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Visual Migraine

A visual migraine is a temporary visual distortion that often begins with a small sparkling, shimmering area that slowly expands outward. The growing spot often has jagged, zig-zag edges. The visual symptoms typically last approximately 20-30 minutes and then completely resolve. The area where vision is disrupted is known as a ‘scotoma’ and the whole episode is often referred to as an ‘aura.’

In a typical migraine, a throbbing headache quickly follows the visual symptoms. The headache lasts several hours and is accompanied by nausea and sensitivity to light and sound. The intensity of the headache may range from mild to severe.

What are the ‘red flags’ that my visual symptoms are not due to migraine?

The typical symptoms of a visual migraine are “positive,” meaning that there is something shimmering or sparkling that is disrupting the vision. Migraines are less likely to cause “negative” symptoms of pure visual darkness. An episode of visual darkness typically requires additional evaluation for other conditions, including a “mini-stroke” (a TIA, or transient ischemic attack).

Can I have a visual migraine without a headache?

Definitely. It is actually very common to have a visual migraine without any headache. The medical term for this is “acephalgic migraine,” which literally means migraine symptoms without headache. Except for the absence of a headache, the visual symptoms in acephalgic migraine are identical to the episodes that accompany a classic migraine aura.

What causes a migraine?

Although migraines are extremely common, their exact cause remains unknown. It appears likely that the visual aura relates to a phenomenon called “cortical spreading depression” which temporarily affects electrical impulses in the brain. The pain of a migraine headache probably relates to spasm or irritability of blood vessels in the brain, which are sensitive to pain (unlike the brain tissue itself, which does not have pain receptors). Beyond these hypotheses, however, the exact mechanism that triggers a migraine remains unknown.

It is often possible to identify certain risk factors that increase the chance of having migraines. A positive family history is very common, so the doctor will often ask about headaches in one’s parents or siblings. Overall, migraines are more common in women than in men. In addition, a person’s hormonal status can affect the pattern of migraines they experience; therefore, it is natural for a woman to notice a change in headaches and other migraine symptoms in adolescence or around the time of menopause.

Many individuals can identify specific triggers for their migraines. These triggers include fatigue, skipping a meal, caffeine withdrawal, stress, and certain foods (including red wine, chocolate, or aged cheese). For many patients with isolated visual migraines, however, the events can be very infrequent and no definite trigger can be determined.

What are the acute treatments for migraine?

An isolated visual migraine, without headache, typically does not require any acute treatment, since the visual symptoms resolve on their own fairly quickly. The first few times someone experiences a visual migraine it usually causes a lot of anxiety. Once someone has become familiar with the symptoms of a visual migraine, new episodes no longer cause the same level of anxiety.

It can be helpful to try to rest during the episode. Some patients benefit from other strategies, including eating something, having caffeine, or taking an over-the-counter medication such as acetaminophen (Tylenol®) or ibuprofen (i.e., Advil® or Motrin®).

Patients in whom the visual symptoms are accompanied by a severe headache often benefit from additional therapies. The goal of these medications is to try to cut short (or “abort”) the headache before it becomes too severe. Some patients find naproxen (i.e., Aleve®), which is a stronger anti-inflammatory medication, to be helpful. Other patients try a class of medications known as “triptans.”

Triptans are specially designed to work on receptors on blood vessels and brain cells in order to halt a migraine at an early stage. Although there are a number of different triptans, made by several different pharmaceutical companies, each of these is approximately equally effective. Triptans are often taken orally, but also come as injections and nasal sprays. These medicines are generally not considered safe in patients with a history of strokes, heart attacks, or other vascular diseases.

What are the preventive treatments for migraine?

Many patients with isolated visual migraines, without severe headaches, have relatively infrequent episodes that do not require specific preventive treatments. If a patient is aware of the particular triggers that seem to bring on an episode, then those triggers can be avoided.

In patients where the pattern of migraines includes frequent, severe headaches, it is very reasonable to consider additional preventive treatments. The main goal for any of these strategies is to reduce the overall frequency and severity of the headaches. None of the preventive treatments is a “magic bullet” that is 100% effective. For example, it would be considered successful if a preventive treatment helped reduce the number of severe headaches from 8 per month to 2-4 per month.

