

Scintillating scotoma is a well-recognized form of migraine aura, but visual changes can have many different causes.

Medical assessment is particularly important when visual symptoms occur for the first time, vision suddenly disappears or changes, symptoms affect only one eye, the pattern is significantly different from previous episodes, or the visual disturbance lasts much longer than usual.

Visual symptoms can also occur with eye disorders, transient ischemic attacks, stroke and other medical conditions.

Knowing your usual pattern can make it easier to recognize when something feels different.

What Can Trigger a Migraine Attack?

It is helpful to distinguish between the underlying mechanisms of migraine and the triggers that may make an attack more likely in someone who is susceptible to migraine.

Commonly reported migraine triggers include:

• Not getting enough sleep
• Oversleeping
• Changes in sleep or daily routines
• Stress
• Relaxation after a period of stress
• Hunger or skipping meals
• Dehydration
• Alcohol
• Bright lights, loud sounds or strong smells
• Changes associated with the menstrual cycle
• Weather and barometric pressure changes

Triggers vary considerably from person to person.

Rather than trying to avoid every factor that has ever been described as a migraine trigger, it can be more useful to understand which factors repeatedly appear to be associated with your own attacks.

Can Rain, Weather and Barometric Pressure Affect Migraine?

Some people notice headaches before rain arrives or feel that migraine attacks become more likely when storms are approaching.

The relationship between weather and migraine continues to be studied.

Recent research has examined weather changes as possible migraine triggers, including associations with temperature and barometric pressure.

Responses to weather vary between individuals. The same change in air pressure may coincide with a migraine on one occasion but not another, while sleep, fatigue and other factors may also contribute.

If weather appears to affect you, understanding your own attack pattern may help you plan around periods when symptoms tend to occur.

Are Migraines More Common Around Menstruation?

Migraine is more common in women, and an association with the menstrual cycle is well recognized.

Researchers have investigated the relationship between migraine attacks and changes in hormonal conditions around menstruation, including changes in estrogen.

If migraines repeatedly occur around the same stage of the menstrual cycle, understanding the timing and characteristics of those attacks can also be useful when discussing symptoms with a healthcare professional.

When attacks are frequent, severe or have a significant impact on everyday life, a healthcare professional can help assess treatment options based on the individual's symptoms.

Why Can Migraine Cause Nausea and Vomiting?

Migraine can involve nausea and vomiting as well as head pain.

During an attack, changes are thought to occur not only in pain-related neurological pathways but also in the autonomic nervous system and gastrointestinal function.

For some people, nausea can be more difficult to manage than the headache itself and may make it harder to drink fluids or take oral medication.

Depending on the symptoms, healthcare professionals may consider anti-nausea medication or treatment approaches that do not rely solely on oral medicines.

If nausea or vomiting regularly accompanies your migraines, mentioning this when speaking with a healthcare professional can help with treatment planning.

Can Migraine Cause Pain Behind the Eyes?

Migraine pain can be felt not only around the temples but also around or behind the eyes.

The trigeminal nerve is involved in sensation around the face and eyes, which is one reason migraine-related pain may be perceived around the eye area.

When pain occurs behind the eye, it is also useful to pay attention to any other accompanying symptoms.

Symptoms such as significant redness in one eye, sudden loss of vision, rainbow-like halos around lights, or severe eye pain together with nausea can also occur with urgent eye conditions such as an acute angle-closure glaucoma attack.

Sudden or unusual changes should be medically assessed promptly.

Can Migraine Be Associated With Dizziness?

Some people with migraine also experience dizziness.

One recognized condition is vestibular migraine.

Vestibular migraine may involve recurring episodes of spinning sensations, feelings of movement or imbalance, dizziness triggered by head movement, and nausea.

Dizziness can also have many causes involving the inner ear and other systems, so information such as how often it occurs, how long it lasts and how it relates to headaches can be helpful during a medical assessment.

