By Roger M. Kaldawy, M.D.
Milford Franklin Eye Center

Migraines are notorious for their debilitating headaches, but they can also manifest in other ways. Ocular migraines, often misunderstood and underdiagnosed, are a unique subtype of migraine that primarily affects vision. In this article, we’ll delve into the world of ocular migraines, exploring their symptoms, causes, diagnosis, and management.

What Is an Ocular Migraine?

Ocular migraines, also known as retinal, visual, or ophthalmic migraines, are a distinct form of migraine characterized by temporary visual disturbances. Unlike typical migraines, which involve throbbing head pain, ocular migraines primarily affect the visual system. They can be frightening and disorienting, but they are generally not as painful as traditional migraines.

Symptoms

The hallmark symptom of an ocular migraine is visual disturbance, which can vary from person to person. In those shapes can appear when they do not exist (positive hallucinations) and in other shapes disappear when they exit (negative hallucinations). 

Common symptoms include:

Shimmering lights: Perhaps the most recognizable sign of an ocular migraine are the scintillating scotomas which are shimmering or flickering lights that appear in the field of vision. These lights often have a jagged or zigzag pattern and can expand over several minutes before fading away.

Blind spots: Some individuals may experience temporary blind spots in their vision. These blind spots typically last for less than an hour and can occur before or during the headache phase of an ocular migraine.

Blurred vision: Distorted images or a sense of looking through frosted glass may occur during an ocular migraine episode.

Headaches: Although ocular migraines are primarily associated with visual symptoms, some individuals may experience a mild headache after the visual disturbances subside. However, this headache is usually less severe than typical migraines.

It’s important to note that ocular migraines do not result in permanent vision loss. The visual disturbances are temporary and resolve on their own- on average, 10 to 15 minutes later.

Causes

The exact cause of ocular migraines remains unclear, but they are believed to be related to the same underlying mechanisms as traditional migraines. Some potential triggers and factors that may contribute to ocular migraines include:

Vasospasm: Ocular migraines are thought to involve the temporary narrowing (vasospasm) and subsequent dilation of blood vessels in the retina or other parts of the eye. These vascular changes can disrupt blood flow and lead to visual disturbances.

Cortical Spreading Depression: This is a neurological event, which occurs in both traditional and ocular migraines, characterized by a wave of decreased electrical activity in the brain. It is believed to contribute to the visual aura experienced during migraines.

Hormonal Fluctuations, particularly in women, may trigger ocular migraines. These can be linked to menstruation, pregnancy, or the use of birth control pills.

Stress and Anxiety: Emotional stress and anxiety can be migraine triggers for some individuals, including those with ocular migraines.

Dietary Causes: Certain foods and beverages, such as caffeine, alcohol, and processed foods, may play a role in triggering migraines, including ocular migraines, in some people.

Diagnosis

Diagnosing ocular migraines can be challenging because their symptoms often resemble other eye conditions, such as retinal detachment or glaucoma. Therefore, it’s crucial to seek medical attention if you experience any unusual visual disturbances. A comprehensive eye examination and medical history review are typically conducted to rule out other potential causes of visual symptoms.

In some cases, diagnostic tests like visual field testing, optical coherence tomography (OCT), or imaging of the blood vessels may be necessary to confirm the diagnosis and rule out other conditions.

Management and Treatment

Managing ocular migraines often involves a combination of lifestyle changes, preventive measures, and acute treatments:

Identify Triggers: Keeping a migraine diary can help identify specific triggers or patterns associated with ocular migraines. Avoiding triggers like certain foods, stress, or hormonal fluctuations may reduce the frequency of episodes.

Lifestyle Modifications: Adopting a healthy lifestyle can be instrumental in managing ocular migraines. Adequate sleep, regular exercise, stress reduction techniques, and a balanced diet can all contribute to migraine prevention.

Medications: In some cases, healthcare providers may prescribe medications to help prevent or alleviate ocular migraines. These can include beta-blockers, calcium channel blockers, or antiepileptic drugs. Additionally, acute treatments like pain relievers or anti-nausea medications may be prescribed for the headache phase.

Vision Correction: Correcting any underlying vision problems with eyeglasses or contact lenses may improve overall eye health and reduce the frequency of ocular migraine episodes.

Migraine Medications: Some individuals with frequent ocular migraines may benefit from medications specifically designed to prevent migraines, such as triptans or CGRP inhibitors.

Conclusion

Ocular migraines are a unique and often bewildering subtype of migraine that primarily affects vision. While they may not cause severe head pain, the temporary visual disturbances they produce can be disconcerting. It’s essential to understand the triggers, causes, and management strategies for ocular migraines to minimize their impact on daily life. If you experience unusual visual disturbances, consult a healthcare professional for proper evaluation and guidance on managing this condition effectively. By addressing triggers, making lifestyle changes, and, when necessary, using medication, individuals with ocular migraines can often find relief and maintain a better quality of life.Our center and ophthalmologists have state of the art equipment to diagnose and treat many eye problems, including ocular migraines.  7 dedicated eye care providers here to help you in 3 state-of-the-art facilities in Franklin, Milford and Millis.  We are available and have Saturday and after-hours appointments. From the basic eye exam to the high-tech surgeries performed locally in Milford, our center is now able to better recognize and manage the problem of ocular migraines and continue to provide world class eye care for the entire family.

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