There are numerous medications that can be used as a preventive treatment for migraine. One medication that is used commonly, particularly because it has no side effects, is vitamin B2 (riboflavin). Approximately 100mg of riboflavin daily is thought to improve migraine headaches (higher doses have been studied in trials but it isn’t clear that the body actually absorbs those high doses). One common side effect of riboflavin is that the urine turns bright yellow. Other herbal medications used to reduce migraine headaches include petasites (butterbur) and feverfew.

The other medications used as preventive treatments frequently cause side effects, but starting with a low dose and then increasing very slowly is usually a helpful strategy. Some commonly tried medications include amitryptiline, gabapentin, and topiramate. Less commonly, medications such as propranolol or valproic acid are used. For some patients, botulinum injections (in the forehead and scalp) can help reduce headaches.

How can I treat migraines without using medicines?

It is very important to remember that many of the most effective preventive treatments for migraines do not require any medications. Frequent aerobic exercise is an excellent example of an effective way to improve headaches. Other strategies may include better sleep habits, stress reduction, massage, yoga, and acupuncture.

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Where can I find more information about migraines?

Consider the following sources

  • National Institutes of Health
  • National Headache Foundation
  • North American Neuro-Ophthalmology Society

Ocular Migraines and Stroke

Henry Hoffman
Thursday, September 27th, 2018

Today, migraines are considered “the most common neurological disorder” according to the Journal of Stroke, and, in the United States alone, about 30 million people suffer from these debilitating headaches. Research has determined that all migraineurs are at a higher risk of suffering a stroke, and this risk factor is potentially doubled or tripled for individuals who suffer from migraines with visual disturbances collectively known as “aura.”

Unfortunately, migraines with aura exhibit similar symptoms to those associated with certain life-threatening conditions, namely transient ischemic attacks (TIAs) and strokes. For this reason, many migraineurs may mistake early stroke warning signs for classic migraine symptoms. Telling the difference and recognizing a medical emergency for what it is can be difficult, but isn’t impossible.

What Is a Migraine? What Is an Ocular Migraine?

Migraines currently affect up to 15 percent of adults. However, there are many types of migraines, each with a specific set of symptoms and risk factors. Migraines are typically defined as recurring episodes of throbbing or pulsing headaches “lasting four to seventy-two hours, typically starting on one side of the head,” according to the Digital Journal of Ophthalmology. Normally, these symptoms are exacerbated by rigorous activity and may also include nausea, photophobia (sensitivity to light), osmophobia (sensitivity to odors), and hyposmia (lost or impaired sense of smell).

An ocular migraine is a migraine that involves a visual disturbance. When experiencing an ocular migraine, or a migraine with an aura, an individual will see flashing or shimmering lights, lines, stars, or, in some cases, blind spots. These visual disturbances can even include partial or total temporary blindness in the affected eye. Many individuals experiencing ocular migraines report seeing lines or a zigzagging pattern during the episode. Aura occurs in fewer than 20 percent of all migraines, according to the American Heart Association, but some notice these visual phenomena prior to the onset of the headache itself. Those who experience migraines with aura, often have a history of at least one conventional type of migraine, as well. An ocular migraine will typically only last about 30 minutes, with the aura affecting only one eye at a time. Unfortunately, migraines are often debilitating, and the general underlying cause is not fully understood. Nonetheless, understanding common triggers can help minimize the risk of developing a migraine.

What Can Trigger a Migraine?

For many migraine sufferers, symptoms are often “triggered” by various stimuli or situations. These triggers can vary among migraineurs, but there are many common culprits.

Women between the ages of 20 and 45 are the demographic most likely to suffer from migraines, and women overall are three times more likely to experience migraine headaches than men. This discrepancy between the sexes was once erroneously attributed to a perceived inability of women to cope with stress. Interestingly enough, in youth, boys are actually more likely to experience migraines than young girls. However, per the Nashville Neuroscience Group, once menstruation begins, the fluctuation of hormones in women causes a substantial increase in migraines. Stress can also play a substantial part in triggering symptoms; in a recent study, nearly 60 percent of participants listed stress as a precipitating influence.

