Ocular migraines can be described as a related group of conditions, all affecting vision, usually temporary, and sometimes without pain. The causes of these migraines are still under debate. Ocular migraines are more common in women of childbearing years who have a history of migraines with auras, and for whom the diagnosis is one of exclusion (a diagnosis reached by process of elimination). There are two types of ocular migraine: ophthalmic (migraine with aura) and retinal migraines.
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- Ophthalmic, or visual, migraines are thought to result from abnormal electrical activity slowly spreading across certain regions of the outer brain cortex. They affect both eyes. This is responsible for the development of the slowly progressing visual changes, usually over 20 to 60 minutes. These migraines are also known as scintillating scotomas.
- In retinal migraines, the visual symptoms take place in the retina rather than across the outer brain cortex. They occur in only one eye, before or during the headache phase. The disturbance in retinal migraine may also result from abnormal spreading of electrical activity, except it occurs in the retina. The disturbance may also be due to reduced retinal blood flow.
- A migraine headache results in moderate to severe headache and lasts for 4 to 72 hours with a number of connected symptoms. It may be tied to family genetic traits and triggered by certain foods, stress, or environmental factors that affect the proper functioning of the cerebral cortex.
Migraines with aura cause no permanent visual or brain damage and do not require treatment. Retinal migraines, on the other hand, have more potential for long-term vision loss. Either way, getting evaluated and monitored by your eye doctor is highly recommended to rule out other concerns.
Types of Ocular Migraines
Ophthalmic Migraine Occurs in the Visual Cortex
Ophthalmic migraine is a vision-loss symptom that occurs due to the aura phase of the common migraine headache. It can occur with or without a headache. An ophthalmic migraine takes place in the brain, which affects vision in both eyes, and is generally believed to originate at the occipital (visual) cortex rather than in the eye itself. For this reason it is experienced in both eyes, not just one eye. It is also known as a scintillating scotoma.
A scintillating scotoma can occur with or without a migraine headache. Scintillating means sparkling or shining, and a scotoma is a partial loss of vision or a blind spot in an otherwise normal visual field.
This condition is marked by a spasm, or spreading wave of spasms that arise in the occipital area of the brain (visual cortex). Related blood vessel spasm and redilation is likely linked to these electrical charges. The experience of a person suffering from this condition is a sparkling or flickering of lights, as well as dots, wavy lines, zigzags, arcs, camouflage patterns, or blurry areas toward the periphery of vision (or in some cases, off to one side). Typically, the scotoma starts as a small visual disturbance that slowly starts growing over much of the visual field over about 15-20 minutes before disappearing completely.
A headache might follow the visual effect, ranging from mild to severe, or accompanied by feeling tired, depressed, or washed-out. Sometimes a sensory aura (for example, tingling or numbness in a limb, or problems speaking) will occur at the same time or just after the visual aura.
Retinal Migraine Occurs in One Eye
Retinal migraine usually occurs in one eye, and there may be an abnormal spread of electrical activity in the retina. The migraine may also be caused by the sudden constriction (spasm) or blockage behind, or in, an eye. It may occur with, or without, a throbbing headache at the side of the head. The patient may also simultaneously experience sensitivity to light or nausea. The temporary loss or distortion of vision in one eye makes it difficult to conduct close visual work and makes it dangerous to drive. This type of migraine is generally of short duration, an hour or less, and then vision returns to normal. However, some researchers have found that irreversible vision loss is also possible.
Retinal migraine, as defined by the International Headache Society, is actually fairly uncommon. Most cases are diagnosed as ophthalmic migraine.
This rare condition was once thought to be a type of migraine, but instead, it appears to be an inflammation (of cranial nerves) or neuralgia. It is usually accompanied by long-lasting neuropathy of the eye-movement nerve (oculomotor) or of the nerve associated with outward gaze (trochlear), with double vision, pupil abnormalities, and eyelid droop. Symptoms usually resolve fairly quickly.
A standard migraine headache is defined by a moderate to severe headache that lasts for 4–72 hours, with a number of connected symptoms. It may be tied to family genetic traits and triggered by certain foods, stress, or environmental factors that affect the proper functioning of the cerebral cortex. Migraine headaches result primarily from changes in the small blood vessels in the head or eyes, either in the form of vasodilation or spasms.
Approximately 20% of migraine headaches are preceded by an aura, usually occurring 20–60 minutes before the headache starts. Visual disturbances may include blind spots, the appearance of flashing lights, spots of light, or wavy lines in the field of vision.
Symptoms can be quite varied and related to possible underlying problems.
Ophthalmic Migraine Symptoms
- Visual changes in both eyes
- A blank spot in the visual field
- Flickering of light, shimmering white light, colored lights in the periphery of vision, or bright colored streaks
- Zigzag lines in the visual field
- Blurred area of vision, mostly around the periphery, as though you were looking at heat waves rising off hot pavement
- Sometimes, allodynia, which includes a hypersensitive area on the face or head during migraine or before or afterward (interictally).
