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Ocular Migraines: Causes, Symptoms, Treatments, and Risks

Posted on March 11, 2021
Medically reviewed by
Amit M. Shelat, D.O.
Article written by
Joan Grossman

Ocular migraines cause visual disturbances that are almost always temporary. Although migraines are commonly associated with headaches, an ocular migraine can occur with or without a headache. Visual symptoms with migraine, typically called aura, can be distressing, as many MyMigraineTeam members have shared:

  • “Second migraine aura in five hours.”
  • “I’ve had migraines forever, but the aura is getting worse with age 😫”
  • “I have had three severe migraines in the last couple of weeks. Each one started with an aura of zigzag lines in my right eye.”
  • “My visual auras affect a big portion of my vision, so doing day-to-day things is difficult (because I can’t see).”
  • “The aura lasts maybe 20 to 30 minutes. I’m always afraid that it won’t stop!”
  • “My aura starts from the outside corner of my right eye and travels across to my left eye from the inside corner to the outside corner. I cannot see through the pulsating waves.”

Ocular migraines can coincide with various types of migraine, including hemiplegic migraine, cluster headaches, cervicogenic headaches, and chronic migraine. An ocular migraine without head pain can be a warning that a migraine headache will follow. The condition is associated with a greater risk of stroke.

Types of Ocular Migraine

The term ocular migraine is sometimes used to refer to any migraine with visual symptoms. However, there are distinct types of ocular migraine.

Migraine With Aura

A migraine aura is a visual or sensory disturbance that can affect hearing, sight, speech, or touch. An aura can either precede a headache, coincide with a headache, or occur without a headache. Visual symptoms occur in 90 percent of people who experience aura and may appear as flashes of light, shimmering zigzag lines, blind spots, or another visual impediment. Visual aura occurs in 25 percent to 30 percent of people who experience migraines of different types.

Migraines that have aura without a headache are sometimes called silent migraines or acephalgic migraines.

Retinal Migraine

Retinal migraine is characterized by visual symptoms in only one eye. Retinal migraines can be experienced in either eye but only occur in one eye at a time. The condition causes aura and more intense visual symptoms, like temporary blindness. In rare instances, retinal migraine can be a serious condition that causes permanent vision damage or blindness in one eye.

Retinal migraine is associated with simultaneous migraine headache or a history of migraine. The condition is considered rare and affects 1 out of 200 people who experience migraines.

Migraine With Brainstem Aura

People who have migraine with brainstem aura (MBA) experience visual symptoms that are similar to migraine aura. However, symptoms can also occur in just one eye. The condition is characterized by headaches in the back of the head that span both sides of the head. The condition is rare and occurs more commonly in adolescent girls.

Causes of Ocular Migraines

The exact causes of ocular migraines are not fully understood. Migraines are believed to be caused by environmental factors and complex genetic disorders, which affect the sensory nervous system. Neurological symptoms from migraines can amplify sensitivity to light, sound, smell, and touch. However, there is some variation in the specific causes of different types of ocular migraines.

Causes of Migraine Aura

Migraines generally have four phases: prodrome, aura, headache attack, and postdrome. Not everyone with migraines experiences all four phases. The aura phase, which usually lasts an hour or less, is when visual disturbances are experienced. It can also coincide with headache and other migraine symptoms.

Different types of brain activity have been measured during migraines with aura. They show changes in blood flow and metabolism in the occipital cortex, an area of the brain that affects vision. Cortical spreading depression (CSD) is a slowly spreading wave of changing brain activity. It has been associated with visual aura in migraines. The slow spread of brain disturbance is believed to correspond with the gradual onset and duration of aura.

Causes of Retinal Migraine

In retinal migraine, only one eye is affected at a time. This type of migraine is associated with a problem with blood vessels in the optic nerve or the eye itself, rather than the occipital cortex. A constriction of blood flow in the central retinal artery may cause the condition. There is also speculation that the condition is caused by a spreading depression in neurons in the retina. This phenomenon resembles a cortical spreading depression but is more localized.