Other common migraine triggers are diet-related and may be avoided by employing restrictions. Migraines are routinely reported to be triggered by dairy, alcohol, chocolate, citrus fruits, and nuts, as well as by fasting. Certain types of odors (namely cigarette smoke, cleaning agents, and perfumes) may trigger migraines for some sufferers. Meteorological triggers related to low temperature, relative humidity, and atmospheric pressure are also important to note, although these stimuli are less frequently reported as triggers than the aforementioned factors.

Clinical evidence also links higher levels of daily light exposure with higher migraine frequency. However, while many people specifically report a fluorescent lighting as a migraine trigger, there remains no clinical evidence to support a direct relationship. Dr. Andrew Hershey, director of the Cincinnati Children’s Headache Center, proposes this explanation: “Although many people are convinced fluorescent lights are the specific trigger, it may be that light, in general, is the problem, and fluorescent lights just happen to be the type of lighting to which they are most often exposed in classrooms or the workplace.”

While migraines and their onset symptoms are quite common, what feels like an ordinary (albeit uncomfortable) migraine headache accompanied by an aura could be a warning sign of a much more dire, life-threatening situation, such as a stroke.

What Is the Connection Between Ocular Migraines and Stroke?

Ischemic strokes, or strokes caused by a blockage to the brain, account for the majority of all stroke cases in the United States today—nearly 87 percent, in fact—and individuals suffering from migraines with aura are “2.4 times more likely to have an ischemic stroke” than those who have migraines without aura, according to the American Heart Association. Recent studies have identified a direct correlation between migraines and the eventual development of certain cardiovascular diseases, especially among women. Although the exact underlying cause is not fully understood, one thing remains very clear: individuals experiencing migraines with aura have a greater risk of stroke than individuals who do not.

Souvik Sen, M.D., M.P.H., study author and neurologist at the University of South Carolina School of Medicine has said, “Since migraines alter the blood vessels in the brain, the greater incidence of strokes caused by blood clots in the heart or the brain’s blood vessels suggests that migraine also affects blood vessels in the heart and neck. That’s what possibly leads to these specific subtypes of stroke.”

Experts are now advising individuals suffering from ocular migraines (as well as migraines without aura) to be vigilant about their symptoms, as typical migraine symptoms could signify something much more serious.

How to Tell If You’re Experiencing a Migraine or a Stroke

If you routinely experience migraines with or without aura, it’s paramount to understand the signs and symptoms of a potential stroke. As previously mentioned, many symptoms are identical across migraines, strokes, and transient ischemic attacks (TIAs). These shared symptoms include, but are not limited to, visual changes and disturbances, muscle fatigue, and impaired speech.

Before we dive into the key differences between migraines and strokes, let’s first define “positive” and “negative” symptoms. A positive symptom is the addition of a symptom, as a result of excess electrical discharges in your central nervous system (CNS). Positive symptoms include visual disturbances such as flashing lights, and motor disturbances such as muscle spasms. Conversely, negative symptoms are caused by a loss of CNS function and manifest as a negation of normal functionality. Typical negative symptoms include tunnel vision, hearing loss, and loss of motor control or numbness.

This distinction is important to functionally understand, because strokes normally produce negative symptoms, whereas migraines with aura normally produce positive symptoms. For example, common stroke side effects include numbness in the face or along one side of the body, trouble speaking, loss of balance, and blurred vision, according to the CDC. A migraine with aura, on the other hand, may cause the migraineur to see flashes of light, a visual zigzagging pattern, blinking lights, and dots.

Furthermore, in the case of a TIA, the onset of symptoms is usually abrupt (occurring over a matter of minutes), while a migraine with aura normally becomes progressively more noticeable “over minutes to tens of minutes.” Similarly, the duration of your positive or negative symptoms may offer a pertinent warning. For example, a migraine with aura will typically last between 10 and 30 minutes, but may continue for several hours. TIAs, on the other hand, “nearly always last less than one ,” according to Practical Neurology.

While avoiding migraine triggers is a worthy preventative effort, it simply isn’t possible to avoid every single migraine trigger in daily life. Thankfully, there are many ways to manage your symptoms once a migraine begins to develop.