Retinal Migraine Symptoms
- Vision loss in one eye, lasting less than one hour
- Possible migraine headache
- Sensitivity to light
- Throbbing or pulsing feeling
- Feeling worse when you move around
"Regular" migraines appear to occur due to constriction and dilation of fine arteries in the head; they can be intensely painful. The pain often stays on one side of the head and might be accompanied by nausea and vomiting. An ocular migraine can appear simultaneously with a migraine headache, in which case the symptoms can be greater, including pulsating and throbbing pain.
Acute Angle-Closure Glaucoma
Ocular emergency. Acute angle-closure (closed-angle or narrow-angle) glaucoma can produce migraine-like symptoms, such as eye pain, intense headache (usually over one brow), halos around lights, dilated pupils, vision loss, red eyes, nausea, and vomiting. If these symptoms are new and unrecognized then you should see your doctor immediately, or go to the emergency room. Narrow-angle issues are typically identified through a comprehensive eye exam.
Causes of Ocular Migraines
Some scientists think that ocular (visual) migraines are caused by or triggered by inflammatory substances released in the tissues surrounding the circulatory and nerve system of the head and brain.
Ocular migraines may be due to stress and fatigue - the same probable causes of migraine headaches. Learn more about migraine headaches, computer eye-fatigue. These related causes can include improper glasses and other conditions such as hypertension, sinus conditions, tumors, hormonal changes, certain foods such as alcohol, aged cheese, MSG or chocolate, or other allergies rather than due to problems related to the eyes.
Other causes include being female, being younger than 40, and people with a family history of migraines or other headaches. Additionally, people with diseases such as lupus, hardening of the arteries, sickle cell disease, epilepsy, or depression are at greater risk.
For some people low blood sugar (skipping meals), bending over or being at high altitude can cause ocular migraines. Hormonal birth control pills are another possible cause.
Scientists are not sure exactly what causes ocular migraines, but some think that inflammatory substances released in the tissues that surround the circulatory and nerve systems of the head and brain can trigger them. Specifically, ocular migraines do appear to be tied to blood-vessel spasms in the retina or in the back of the eye in the vessels that supply the retina with blood. Doppler studies have revealed cessation of retinal arterial flow during an exercise-induced retinal-migraine episode.1
An ocular migraine can appear simultaneously with a migraine headache.
Ocular migraines tend to go away after a few minutes to an hour and generally treatment is not needed. However, if you have them repeatedly it will be a good idea to have an exam. Normal practice is for a medical doctor to get your complete medical history and give you a thorough physical exam to rule out causes of the headache from other physical conditions. An ophthalmologist can verify that eye-related problems are not contributing to the condition.
Similarly, if you have frequent migraine headaches, you should talk to your health care professional.
Spasms and constriction of tiny blood vessels that cause ocular migraines can be lessened through targeted supplementation, healing modalities such as massage to reduce tension in the neck and shoulder muscles, craniosacral therapy (a gentle, noninvasive form of bodywork that addresses the bones of the head, spinal column, and sacrum), chiropractic (to relieve tension along the spinal column), and acupuncture or shiatsu to balance out meridians that can contribute to, or result in, onset of ocular migraine headaches.
Diet, Nutrition & Lifestyle Choices
Evidence is beginning to support the idea that migraine headaches are associated with mitochondria dysfunction. Supplements such as riboflavin (B2), coenzyme Q10, magnesium3, niacin, carnitine, and lipoic acid, which support mitochondrial function, have been shown to help alleviate migraine headaches.2
- Be sure to also read our lifestyle recommendations for migraine headaches.
- See our essential vision wellness tips for this eye condition.
- Stress. Manage stress - meditate, take cool walks in the morning, do yoga ... whatever works well for you.
- Computer. Avoid long hours on the computer and take frequent breaks.
- Exercise regularly, at least 3x weekly. Exercise reduces the amount of pain from migraines although it does not directly stop migraines by itself.
- Pay attention to what you eat in the event that the ocular migraines are tied to an allergy.
- Sleep routine. Wake up at the same time each morning, and get plenty of sleep at night
- Finally, acupuncture is worth considering.
- Migraine headaches. While migraine headaches are often confused with ocular migraines, and the causes are similar, the migraine headache involves pain on one side of the head sometimes with nausea and does not typically include visual ocular migraine symptoms. Conversely, an ocular migraine may sometimes include a migraine headache.
1. Jehn A, Dettwiler B, Fleischhauer J, Sturzenegger, M., Mojon, D.S. (2002). Exercise-induced vasospastic amaurosis fugax. Arch Ophthalmol, 2002;120:220–2.
2. Yorns, W.R. (2013). Mitochondrial Dysfunction in Migraine. Sci Dir, 20(3):188-193.
3. Jehn A, Dettwiler B, Fleischhauer J, Sturzenegger, M., Mojon, D.S. (2002). Exercise-induced vasospastic amaurosis fugax. Arch Ophthalmol, 2002;120:220–2.