Ocular migraines (also known as eye migraines, ophthalmic migraines, retinal migraines, or visual migraines) are painless, temporary visual disturbances that can affect one or both eyes. Though they can be quite alarming, ocular migraines are typically harmless and resolve on their own within approximately 30 minutes.
A number of different visual symptoms may occur with ocular migraines. These may include the appearance shimmering, flashing, or flickering lights (scintillations), the development of a small, enlarging blind spot (scotoma) in your central vision, and wavy or zig-zag lines surrounding the blind spot, sometimes appearing as a “heat wave”. The blind spot often enlarges and may move across your field of vision. A person might even observe what appears to be the sensation of looking through a cracked window. The entire experience of an ocular migraine may last only a few minutes and will usually resolve without medication within 30 minutes. In some cases, it might last longer. If you experience vision loss lasting more than 30 minutes, be sure to see an eye specialist.
Some migraine sufferers will experience symptoms in the days weeks before the attack that warn them of an impending migraine or ocular migraine. These might include changes in mood, cravings for certain foods, or a feeling of tiredness.
If a visual disturbance such as that of an ocular migraine is followed by a throbbing, one-sided headache, this is called a “migraine with aura” (formerly referred to as a classic migraine), and the visual disturbance is referred to as an aura rather than an ocular migraine. A migraine headache without any visual disturbance preceding it is called a “migraine without aura” (formerly called a common migraine).
Migraine auras usually are visual in nature, but they can include disturbances of hearing, speech or smell; progressive numbness or tingling in the face or arms or legs; or generalized weakness.
What Causes an Ocular Migraine?
Ocular migraines are believed to have the same causes as migraine headaches. As there can be a genetic component to migraines, many patients will have a family history of ocular migraines or migraine headaches. While these can affect children, migraines and ocular migraines frequently start at puberty but most commonly affect adults in their 30’s and 40’s. Women are more often affect than men.
Ocular migraines are caused by a sudden constriction (tightening) of blood vessels, which reduces blood flow to the eye or to visual pathways in the brain. This is believed to be due to a release of inflammatory substances around the nerves and blood vessels though it is unclear what is the underlying cause for this occurrence.
Common migraine “triggers” that can cause a susceptible person to have a migraine or ocular migraine attack include certain foods, such as red wine, alcohol, aged cheeses, caffeine, nitrates (often found in smoked or cured meats, hot dogs, and other processed foods), and chocolate. Food additives, such as monosodium glutamate (often called MSG), and artificial sweeteners such as aspartame also can trigger migraines in some people.
Other potential migraine triggers include cigarette smoke, perfumes and other strong odors, glaring or flickering lights, lack of sleep and emotional stress. Among women, hormonal changes can be triggers—especially menstrual periods, menopause, pregnancy, and use of birth control pills.
Consider keeping a journal of your diet and activities just prior to your episodes of ocular migraine as this may help us to identify possible migraine triggers that you can avoid in the future.
Ocular Migraine Treatment and Prevention
Because they generally are harmless and typically resolve on their own within a half hour, ocular migraines usually require no treatment.
If you are performing tasks that require good vision when an ocular migraine occurs, stop what you are doing and relax until the visual disturbance passes. If you are driving, pull off to the side of the road as soon as you can safely do so, and wait for your vision to return to normal.
There is no test to confirm the diagnosis of ocular migraine. Nonetheless, whenever you are experiencing unusual visual symptoms such as those described here, it is recommended that you undergo a comprehensive eye exam with an eye doctor. This is important so as to rule out sight-threatening conditions such as a retinal tear or detachment, which require urgent attention and/or treatment. Rarely, ocular migraine symptoms can also be associated with stroke.
If you are experiencing recurrent ocular migraine visual symptoms and/or associated migraine headaches, it may be a good idea to see your primary care physician. Your doctor can advise you of the latest medicines for treating ocular migraines, including medicines designed to prevent future attacks. Over-the-counter, anti-inflammatory medications (such as aspirin, ibuprofen, etc.) may reduce the severity of an acute attack. Drugs that constrict the blood vessels, including caffeine and ergotamines, are also sometimes used. As well, prescription medications that deal directly with the presumed chemical imbalances of migraine may available (including Imitrex®, Amerge®, Maxalt®, and Zomig®). In some cases, patients suffering from chronic migraine headaches may be treated with BOTOX® (botulinum toxin) injections given around the head and neck to dull future headache symptoms. These may be administered by our experienced eye doctor, Michael Manning, MD.
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