Strategies for Coping with Migraines

As anyone who has ever experienced a migraine knows all too well, once that initial wave hits, the migraine symptoms will only progress over the following minutes and hours, if not days. Fortunately, there are many strategies available to help patients cope with these debilitating episodes.

Stress is one of the main causes of many migraines, therefore, attempts to minimize stress and general anxiety are sound initial steps for many individuals. However, relaxation can mean very different things to different individuals, so each migraineur must devise a relaxation regimen based on his or her preferences. Trigger coping mechanisms might involve measures as basic as taking a nap, reading a book, or soaking in a warm bath.

If these preliminary steps have failed to minimize migraine frequency or offer adequate relief for your migraine symptoms, it may be time to discuss options with your doctor. In fact, many individuals who suffer from migraines are prescribed medication to manage their symptoms. If you are prescribed a migraine medication, you should take your prescribed dose at the first sign of a headache. (It’s important to note that many over-the-counter medications may be used to treat migraine symptoms as well.)

Migraines Can Be Managed With Proper Care and Treatment

In the United States alone, strokes account for nearly 140,000 deaths every single year. If you or a loved one are experiencing a stroke, seek immediate medical attention to prevent long-term damage and disability. According to the CDC, “Patients who arrive at the emergency room within 3 hours of their first symptoms often have less disability 3 months after a stroke than those who received delayed care.”

Understanding your migraines and your specific migraine triggers may help you avoid or at least minimize the occurrence of these disorienting episodes. However, even with the most robust prevention, migraines will still occur for many sufferers. With the inherent elevated stroke risk associated with all migraines (especially those with aura), it’s crucial to know how to recognize the symptomatic discrepancies between the two, and act fast if faced with a potential stroke.

If you or a loved one has experienced a stroke, you know that it can have a significant impact on one’s life. Here at Saebo, we are committed to stroke support and recovery to improve the overall quality of life for all survivors and their families. Saebo offers a wide range of products that combine cutting-edge technology with evidence-based rehabilitation techniques. Our offerings and network of Saebo-trained therapists can help you or a loved one to obtain all the necessary tools to maximize stroke recovery.

All content provided on this blog is for informational purposes only and is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. If you think you may have a medical emergency, call your doctor or 911 immediately. Reliance on any information provided by the Saebo website is solely at your own risk.

Ask any person with migraines what it’s like to have this health condition, and you’ll likely hear a slew of words that drill down to one thing: excruciating pain. But you might also get a few responses that, surprisingly enough, have nothing to do with head pain at all. Not all migraines come with discomfort. Instead, you could have an ocular migraine that messes with your vision but may not involve excruciating head pain.

An ocular migraine is basically when you experience the aura that can come with migraines, but not necessarily the achiness most people envision when they think of migraines, neurologist Andrew Charles, M.D., director of the UCLA Goldberg Migraine Program, tells SELF. Apparently, migraines contain multitudes.

Ocular migraines can make you see things that aren’t there, and they can also cause a temporary loss of vision. Either way, they can make it difficult to live your life as usual.

So, let’s talk aura, those sensory changes that can accompany migraines (but don’t always). Aura most often manifest as visual disturbances like seeing flashes of light, zigzagging patterns, blind spots, or shimmering spots or stars, the Mayo Clinic says, and can last for up to an hour. It’s also possible to experience other kinds of aura, like hearing music or feeling like someone is touching you, but an ocular migraine only involves the eye effects and can make it hard to do things like read and drive.

Ocular migraines are a type of silent migraine, which is a catch-all description experts sometimes use for migraines that don’t necessarily cause pain. While an ocular migraine is one form of silent migraine, these terms aren’t interchangeable, Ilan Danan, M.D., M.Sc., a neurologist at the Center for Sports Neurology and Pain Medicine at Cedars-Sinai Kerlan-Jobe Institute in Los Angeles, tells SELF. (For example, if you have other sensory disturbances like hearing music but don’t have head pain, that counts as a silent migraine but not an ocular one.)

