What Do Ocular Migraines Indicate?

Migraine with aura

Migraine with aura causes symptoms such as flashes of light, blind spots, seeing stars or patterns, and other mild vision changes that resolve quickly. Although visual disturbances are the main symptoms, aura can affect other senses as well and interfere with speech, motor abilities, or smell. 

Migraine aura can occur with or without a headache. While symptoms are usually brief, they continue for more than an hour in roughly 20% of cases. When aura symptoms emerge in conjunction with head pain, they usually occur in the: 

• Premonitory phase: Phase between the symptoms that warn of an approaching attack
• Peak pain phase: When the head pain occurs

Migraine with aura affects 25%-30% of people with migraines, and less than 20% of people with migraine aura experience the aura phase with every migraine attack.

Retinal migraine

Retinal migraine is a type of migraine attack that causes vision changes in only one eye before or during the headache phase. Retinal migraine symptoms are more noticeable than aura symptoms and may include reduced vision, twinkling lights, and brief blindness.

Retinal migraine can result in irreversible vision loss. Because it can be difficult for people to distinguish between migraine with aura and retinal migraine, it is critical to visit a doctor if you suspect you have retinal migraine symptoms. 

Painless ocular migraine

You may not experience a headache if you have a painless ocular migraine. If a headache does occur, it is usually mild. The most common symptoms of an ocular migraine are seeing a fuzzy spot or flashing lights. Other sensory or motor control issues may occasionally accompany vision changes and normally last less than 30 minutes.

If these symptoms arise, you should avoid strenuous activity such as driving until they pass.

Most clinicians do not link ocular migraines with other medical problems. However, it is recommended to visit an ophthalmologist to better understand your vision issues.

While the exact cause of ocular migraines is unknown, they are likely caused by the same factors that lead to migraine headaches. 

Triggers and risk factors may include:

• Hunger or thirst
• Stress or fatigue
• Severe heat or strenuous exercise
• High altitude
• Caffeine withdrawal
• Strong odors such as smoke or perfume
• Foods such as wine, aged cheese, chocolate, and some artificial sweeteners
• Hormonal changes (puberty, menstrual cycles, or menopause)
• Strong lights such as fluorescent or strobe lights
• Reading small text or playing video games
• Long-distance driving
• Family history 
• Female sex

Symptoms differ from person to person depending on the intensity of the ocular migraine:

• Blindspot that begins as a small dot and grows larger, typically affecting one eye
• Temporary blindness in one or both eyes (severe cases)
• Flashes of lights
• Flickering lights
• Bright lines
• Zig-zag lines
• Patterns in a star shape 
• Headaches may or may not be present

Your ophthalmologist will take a complete medical history and conduct a thorough physical examination:

• Examination: Examination is done in a darkened room using an ophthalmoscope, and you will be asked to look in different directions.
• Slit-lamp examination: You may be given eye drops to dilate your pupils. A powerful light is shone straight into the eye, and the back of the eye is examined under a microscope.

Tests that may be ordered include:

• Imaging tests such as CT scans or MRI scans
• Blood tests
• Spinal taping

Treatment of retinal migraine often involves taking pain relievers for headaches and limiting exposure to triggers

Medications that help with ocular migraine include:

1. Nonsteroidal anti-inflammatory drugs
2. Beta-blockers
3. Calcium channel blockers
4. Tricyclic antidepressants
5. Antiepileptic drugs

Management of symptoms may include rest, avoiding potential migraine triggers, eating a nutritious diet, and practicing stress reduction techniques.