Symptoms, Diagnosis, and Treatment of Ocular Migraine

Symptoms, Diagnosis, and Treatment of Ocular Migraine - Amanda Dalbjörn
Symptoms, Diagnosis, and Treatment of Ocular Migraine – Amanda Dalbjörn

While headaches are the most common migraine symptom, visual disturbances can also occur. This may cause you to wonder about “ocular migraine,” which is a popular colloquial term for a specific type of migraine with visual disturbances, but is not a strict medical term with a clear definition. However, there are many ways to experience a migraine, and some are particularly perplexing due to the unwelcome visuals. From symptoms and causes to how to deal with an ocular migraine, here’s everything you need to know.

What exactly is an ocular migraine?

Who knows? The Mayo Clinic1 says “ocular migraine” is a confusing term. According to neurologist Andrew Charles, M.D., director of the UCLA Goldberg Migraine Program, some experts call the visual disturbances (aura) associated with migraine “ocular migraine.” In that case, an ocular migraine is like seeing all the trippy visuals at a concert or music festival, but at the worst times (and without the music). Obviously, you don’t want this to happen unexpectedly.

Ocular migraine refers to a unique experience that some people with migraines have: a migraine with an aura but no pain. This type of migraine is also known as an acephalgic migraine (cephalgia means head pain, so acephalgic is the lack of it). While a migraine without pain may seem insignificant, the visual disturbances that accompany an ocular migraine can seriously impact your life.

Ocular migraine is a type of silent migraine, which is a term experts use to describe migraine attacks that don’t hurt. While an ocular migraine is a type of silent migraine, Ilan Danan, M.D., M.Sc., a neurologist at Cedars-Sinai Kerlan-Jobe Institute in Los Angeles, says the terms aren’t interchangeable. (For example, hearing music but not having headaches is considered a silent migraine but not an ocular migraine.) According to the Mayo Clinic3, a retinal migraine is a rare condition in which a person with a migraine has repeated episodes of reduced vision or even blindness in one eye. It’s important to note that loss of vision in one eye is more common than retinal migraines, so seek medical attention if you’re not sure.

The point is to be as specific as possible when discussing your symptoms with your doctor, because “ocular migraine” can mean different things to different people. In this article, we define ocular migraine as a migraine with visual disturbances but no pain.

What is a migraine ocular?

Aura are those sensory changes that can (but don’t always) accompany migraines. The Mayo Clinic4 says an aura usually manifests as visual disturbances. You may also hear music or feel someone touching you. An ocular migraine only affects the eyes.

While some people get an aura before a migraine headache, an ocular migraine is a visual disturbance without the typical migraine headache pain.

Ocular migraine signs and symptoms

Migraines can cause you to see stars… literally. Squiggles, blind spots, and other visual muddles can make it difficult, if not impossible, to see. As you can imagine, an ocular migraine can completely ruin your day.

According to a review article published in the Journal of Headache and Pain5, these are common visual disturbances associated with a migraine aura:

  • Vision haze
  • Visual zigzags
  • Spots
  • A few bright stars
  • vision distorted by water or oil
  • Blindness
  • Ocular migraine causes

What factors contribute to ocular migraine?

Eye migraines are “complicated and debated,” says Ann Morrison, O.D, clinical instructor at Ohio State University College of Optometry.

Misfiring brain electrical activity is one possible factor. According to Dr. Danan, a migraine is caused by abnormal electrical activity spreading across the brain’s surface. According to the Mayo Clinic6, ocular migraines occur when abnormal brain waves travel across the visual cortex, the part of the brain that processes visual signals.

Notably, the causes of migraines are unknown. New research suggests that migraine is linked to our genetics, which could explain why having a family history of migraine can increase your risk of experiencing it.

Eye migraine triggers

Experts know that the same triggers that cause regular migraine attacks can cause ocular migraines.

According to the NINDS:

  • Stress is a common migraine trigger
  • Hormones
  • Anxiety
  • Lights that flash
  • Insufficient sleep
  • Meal skipping
  • Some foods or drinks (like alcohol, caffeine, or aged cheeses)

Eye migraine treatment

So, how can we restore your normal vision? Ocular migraine treatment is similar to other types of migraine treatment, and there are many options.

The first step is to see a doctor to confirm that you have an ocular migraine and not something else. Because vision changes can be caused by a variety of factors, your provider may advise you to see an eye doctor.

In an eye exam, Dr. Colleen Halfpenny, a cornea surgeon at Wills Eye Hospital, says: Retinal detachment (when the thin, light-sensitive layer of tissue at the back of your eye becomes dislodged) can cause similar symptoms and damage your vision if left untreated, she says.

If you have an ocular migraine, you can either wait it out or ask your doctor about treatment options. To what extent does ocular migraine affect your life? If you only have occasional visual disturbances, you might decide to deal with them as they come. That’s easier said than done. An ocular migraine doesn’t care about your schedule, job, or upcoming exams, so it can strike at any time. If you’re driving, pull over to the side of the road, or call in sick if you’re at work.

Consult your doctor about migraine treatment options if you regularly suffer from ocular migraines. Migraine treatments are usually classified as abortive or preventive.

Abortive therapies include the following:

  • Pain relievers: Nonsteroidal anti-inflammatories like ibuprofen and aspirin may help some people stop a migraine episode, but not for severe or chronic migraines.
  • Triptans are prescription drugs that block the brain’s pain pathways.
  • Dihydroergotamine: This medication works on the brain’s blood vessels to reduce swelling.
  • Lasmiditan is an oral drug that targets serotonin receptors.

Preventive therapies include the following:

  • Blood pressure medications such as beta-blockers, ACE inhibitors, and angiotensin receptor blockers have been shown to reduce migraine frequency.
  • Antidepressants can help migraine sufferers by increasing serotonin and norepinephrine levels in the brain.
  • Anti-seizure medications are common migraine preventives.
  • CGRP antagonists: These are injected medications that work against a specific protein released around the brain (which causes a migraine).
  • Magnesium supplements may help prevent auras.
  • Botox injections: Botox is approved for chronic migraine treatment.

So, yes, finding the right fit may take some time. The best treatments for migraine with aura may not be the best treatments for migraine without aura, according to a 2019 review article8 published in the Journal of Headache and Pain.

As you can see, it’s critical to describe your symptoms in detail to your doctor so they can recommend the best treatment option for you. Your GP may refer you to a neurologist who specializes in migraine diagnosis and treatment.

Ocular migraine prevention

If you’ve ever had an ocular migraine, you’d probably do anything to avoid it. Depending on how frequently you get ocular migraines and how severe they are, your doctor may recommend a preventive treatment or prescribe an abortive treatment.

Dr. Ross advises avoiding your triggers if you know what they are. If you’re not sure what triggers your migraines, start journaling. Keep track of your migraine attacks, your diet, your sleep, your stress levels, and anything else that may be relevant (like your period, your workouts, etc.). This can help you and your doctor figure out what triggers ocular migraine attacks.


Must Read