Ocular Migraine

Have you ever had strange visual disturbances like flashing lights, jagged lines, circles, squares, or distortions of things you see out of either one or both eyes? Do some objects seem further away or closer?

Perhaps you have experienced symptoms beyond these disturbances to dizziness, ringing in the ears, trouble focusing, slurred speech or trouble finding the right word when you talk. You may be suffering from Ocular Migraines.

Visual disturbances are referred to as aura, which are symptoms that about 15-20% of migraine sufferers deal with before their headaches begins.

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What are Ocular Migraines?

Ocular Migraines can be categorized into different types such as:

  • Silent Migraines

  • Ophthalmic Migraines

  • Acephalic Migraines

    • Silent or Acephalic Migraines are characterized by the strange visual disturbances described above, usually lasting less than an hour, but no headache pain. Ocular Migraines also produce the aura symptoms above with or without headache pain.

    Rare Ocular Migraines include:

  • Retinal Migraines

  • Ophthalmoplegic Migraines

  • Basilar Migraines

    • What are the symptoms?

    Your symptoms are going to depend on the type of Migraine you are experiencing.

    Symptoms may include:

  • Image distortion generally beginning in the center of the image and then moving to one side

  • Images “graying out” or looking wavy

  • Temporary vision loss, usually in one eye as seen in Retinal Migraines

  • Zigzagging lines or patterns, especially at the outer edges of your vision

  • Shimmering or colored lights

  • Loss of vision in one spot or off to one side

  • Uncommonly, you may experience a headache with severe pain following the visual disturbances.

    • Other less common symptoms include:

  • Nausea or vomiting

  • Lateralized pain (often around the eye) accompanied by nausea, vomiting and Double Vision in the case of Ophthalmoplegic Migraines

  • Rarely, you may be left with a permanent neurologic deficit following a migraine, probably from irreversible decreased blood supply to a part of the brain resulting in damage. This can be described as an Ocular Migraine Stroke

    • Also rare is the Basilar Migraine whose symptoms may include:

  • Visual disturbances such as a graying out visually or even temporary partial blindness

  • Eyelid Twitching
    •

  • Nystagmus
    •

  • Dizziness

  • Vertigo

    • What are the causes?

    The cause of these Migraines is not known well. Some believe that it is vascular in origin. The mechanism proposed is marked by a sudden constriction (or narrowing) of blood vessels, which reduces blood flow to the eye.

    It is this decreased blood supply that causes the strange visual disturbances. Most last under five minutes. Vision usually returns to normal afterward.

    Research is confirming that the Migraines are genetically based. Ocular Migraines have been described as a neurological disease in which the brain is sending out confusing signals due to an inherited genetic abnormality.

    Usually the Migraines are harmless, but if you experience sudden loss of vision in one eye or any of the visual disturbances described above, you should consult your eye care provider to make sure you do not have a more serious condition like an Eye Stroke.

    Whether the underlying cause is decreased blood supply or misfiring nerve cells in the brain, precipitating factors have been recognized that start the migraine reaction in people prone to these attacks.

    Triggers which may contribute to Migraines include:

  • Stress

  • Premenstrual changes

  • Alcohol Consumption

  • Hunger

  • Use of Oral Contraceptives

    • Certain foods such as:

  • Red wine

  • Chocolate

  • Aged cheese

  • Milk

  • Chicken livers

  • Meats preserved in nitrates or

  • Foods prepared with monosodium glutamate

    • For some, sunlight exposure, exercise, and/or changes in weather or season can be triggers

    What about Ocular Migraines versus Brain Tumor?

    Because Ocular Migraines and Brain Tumors both affect the neurological system, these conditions can give you similar symptoms of headache, visual disturbances, nausea, vomiting, hypersensitivity to light, sound, smells, and movement, or even changes in mood/behavior.

    In order to make the correct diagnosis, your doctor will ask you questions about the frequency of your complaints and take a thorough history of your symptoms. Aura symptoms, for example, are rare in Brain Tumors.

    Also, unlike symptoms of Ocular Migraines which are episodic, symptoms of Brain Tumors happen more consistently.

    The questions your doctor asks you will help him or her get a subjective assessment of your condition. You can help your doctor by keeping a journal.

    In this journal you can talk about frequency and description of your symptoms as well as document your food consumption in order to discover possible triggers, and any other pertinent information.

    However, objective testing will be necessary to confirm findings or rule out Brain Tumors.

    Such testing may include:

  • Magnetic Resonance Imaging (MRI) which can show abnormal cell growth in the soft tissue of the brain

  • CT Scan can show abnormal cell growth in the bony structures of the skull

  • Electroencephalography (EEG) recordings can determine unusual electrical activity in the brain

    • What about Ocular Migraines versus Sinus Headache?

    Besides the more serious condition of Brain Tumors, your doctor will want to make sure that your symptoms are not due to Sinus Headaches.

    You want the correct diagnosis to be made so that the appropriate treatment is used. If the treatment you are given is not adequate for your condition, it may make your symptoms worse.

    Sinus Headaches are usually due to swelling in the sinus cavities around the nose and eyes. Your sinuses may be congested with mucus often caused by allergies or infections.

    Your symptoms may include:

  • Fever

  • Stuffy nose

  • Toothaches

    • Head pain which can worsen with:

  • Leaning forward or lying down

  • Bending down or leaning over

  • Cold and damp weather

  • Pain is often worse in the morning and better by afternoon

    • Head pain can be confused with certain types of migraines which can cause head pain and nasal drainage and be triggered by changes in the weather or season

    How are Ocular Migraines treated?

    As mentioned earlier, if you experience vision loss or visual disturbances consult your eye doctor to make sure you do not have a more serious eye disease like an Eye Stroke.

    If you have head pain with your symptoms, your general doctor will investigate the underlying cause in order to tailor the treatment option you need.

    In the meantime, manage your symptoms by:

  • Rest in a dark room until visual disturbances subside and vision returns to normal

  • If you have nausea, purchase an over the counter anti-nausea medication or take one prescribed by your doctor

  • Take pain killer like ibuprofen or aspirin for any headache pain. Do not exceed the daily recommended dosage. If you need something more effective, consult your general doctor

    • Strive to prevent these episodes by avoiding triggers, which may include food, sleep or environmental adjustments

    Return From Ocular Migraine to Eye Diseases

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