Even if you think you’ve never heard of ocular migraines before, you might have, because there are a few different ways to refer to this health condition. Doctors often call them migraine aura without headache, Dr. Charles says. You could also use the term acephalgic migraines (cephalgia means head pain, so acephalgic is the lack of it).

As if migraine lingo isn’t confusing enough, sometimes people use the term ocular migraine to refer to what doctors call a retinal migraine. Retinal migraines happen when a person experiences short periods of reduced vision or blindness, often before or with head pain, according to the Mayo Clinic. However, a retinal migraine usually only affects one eye while ocular migraines typically impact both.

The mechanism behind ocular migraines isn’t 100 percent understood, but experts have their theories.

The cause of ocular migraines is “complicated and often debated,” Ann Morrison, O.D., a clinical instructor at the Ohio State University College of Optometry, tells SELF.

One potential factor is misfiring electrical activity in your brain. “An electrical impulse causes abnormal electrical activity that spreads over the surface of the brain, triggering the migraine,” Dr. Danan says. The thinking is that if that wave of abnormal activity travels across your visual cortex, the part of your brain that processes visual signals, you can wind up with an ocular migraine, according to the Mayo Clinic.

It’s still not clear why people with ocular migraines can have the good fortune of missing out on the head pain while still experiencing vision changes. Some people only have an ocular migraine and then are able to go about their lives. But for others, that aura can be a sign that pain is on its way, with the potential of lasting up to 72 extremely uncomfortable hours.

Ocular and visual migraines: What’s the difference?

Conditions

By Gary Heiting, OD

An ocular migraine is a rare condition characterized by temporary vision loss or even temporary blindness in one eye. Ocular migraines are caused by reduced blood flow or spasms of blood vessels in the retina or behind the eye.

In an ocular migraine, vision in the affected eye generally returns to normal within an hour. Ocular migraines can be painless or they can occur along with (or following) a migraine headache.

Unfortunately, the term “ocular migraine” is often used to describe a much more common (and harmless) condition — called a visual migraine or migraine aura — characterized by temporary visual disturbances that generally disappear within 30 minutes.

Unlike ocular migraines, a visual migraine typically affects both eyes.

Now let’s take a closer look at ocular migraines and visual migraines:

Ocular migraine and visual migraine symptoms

Ocular migraine symptoms generally include a small blind spot that affects your central vision in one eye. This blind spot gets larger, making it impossible for you to drive safely or read with the affected eye.

In some cases, the entire visual field of one eye may be affected. Generally, the episode lasts less than an hour.

Visual migraine symptoms can vary, and may include:

Visual migraines often appear suddenly and may create the sensation of looking through a cracked window. The visual migraine aura usually moves across your field of view and disappears within 30 minutes.

  1. A flickering blind spot in the center or near the center of your field of view
  2. A wavy or zigzag ring of colored light surrounding a central blind spot
  3. A blind spot that slowly migrates across your visual field

The symptoms of a visual migraine typically affect both eyes and last 30 minutes or less. A migraine headache may occur shortly after the symptoms of a visual migraine subside or no headache may occur.

If you’re experiencing a blind spot or other visual disturbance and you’re not sure if it’s an ocular migraine or a visual migraine, then cover one eye at a time. If the visual disturbance is occurring in just one eye, it’s likely that it’s an ocular migraine. If it affects both eyes, it’s probably a visual migraine.

But don’t take chances. If you suddenly experience any sort of blind spot in your field of vision, call or consult an eye doctor immediately to determine if it’s harmless or possibly a sign of something more serious, such as a retinal detachment.

What causes ocular and visual migraines?

Ocular migraines are believed to have the same causes as migraine headaches.

Migraine headaches have a genetic basis, and some studies say that up to 70 percent of people who suffer from the disorder have a family history of migraine headaches.

According to the World Health Organization, migraine headaches appear to be triggered by activation of a mechanism deep in the brain, which releases inflammatory substances around nerves and blood vessels in the head and brain.

Imaging studies have revealed changes in blood flow to the brain during ocular migraines and migraine auras. But why this happens and what brings about the spontaneous resolution of ocular migraines and visual migraines remain unknown.

