Retinal migraine, also called ocular migraine, is a rarer type of migraine. Retinal migraine attacks cause a very brief loss of vision or other visual problems (like flashes of light or dimming vision) in one eye before the migraine headache begins. Having these auras (sensations that happen immediately before the headache itself) and accompanying temporary blindness can be frightening.
Here, we break down what retinal migraine is, its symptoms, how it’s diagnosed, and available treatments.
Retinal migraine is a type of migraine with aura. Typical symptoms of migraine attacks include throbbing headaches that usually are on one side of the head, often with nausea or vomiting and sensitivity to light or sound. About 1 in 5 people with migraine also have auras.
Auras of classic migraine headaches usually involve seeing halos or bright spots, hearing certain noises, feeling numbness or tingling, or having a “rising sensation” in your belly. People with retinal migraine have auras that relate to a part of the eye called the retina. The retina is where the light that enters the eye gets turned into images before being sent to the brain. Each eye has its own retina, whereas the part of the brain that deals with vision takes inputs from both eyes. Because retinal migraine affects one retina rather than the brain, retinal migraine symptoms happen in one eye, unlike visual auras from other migraines, which are seen in both eyes.
It is thought that the cause of a retinal migraine attack is a vasospasm, which is a sudden, temporary narrowing of the blood vessels that provide oxygen to the retina. This brief decrease in blood flow causes temporary vision loss or disturbance in one eye right before the migraine headache begins.
Like other subtypes of migraine, retinal migraine is caused by a mix of genetic and environmental factors. A family history of migraine can increase your risk of developing migraine in general, including ocular migraine. This type of migraine typically occurs between the ages of 30 and 39 and is more common in women than in men.
Environmental factors can also trigger or worsen retinal migraine in some people. For instance, high blood pressure can often make migraine attacks worse.
Other common triggers include:
Retinal migraine attacks can include visual symptoms such as:
These visual auras are usually monocular (in one eye), as opposed to binocular (in both eyes), and happen soon before the migraine headache starts. The loss of vision usually lasts for 5 to 60 minutes.
It is currently not clear whether people with ocular migraine and vasospasm are more likely to develop permanent vision loss in the future, due to repeated oxygen loss to the retina that may cause retinal cells to die. This is still a subject of ongoing research.
There is no single test for diagnosing retinal migraine. Instead, a diagnosis may require seeing a range of specialists including neurologists (doctors who specialize in brain disorders) and ophthalmologists (doctors who specialize in eye disorders).
Your eye doctor may perform visual field testing to gauge how far you can see to either side and up and down while looking directly ahead. The doctor will also likely take a look into your affected eye using an ophthalmoscope — just like during regular eye exams — to check for vasospasm. You may also be asked to draw on a sheet of paper what you see in each eye to confirm an aura.
Additionally, your doctor will also talk to you about your symptoms and family history to help make their diagnosis of retinal migraine.
Sudden loss of vision can also result from serious conditions such as a stroke or a blockage of the ophthalmic artery, the source of blood flow to the eye. Strokes and blood vessel disease are often due to clots coming from the heart or the carotid arteries (the two big arteries in your neck).
Many of the treatments for ocular migraine are similar to general migraine treatments. There are two types of medications used to treat migraines — those that you take during a migraine attack and those you take regularly to prevent or decrease future migraine attacks (sometimes called prophylactic therapies).
The main treatment for migraine attacks is quick pain relief through over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) such as:
Aspirin is widely recommended for retinal migraine attacks because it is known to be beneficial for people with vascular diseases in general.
Triptans, one of the main drugs normally used for treating migraines, are not recommended for people with retinal migraines. This is because one side effect of triptans is an even greater narrowing of blood vessels.
Preventative medications for retinal migraine may include:
These drugs can have side effects, and it is important to talk to your doctor about all of your options. Let them know about any other medical conditions or previous drug reactions you may have.
Simple lifestyle changes — including maintaining good sleep hygiene, eating smaller meals, and exercising regularly — may help, as well. Consider keeping a migraine diary where you record when you get migraine attacks and what might have triggered them. Then, try your best to avoid those triggers.
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