Causes of Migraine With Brainstem Aura

The causes of MBA are not well understood. Like other forms of migraine, a combination of genetic mutations, environment, and changes in brain activity are factors. Abnormal blood flow and nerve function in the brain stem and occipital cortex may also cause the condition.

Risk Factors for Ocular Migraine

Ocular migraines have similar risk factors to migraines in general. Women are three times more likely than men to have migraines, including ocular migraines. Genetic and environmental factors may increase the chances of ocular migraine, including:

  • Family history of migraine
  • Hormonal changes, like puberty and menstruation
  • Birth control pills or other hormonal contraceptives
  • High blood pressure
  • High altitude
  • Change in weather

Lifestyle factors can trigger ocular migraines, including:

  • Stress or lack of sleep
  • Dehydration
  • Skipping meals
  • Smoking
  • Alcohol, especially red wine
  • Caffeine

Symptoms of Ocular Migraines

Disturbances with vision and migraine aura can be disorienting. Visual symptoms in all types of ocular migraine tend to last between 10 and 60 minutes. In many cases, ocular migraine symptoms are an indication of an impending migraine headache attack. Although symptoms that impair vision can be disturbing, they are temporary in most cases. Symptoms may include:

  • Sensitivity to light
  • Flashing or sparkling lights, sometimes called scintillation
  • Seeing zigzag patterns or other geometric forms
  • Blind spots, also called scotoma
  • Temporary loss of vision

Other common migraine symptoms may coincide with visual symptoms, such as:

  • Dizziness or vertigo
  • Sensitivity to light
  • Tingling or numbness
  • Nausea or vomiting
  • Headache

Ocular migraine symptoms can make activities difficult or hazardous. Balance and walking may become difficult and cause an increased risk of falling. Activities such as driving and operating equipment may be dangerous while experiencing visual symptoms and should be avoided.

Diagnosis of Ocular Migraine

Ocular migraines, like other migraines, are diagnosed by neurologists, based on symptoms, medical history, family history of migraine, and physical, eye, and neurological exams. When symptoms are unusually severe or complex, a brain scan may be required to rule out other problems that may be causing pain, such as a tumor or infection.

Treatment Options for Ocular Migraine

When visual disturbances with ocular migraine occur without head pain, symptoms usually resolve within an hour and do not require much treatment. People with migraine aura tend to benefit from basic remedies, such as:

  • Rest
  • Over-the-counter analgesics, such as Advil or Motrin (ibuprofen) or Tylenol (acetaminophen)
  • Eating or having some caffeine
  • Anti-nausea medication such as Reglan (metoclopramide) or Compro (prochlorperazine), if nausea or vomiting occur

More acute ocular migraine with headache is generally treated the same as migraine without visual symptoms, with some notable exceptions. Two types of drugs that are often used to treat acute migraine are not recommended for retinal migraine.

  • Triptans, sometimes called abortives, such as Imitrex (sumatriptan) and Maxalt (rizatriptan), should be avoided for retinal migraine.
  • Dihydroergotamines, also called ergot alkaloids, such as Migranal (dihydroergotamine) and D.H.E.45 (dihydroergotamine mesylate), should also be avoided by people with retinal migraine.

Preventive treatments that are typically used for other types of migraine may also be beneficial for preventing ocular migraine.

Join a Supportive Community

At MyMigraineTeam, you can join a community of more than 65,000 people who are sharing experiences with migraine. More than 17,000 members have reported having migraine with aura, and another 5,800 members report having retinal migraine. Ask questions, share tips, and learn how others are managing ocular migraine.

Add your comment below, or go to MyMigraineTeam now and start a new conversation today.

All updates must be accompanied by text or a picture.
Amit M. Shelat, D.O. is a fellow of the American Academy of Neurology and the American College of Physicians. Review provided by VeriMed Healthcare Network. Learn more about him here.
Joan Grossman is a freelance writer, filmmaker, and consultant based in Brooklyn, NY. Learn more about her here.

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