Migraine is one of the most common chronic conditions, with migraine sufferers outnumbering both asthma and Type 1 diabetes sufferers in the U.S. While many use the term migraine to identify every severe headache, there are actually seven types of migraine headaches. Some of those can then be broken down into other types, often by their symptoms. One of the more rare forms of migraine is an ocular migraine, a migraine with visual disturbances in one eye.
What is an ocular migraine?
Ocular migraines are an exceedingly rare type of migraine, diagnosed in an estimated one out of 200 migraine sufferers. They may also be called a(n):
- Retinal migraine
- Optical migraine
- Ophthalmic migraine
- Eye migraine
- Optic migraine
- Visual migraine
As Pittsburgh Eye Associates explains: “These visual problems associated with migraines technically are known as ophthalmic migraines, but are much more commonly (though incorrectly) called ocular migraines.” Because more people know it by this name, we use this throughout this article.
Those suffering from ocular migraines may experience some or all of the following symptoms:
- Small scotoma (blind spot) in the center of vision that gets larger
- Scotoma that is outlined in zig-zag or wavy lines
- Scintillations (flashing or flickering lights around the blind spot)
- Temporary blindness, partial or total in one eye
These symptoms are monocular, affecting one eye only. The same eye is usually affected during each episode. In general, ocular migraines are distinct from migraine with aura in that they most often affect only one eye. Ocular migraines can be preceded or accompanied by a headache. However, it is possible to experience a visual migraine with no headache.
What are migraines?
Migraine headaches in general share some symptoms with ocular or retinal migraines. Most migraine sufferers experience four distinct phases of migraine headache:
- Prodromal: This is the days or hours before a migraine. Symptoms could include fatigue, irritability, and mood swings.
- Aura: Not everyone will experience the aural stage, but if they do, sensory changes occur, as does sensitivity to sound and light.
- Attack: The attack phase is the acute period of migraine. Symptoms such as pain, fatigue, and nausea occur.
- Postdromal: After an attack has passed, sufferers may feel a sense of euphoria. They may also be tired.
These phases, in particular, typify a migraine versus a headache. Migraines are also more intense and, as with optic migraines, accompanied by other symptoms. As noted by AllAboutVision:
“Migraines most commonly affect adults in their 30s and 40s, but they frequently start at puberty and also can affect children. Women are up to three times more likely than men to have migraines. Though statistics specifically for ocular migraines are unavailable, approximately 15 to 18 percent of women and 6 percent of men in the United States suffer from migraine headaches, according to WHO.”
The following video cover the basics of migraines.
Ocular migraines versus migraine with aura
Ocular, or retinal, migraines are distinct from migraine with aura in that they only affect one eye. Mayo Clinic writes the following about migraine auras:
“Migraine auras include a variety of sensations — often visual, but which also may include other sensations, such as numbness — that precede or accompany a migraine. Aura can sometimes occur without an associated headache. A migraine aura that affects your vision is common. Visual symptoms are short lasting.”
While migraine with aura can hamper daily activities, such as reading or driving, they typically aren’t considered serious. And they’re common in people who do experience migraines. These auras can consist of:
- Flashing lights
- Blind spots
- Shimmering spots in the field of vision
How long do optical migraines last?
Optical migraines can occur with no warning, and usually last between 20 and 60 minutes (but sometimes as long as three days). Loss of vision–either partial or total–usually only lasts ten to 20 minutes. NHS explains the onset process as:
“Vision may slowly become blurred or dimmed, or there may be flashes of light. Some people see a mosaic-like pattern of blank spots (scotomas), which enlarge to cause total loss of vision.”
Some ocular migraine sufferers do experience the prodromal phase (about 60%), but for 40% of sufferers the visual effects begin without warning.
Causes of ocular migraine
The research on what causes ocular migraines is mixed, but the World Health Organization believes that there is a genetic connection. It is true that nearly 70% of people who suffer from migraines of any kind have a family member who also suffers from migraine headaches. Migraine with aura in particular seems to have a strong genetic link.
However, other research has refuted the genetic link. Two studies in particular, one involving twins, found that the genetic link is weak or is at least weaker than other genetically-linked conditions such as depression or Down syndrome.
Spasms in the blood vessels in the retina may cause ocular migraines. Any changes in the nerve cells that involve the eye may also cause this type of migraine.