Caffeine and Migraine: Finding the Right Balance

The relationship between caffeine and migraine can vary depending on how much caffeine a person consumes and their usual habits.

Some people find that a small amount of caffeine makes a headache feel easier to manage, and caffeine is also included in some pain-relief medicines.

On the other hand, high habitual caffeine intake, increasing caffeine consumption or suddenly stopping regular caffeine intake may be associated with headaches. Headaches that occur after suddenly reducing caffeine are often referred to as caffeine withdrawal headaches.

A useful approach is to understand your usual caffeine intake and avoid large day-to-day changes, rather than consuming large amounts specifically in response to migraine symptoms.

Caffeine is found not only in coffee but also in tea, green tea, energy drinks, chocolate and some medicines.

Migraine vs Tension-Type Headache: What Is the Difference?

Alongside migraine, another common type of headache is tension-type headache.

Some people experience both migraine and tension-type headaches.

Understanding the features of your headaches can be useful when deciding how to manage them and when discussing them with a healthcare professional.

What to Do During a Migraine Attack

Physical activity can make migraine pain worse for some people. During an attack, resting in an environment with minimal sensory stimulation can be helpful.

If light or sound feels uncomfortable, a quiet room with dimmer lighting may be easier to tolerate.

If you are able to drink, take fluids according to your comfort and needs.

Some people find a cool towel or wrapped cold pack on the head or neck comfortable. If using something cold, wrap it in a cloth to avoid excessive cooling of the skin.

If using an over-the-counter pain reliever or prescribed migraine medication, follow the recommended dosage and instructions provided by your doctor or pharmacist.

Everyday Habits That May Help Reduce Migraine Attacks

Understanding your personal triggers and keeping your daily routine relatively consistent can be useful parts of migraine management.

Everyday habits to consider include:

• Keeping sleep and wake times relatively consistent
• Avoiding large changes in sleep duration on weekends
• Avoiding very long gaps between meals
• Drinking fluids regularly according to your needs
• Keeping caffeine intake relatively consistent
• Understanding whether alcohol is associated with your headaches
• Maintaining comfortable physical activity between attacks
• Recognizing sensory triggers such as strong light or sound

Try Keeping a Headache Diary

A headache diary can help you understand patterns that may be associated with your migraine attacks.

Recording not only the headache itself but also what happened before and around the attack can make recurring patterns easier to recognize.

You may want to record:

• Date and time the headache began
• How long it lasted
• Pain intensity
• Whether visual aura or other aura symptoms occurred
• Nausea, dizziness or other symptoms
• Sleep
• Timing of meals
• Caffeine and alcohol intake
• Menstrual cycle
• Weather or barometric pressure
• Medicines used

There is no need to record everything perfectly every time. A simple diary that you can maintain consistently may help you recognize your own patterns and can also provide useful information when speaking with a healthcare professional.

When Headache Medication Is Being Used More Often

In people who already experience headaches, frequent use of medication for acute attacks can sometimes be associated with an increase in the number of headache days.

This is known as medication-overuse headache (MOH).

Under the International Classification of Headache Disorders, diagnostic criteria include having a pre-existing headache disorder, headaches on 15 or more days per month, and regular overuse of acute or symptomatic headache medication for more than three months.

The frequency threshold depends on the medicine. For example, triptans and certain combination analgesics may meet an overuse threshold at 10 or more days per month, while non-opioid analgesics such as acetaminophen or NSAIDs have a threshold of 15 or more days per month.

If you notice that you are using headache medication more frequently, that your medication seems to be working differently, or that the number of headache days is increasing, consider tracking your medication use and discussing it with a doctor or pharmacist.

Medical Treatment Options for Migraine

Migraine treatment is broadly divided into acute treatment used during an attack and preventive treatment intended to reduce the frequency or burden of attacks.

Depending on the severity and features of an attack, acute treatment may include acetaminophen, NSAIDs, triptans and medication for nausea.

