Is a visual aura of flickering zigzag lines or dots in peripheral vision progressing to a kaleidoscopic pattern followed by headache consistent with migraine with aura?

Yes, This is Classic Migraine with Visual Aura

The visual pattern you describe—zigzag lines or dots starting in peripheral vision and progressing to a kaleidoscope effect followed by headache—is highly characteristic of migraine with aura and meets International Headache Society diagnostic criteria. 1

Why This is Migraine with Aura

Your symptoms match the cardinal features of typical visual aura:

• Zigzag lines (fortification spectra) are the hallmark positive visual phenomenon of migraine aura, often appearing as shimmering or flickering patterns 2, 3
• Gradual progression over ≥5 minutes is a key diagnostic feature that distinguishes migraine aura from vascular events like stroke, which have sudden onset 1, 4
• Peripheral onset with central spread is the typical pattern, with visual symptoms starting in one area and expanding across the visual field 3, 5
• Kaleidoscopic or scintillating patterns represent the characteristic bright, shimmering visual distortions reported in migraine aura 2, 3
• Headache following within 60 minutes of visual symptoms fulfills the temporal relationship required for diagnosis 1, 2

Diagnostic Criteria Met

For formal diagnosis of migraine with aura, you need at least 2 such attacks with these characteristics 1:

• Visual symptoms lasting 5-60 minutes with complete reversibility 1, 2
• Gradual spread over ≥5 minutes (not sudden onset) 1, 4
• Headache within 60 minutes of aura onset (though headache can occasionally be absent) 1, 2
• Complete resolution of all visual symptoms (persistent deficits suggest alternative diagnoses) 2

What Makes This Typical vs. Atypical

Typical features in your case:

• Visual aura is the most common type, occurring in 99% of migraine with aura cases 3
• Zigzag lines starting centrally or peripherally and expanding are the classic presentation 3, 5
• The progression to more complex visual patterns (kaleidoscope effect) represents the spreading nature of cortical spreading depression 3

Red flags that would require urgent imaging (not present in your description):

• Aura lasting >60 minutes suggests possible stroke, AVM, or structural lesion requiring urgent MRI 4
• Sudden simultaneous onset (rather than gradual spread) suggests TIA rather than migraine 1
• Persistent visual deficits that don't resolve completely 2
• First-ever aura in someone over age 50 warrants imaging to exclude other causes 4

No Imaging Needed for Typical Presentations

Neuroimaging is not required when your symptoms are typical as described, since the diagnosis is fundamentally clinical 4. Routine imaging leads to unnecessary testing, cost, and potential false-positive findings 4. However, MRI brain with and without contrast (not CT) is the preferred modality if secondary causes must be excluded 4.

Clinical Pearls

• Visual aura can occur without subsequent headache in some patients (migraine aura without headache), and this is still considered migraine 2, 6
• You may have both migraine with aura and migraine without aura—many patients experience both types of attacks 1
• Aura symptoms can vary between attacks in the same person, though most patients have one consistent pattern 3, 5
• Only 20% of patients report classic fortification spectra, while 42% describe small bright dots and 39% report flashes of light, so your specific pattern may vary 5