Ocular migraine: Everything you need to know
Ocular migraine can be painful and disabling, but there are ways to help prevent and reduce symptoms.
In this article, we discuss the symptoms, causes, and risks of ocular migraine.
What is ocular migraine?
An ocular migraine is a migraine that causes visual symptoms.
The medical community defines ocular migraine as migraine that causes visual symptoms, with or without other migraine symptoms, such as a headache.
According to the American Migraine Foundation, about 25–30% of people with migraine experience aura, but less than 20% of these individuals experience it with every migraine episode.
Ocular migraine that does not cause aura is usually called common migraine. Doctors will typically refer to an ocular migraine episode with aura but without headache or pain as acephalgic or silent migraine.
Silent migraine is fairly rare but tends to occur more frequently as a person ages.
Some people use the terms "ocular migraine" and "retinal migraine" interchangeably, but the two conditions are not the same, and they require different care.
The symptoms that ocular migraine causes vary widely among individuals.
However, they can include:
- seeing temporary flashes of stars, zig-zag lines, or other patterns
- a bright or blind spot that starts in the center of vision and spreads to cover up to half of the visual field
- slurred speech
- impaired motor skills
- sensitivity to light and sound
- nausea and vomiting
- tingling or numbness on one side of the body
- intense pain, which may be pulsating or throbbing, in one or both sides of the head
- pain that activity exacerbates
Silent migraine usually causes some of the visual symptoms of migraine but no head pain.
Visual symptoms due to ocular migraine can be scary and disabling, but most are short lived. However, the nonvisual symptoms, such as intense pain, may last from several hours to a few days.
Aura tends to last between 10 and 30 minutes. It typically develops shortly before or during a migraine headache and is the second of a migraine's four stages. Aura generally sets in before the migraine becomes painful.
Retinal migraine causes headaches as well as severe blind spots or blindness in one eye that lasts for less than 1 hour.
Image credit: Stephen Kelly, 2019
Image credit: Stephen Kelly, 2019
Image credit Stephen Kelly, 2019
Image credit: Stephen Kelly, 2019
Researchers are not sure exactly why migraine headaches or episodes occur.
One theory is that they are due to inflammation in the brain, which can cause blood vessels to swell and put pressure on nerves, causing pain.
Migraine aura may develop because of abnormal electrical activity in the outer surface of the brain, or cortex, which slowly spreads like a wave over the visual portion of the brain.
Migraine also appears to have a link with a person's genes. According to the Migraine Research Foundation, 90% of people with the condition have a family history of migraine.
In females, migraine episodes may also correlate with the hormonal changes that take place during the menstrual cycle.
Some people are more likely to have a migraine episode or headache after experiencing specific triggers.
Everyone's migraine triggers are different, but common ones include:
- staring at a screen for a long time
- driving long distances
- being under harsh or poor lighting
- skipping meals
- too little or too much sleep
- hormonal changes
- weather changes
- alcohol, especially red wine
- anxiety and stress
- strong odors
- loud noises
- too much caffeine
- caffeine withdrawal
- nitrates, such as those in deli meats and many prepared meals
- tyramine, which is in aged cheeses, fava beans, hard sausages, soy products, and smoked fish
- monosodium glutamate (MSG)
- excessive heat or high altitude
Ocular migraine can cause painful symptoms and may be frightening for some people, but the episodes are almost always relatively short lived.
A retinal migraine, however, causes similar symptoms to ocular migraine and can lead to severe and irreversible vision loss.
Anyone who thinks that they may be having a retinal migraine episode should always talk with a doctor or seek emergency care.
Some signs that help distinguish retinal migraine from ocular migraine include:
- symptoms that affect only one eye
- severe vision loss
- temporary blindness
- seeing twinkling lights
If a person does not receive prompt treatment for migraine conditions, they may become more sensitive to the symptoms each time they occur. This process can lead to chronic daily headaches or migraine episodes.
Excessive use of pain relievers can also cause additional headaches called rebound headaches.
The symptoms of ocular migraine can make tasks such as driving, walking, reading, working, and caring for young children difficult. People who experience ocular migraine symptoms should stop what they are doing and rest until the symptoms have passed.
If a person experiences symptoms when driving, they should safely pull over to the side of the road and wait until they feel better to resume their journey.
When to see a doctor
Everyone gets headaches now and again, but a migraine headache requires different treatment.
People should talk to a doctor if they have:
- vision problems with headaches
- several headaches each month that last for many hours or days
- headaches that interfere with everyday life
- nausea and vomiting with a headache
- sensory problems with a headache
- a severe headache that causes a stiff neck
- headaches after a blow to the head
- no history of migraine episodes, but now having frequent headaches
- loss of alertness or confusion with a headache
- convulsions with a headache
- headaches that require pain medications more than twice weekly
As there is no specific test available to identify migraine conditions, a doctor may:
- perform a physical examination
- review a person's full medical history
- ask questions about symptoms, medication use, and lifestyle factors
Taking all of this information into account, a doctor can then use certain guidelines to diagnose someone with a migraine condition.
According to the International Headache Society guidelines, a migraine causes at least five symptomatic episodes, each lasting 4–72 hours without treatment and including symptoms other than a headache.
A doctor may diagnose someone with ocular migraine if they have visual symptoms consistent with migraine. They will also rule out eye conditions.
Treatment and prevention
Stress reducing tools such as acupuncture might help reduce the frequency of severe migraine episodes.
The treatment of ocular migraine usually focuses on preventing and reducing symptoms.
Erenumab (Aimovig) is a medication that blocks the activity of a molecule called the calcitonin gene-related peptide, which plays a role in migraine episodes.
Other medications that manufacturers developed for different conditions may also help prevent migraine symptoms. These include drugs for:
Doctors can also prescribe botulinum toxin A to help prevent chronic migraine. This medication requires a specialist's recommendation. Its other uses include treating spasms.
Some lifestyle changes and therapies may also reduce the frequency and severity of migraine headaches or episodes. These options include:
- avoiding too much time looking at screens
- dealing with stress using tools such as exercise, relaxation techniques, acupuncture, and biofeedback mechanisms
- tracking symptoms to find migraine triggers
- losing weight if overweight
- quitting smoking
- eating regular meals
- staying hydrated
- establishing a consistent sleep schedule
- limiting caffeine and alcohol consumption
- treating anxiety and depression with counseling and other options
Some medications may reduce migraine symptoms once they develop. In general, medications are more effective the sooner someone takes them after symptoms begin.
Over-the-counter analgesics, including aspirin, acetaminophen, and nonsteroidal anti-inflammatory drugs, can sometimes alleviate migraine symptoms.
If these medications fail, a person should speak to a doctor about prescription pain relievers.
There is no cure for ocular migraine, but some medications, lifestyle adjustments, and other therapies can help prevent or reduce migraine symptoms.
Getting appropriate treatment for ocular migraine is vital, as people can become more sensitive to symptoms with each migraine episode, and this can eventually lead to chronic daily migraines.
It is important to talk with a doctor about severe, frequent, or disabling headaches, as well as those that cause other symptoms, such as sensory problems or nausea. A person should seek emergency care for visual symptoms that affect only one eye.