Preventive treatment may be considered when migraine attacks occur frequently or have a substantial impact on everyday life.

In addition to established preventive medicines, treatments that target CGRP or the CGRP receptor are also now used in migraine management.

The most appropriate treatment depends on factors such as headache frequency, aura, age, other medical conditions, pregnancy and breastfeeding, so treatment decisions should be discussed individually with a healthcare professional.

When to Seek Medical Care for Headache or Visual Symptoms

Recurring migraine is classified as a primary headache disorder, but headache can sometimes occur as a result of another condition. These are known as secondary headaches.

Prompt medical assessment is important if you experience symptoms such as:

• A sudden, unusually severe headache unlike anything you have experienced before
• A headache that reaches severe intensity within seconds or minutes
• Headache with fever and significant neck stiffness
• Confusion or loss of consciousness
• Seizures
• Sudden weakness or significant numbness in an arm or leg
• Difficulty speaking or communicating normally
• Sudden loss of vision
• Persistent headache following a significant head injury
• A clear change in your usual headache pattern

These symptoms can also occur with conditions such as subarachnoid hemorrhage, stroke, meningitis and certain eye disorders.

Understanding your usual headache pattern can make it easier to recognize when something has changed.

Q&A: Migraine and Scintillating Scotoma

Q. Can scintillating scotoma occur without a headache afterward?

Yes. A headache commonly follows visual migraine aura, but some people experience aura without a subsequent headache.

Q. How can migraine aura be distinguished from an eye problem?

Typical visual migraine aura often develops gradually, with zigzag lights or changes in the visual field spreading or moving over several minutes.

Sudden changes affecting only one eye, sudden loss of vision, severe eye pain or significant redness may have other causes, including eye conditions.

Visual symptoms occurring for the first time or symptoms that are clearly different from your usual pattern should be medically assessed.

Summary: Understanding Migraine and Your Own Patterns

Migraine is a neurological disorder involving a range of processes, including trigeminal nerve pathways, CGRP-related signaling and sensory processing within the brain.

Scintillating scotoma is one of the characteristic visual symptoms associated with migraine aura. Typical visual aura develops gradually and usually lasts around 5 to 60 minutes.

Sleep, meals, stress, the menstrual cycle, weather and caffeine can all be associated with migraine attacks in some people.

Rather than trying to eliminate every factor commonly described as a migraine trigger, it can be more useful to understand your own individual migraine pattern.

A headache diary can help identify when attacks tend to occur and can also provide useful information when discussing symptoms and treatment with a healthcare professional.

If migraines are frequent, significantly affect everyday life, or your headache or visual symptoms change from their usual pattern, consider discussing them with a doctor or other qualified healthcare professional.

Important Note

This article is intended to provide general educational information about migraine, scintillating scotoma, migraine triggers, everyday management and prevention. It is not a substitute for individual medical diagnosis or treatment. Headache and visual symptoms can have causes other than migraine. Seek prompt medical attention for symptoms such as a sudden severe headache, loss of consciousness, weakness or paralysis, difficulty speaking, sudden loss of vision, fever with significant neck stiffness, or other sudden neurological changes.

References

1. Japanese Headache Society. Clinical Practice Guideline for Headache Disorders 2021.
2. International Headache Society. International Classification of Headache Disorders, 3rd edition (ICHD-3).
3. Japanese Society of Neurology. Migraine.
4. Karsan N. Pathophysiology of Migraine. Continuum. 2024.
5. Kitamura E, Imai N. Molecular and Cellular Neurobiology of Spreading Depolarization/Depression and Migraine.
6. Li S, et al. Association between weather conditions and migraine: a systematic review and meta-analysis. Journal of Neurology. 2025.
7. Lempert T, et al. Vestibular migraine: Diagnostic criteria. Bárány Society / International Headache Society.
8. American Migraine Foundation. Caffeine and Migraine.
9. Japanese Headache Society. Medication-Overuse Headache.