Ocular migraine (retinal migraine): Causes, symptoms, and treatment

An ocular migraine (retinal migraine) is a temporary disturbance of vision, affecting one or both eyes. Episodes of ocular migraines are painless but can be frightening if you don’t know what’s going on. Generally, ocular migraines will resolve on their own in 30 minutes without medication.

An ocular migraine followed by a headache experienced on one side of the head is known as a migraine with aura, and the visual disturbances are then known as the aura, rather than an ocular migraine.

Roughly one in every 200 people who experience migraines will also experience an ocular migraine. To help distinguish between regular migraines and ocular migraines, it’s important that you speak with your doctor.

What causes ocular migraines?

Ocular migraines are believed to share the causes of regular migraines. The World Health Organization believes that migraines have a genetic basis, and some studies have revealed that 70 percent of migraine sufferers have a family history of migraines.

Migraines are triggered deep in the brain, releasing inflammatory substances around the nerve and blood vessels of the brain. Why this occurs is still unclear.
Though the use of imaging studies such as MRI’s, it has been revealed that changes in cerebral blood flow to the brain during ocular migraines and visual auras. But it is still uncertain if this is the cause and not simply an association.

Migraines commonly affect adults in their 30’s and 40’s, but can start in children during the puberty phase. Women are more commonly affected by migraine headaches compared to men. Approximately 15 to 18 percent of women and six percent of men in the United States are estimated to suffer from migraine headaches.

Ocular migraines may also be triggered by changes in blood flow to the brain, as well as cigarette smoke, certain foods, caffeinated beverages, red wine, food additives, and strong odors like perfumes. Other foods include chocolate, smoked meats, and artificial sweeteners. Other potential triggers include glaring or flickering lights, lack of sleep and emotional stress.

Signs and symptoms of ocular migraines

When a person is experiencing an ocular migraine or its onset, they may begin to notice changes in their vision. They may see flashing lights and blind spots, and even experience a temporary loss of vision.

Symptoms can last between four to 72 hours and may only affect one side of the head, feel moderately or very painful, throb or pulsate, and worsen when you move around. Accompanying symptoms include nausea, vomiting, and sensitivity to light.

The International Headache Society (HIS) has defined the symptoms that are typically found during ocular migraines. These symptoms occur in one eye (monocular) and are usually temporary. They include:

• Scintillations: Seeing something that looks like a flash of light, lightning, or a sparkle. This may also be appreciated as halos.
• Scotoma: This is a temporary blind spot, black spot, blurriness, or a partial loss of vision. This usually goes away once the migraine subsides.
• Blindness: Can be partial or complete loss of vision in one eye. This is usually only temporary.
• Migraine headache: Eye symptoms usually are accompanied by a headache that can last from a few hours to a few days. This headache is often located one the same side of the head as the ocular symptoms.
• Other: this may include the addition of light sensitivity, nausea, and vomiting.

Diagnosing ocular migraines

The diagnosis of an ocular migraine is often a clinical one and depend on the presentation of symptoms. If a person fits all the criteria for ocular migraines established by the HIS, a diagnosis can be confidently made.

The diagnostic criteria for the diagnosis of an ocular migraine from the HIS are:

• Two attacks in which the patient experiences the symptoms outlined in points 2 and 3.
• The patient sees flashing lights (scintillations), a blind spot (scotoma), or experiences blindness in one eye. A healthcare professional must be able to confirm these symptoms with an examination or a detailed drawing/description.
• The patient experiences a headache, meeting criteria for a “migraine without aura.” A headache may begin at the same time as the visual symptoms but must begin within an hour after the symptoms start.
• An eye exam performed when there are no ocular or migraine symptoms turns up no evidence of any disease.
• There is no other explanation, such as another disease or disorder, for the symptoms.

Migraines can be difficult diagnose initially, as many other reasons for a headache exists and have to be ruled out first. This ensures that no other more serve condition is causing the migraines, as treating just the headache will not resolve symptoms. The following are underlying conditions that should be ruled out:

• Embolism
• Increased intraocular pressure
• Orbital apex mass
• Giant cell arteritis
• Increased viscosity
• Hemianopia
• Ischemic optic neuropathy
• Carotid dissection

Treatment and prevention of ocular migraines

Ocular migraines are generally harmless, so treatment often is not required as the condition will resolve on its own. If an ocular migraine occurs while you are performing activities like as driving, you should stop and wait until an ocular migraine passes.

If your ocular migraines are a part of a migraine with aura, you will want to speak to your doctor about treatment and prevention of your migraines. This is often done with medications and lifestyle changes.

Some medications that can help relieve symptoms related to ocular migraines include aspirin, beta-blockers, calcium channel blockers, tricyclic antidepressants, and anti-epileptics.

Conceder having a comprehensive eye exam with an optometrist or ophthalmologist. They are experts in vision symptoms and can accurately rule out any other sight-threatening conditions

Reducing stress and avoiding migraine triggers is also recommended. If your ocular migraines appear to be stress related, you may be able to reduce the frequency of your migraine attacks without drugs by simply doing the following:

• Eating well-balanced and healthy meals on a regular basis
• Avoid common migraine triggers, and ones specific to your case
• Get enough sleep
• Try stress-relieving activities such as yoga and massage

When to see a doctor for ocular migraines

You should see a doctor for ocular migraines if your vision suddenly deteriorates. Losing your eyesight suddenly should prompt you to make an emergency appointment with your doctor for immediate medical attention.