Ocular migraine triggers
As with all types of migraines, a little prevention goes a long way. It can be helpful to attempt to determine what triggers ocular migraines for you. Keeping a journal that records time, date, severity, and intensity of ocular migraine can help to identify potential environmental triggers.
Ocular migraine triggers follow many other migraine triggers. These include:
- Certain types of foods, such as aged cheeses and smoked meats
- Strong chemical smells and perfumes
- Glaring or flickering lights
- Loud sounds
- Preservatives and additives in food, such as MSG and artificial sweeteners
- Exposure to cigarette smoke
- Alcohol, especially red wine
- Caffeine, in some cases
- Strenuous activity
- Hormonal changes, including an increase in estrogen around menstruation
- Lack of sleep
- Weather changes
- Stress or anxiety
Recording any activities that were occurring at the time the ocular migraine occurred may help you to figure out how to prevent future attacks. Simply put, a migraine trigger journal is one of the best ways to find out what may be triggering your migraines and how to avoid those in the future.
Can stress cause ocular migraine?
Stress can’t directly cause you to have ocular migraines, but it can be a huge trigger for the onset of one. Because of this, managing stress can go a long way towards managing your symptoms. Preventative activities like yoga or meditation can help. Before you feel one come on, or during your pain episode, you should also:
- Find a quiet room to rest in
- Use pressure points or massage your scalp
- Put a damp towel over your forehead
Diagnosing ocular migraines
Because they are so rare, ocular or retinal migraines can be mistaken for something else. Migraine with aura may be mistaken for an ocular migraine. Aura is one of the phases of migraine that not everyone experiences, but there is an important distinction. Although ocular migraines and migraines with aura both involve visual symptoms, ocular migraines have symptoms present in only one eye.
Diagnosis of ocular migraine follows a similar pattern of diagnosis for other migraines. In addition to taking a thorough patient history, the doctor will usually refer patients to an ophthalmologist to conduct an eye exam.
Ocular migraine complications
While visual changes in one eye can be burdensome to daily activities, they can also indicate a more serious condition. Retinal migraines may indicate a detached retina or it could lead to permanent vision loss in one eye. Always talk to your eye doctor and have a comprehensive eye exam if you’re experiencing blurred vision or blindness in that one eye.
An eye exam is looking at the overall health of your eye but also seeks to rule out this and other conditions such as:
- Amaurosis fugax: Blockage in an artery that can cause temporary blindness due to lack of blood flow
- Spasms in blood vessels in the eye
- Giant cell arteritis: Inflamed blood vessels that can lead to blindness
- Blood clotting conditions, such as sickle cell disease and polycythemia
- Autoimmune disease that can cause problems with blood vessels
Migraine with aura, a similar condition, could also be a symptom of a rare underlying condition. These can include:
- Head injuries
- Cerebral vasculitis
- Trigeminal neuralgia
- Inflammation due to an infection
While migraines with aura, and to a lesser extent ocular migraines, are fairly common conditions, they can be indicative of more serious underlying issues. Because of this, it’s always important to talk to an eye doctor or pain doctor to rule other conditions.
How do I get rid of an ocular migraine?
Treatment for ocular migraine has not been well-studied, but talking to an eye doctor or certified pain specialist can be the first step in finding a treatment that works. Doctors might try to address the potential physical causes of blood vessel constriction or blockages with the following medications:
- Drugs used to treat epilepsy
- Tricyclic antidepressants
Because this type of migraine most often resolves itself within an hour, treatment may not be necessary. Stopping activity and relaxing may be enough to work through symptoms and wait for them to stop. While experiencing an ocular migraine, do not drive or operate other heavy machinery.
Experiencing ocular migraine can be stressful. For this reason, some doctors may recommend mild anti-anxiety medications to be taken as needed during an attack. Lying down, practicing mindfulness meditation, or breathing deeply can also help control the stress and anxiety that may come with an ocular migraine. The following video goes over other ways to prevent migraines before they start.
Because ocular migraine is so rare, it is difficult to pinpoint exact treatments that might work. Keeping a journal to track symptoms, getting plenty of rest, and eating a healthy diet are ways to support your overall health and well-being. This includes working to identify and manage symptoms of ocular migraine.
If you are experiencing visual symptoms without headache pain, talk to your doctor about ocular migraine. To find a pain specialist in your area who understands rare pain conditions like ocular migraine, click the button below.