Common migraine “triggers” that can cause a person to have a migraine attack (including ocular and visual migraines) include certain foods, such as aged cheeses, caffeinated drinks, red wine, smoked meats, and chocolate.

Food additives, such as monosodium glutamate (MSG), and artificial sweeteners also can trigger migraines in some people.

Other potential migraine triggers include cigarette smoke, perfumes and other strong odors, glaring or flickering lights, lack of sleep and emotional stress.

Treatment and prevention

As already noted, visual disturbances caused by ocular migraines and visual migraines typically disappear within an hour or less without treatment.

If you are performing tasks that require clear vision, when an ocular migraine or visual migraine occurs, stop what you are doing and relax until your vision returns to normal.

If you’re driving, park on the side of the road and wait for the vision disturbances to completely pass.

If you experience visual disturbances that are accompanied by a migraine headache, see your family physician or a neurologist for evaluation of your migraine episodes.

Your doctor can advise you on the latest medicines for treating migraines, including medicines designed to prevent future attacks.

It’s also a good idea to keep a journal of your diet and activities just prior to your ocular migraine or migraine aura episodes to see if you can identify possible triggers that you can avoid in the future.

If your ocular migraines or migraine auras (visual migraines) appear to be stress-related, you might be able to reduce the frequency of your migraine attacks without medicine by simply:

  • Eating healthful meals on a regular basis
  • Avoiding common migraine triggers
  • Getting plenty of sleep
  • Trying stress-busters such as yoga and massage

EXPERIENCING VISUAL DISTURBANCES? Don’t take chances. Find an eye doctor near you to discover what’s causing the visual disturbances.

Page updated December 2018

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Gary Heiting, OD

Gary Heiting, OD, is a former senior editor of AllAboutVision.com. Dr. Heiting has more than 30 years of experience as an eye care provider, health educator and consultant to the eyewear … read more

A Clear View of Ocular Migraines

  • Headaches
  • Heads Up

Women. Wisdom. Wellness. Mar 16, 2018

The visual cues are hard to ignore: shimmering or flashing lights, zigzagging lines or stars, black spots. All make it difficult to read, write or drive. If you experience these symptoms, you’re most likely having an ocular migraine. It can occur with or without the pain of a migraine headache.

For people prone to migraines, one of every five has this visual “aura” before the headache pain begins. An ocular migraine by itself lasts anywhere from 10 minutes to an hour and isn’t considered a serious condition.

Although some doctors think ocular migraines are caused by the same factors that create classic migraines, no one knows for certain. Ocular migraines seem to run in families. They have been linked to estrogen, a female hormone that fluctuates during menstruation, pregnancy and menopause, or with use of oral contraceptives or hormone replacement therapies.

Most ocular and retinal migraines don’t require treatment.

Ocular Migraine vs. Retinal Migraine

People may use the terms ocular migraine and retinal migraine to mean the same thing, but there are some important differences. An ocular migraine generally occurs in both eyes. A retinal migraine is rare and tends to occur in just one eye, when vessels that supply the eye with blood narrow. It usually lasts about 10 to 20 minutes and sometimes up to an hour. Symptoms are similar to ocular migraine and may also include complete, temporary vision loss in one eye.

Once the retinal migraine passes, blood vessels open back up and your vision returns to normal. It’s a good idea to have retinal migraines checked out by a doctor to make sure symptoms are not signaling a more serious problem.

What Are Migraine Triggers?

A number of factors can trigger a migraine, whether it’s ocular, retinal or classic migraine. The reasons can vary from person to person. If you have ocular migraines, pay attention to these possible triggers:

  • Stress and anxiety
  • Relaxation after a stressful time
  • Loud sounds or bright lights
  • Strong odors
  • Changes in weather

Retinal migraines are more likely to be triggered by other factors: intense exercise, dehydration, low blood sugar, high blood pressure, hot temperatures and tobacco use.

Certain foods can trigger both types of visual migraines:

  • Red wine or other alcohol
  • Food and drink with caffeine (also, caffeine withdrawal)
  • Hot dogs, sausage and other processed meats that contain nitrates
  • Chips, fast foods, broths and other products with the flavor enhancer monosodium glutamate (MSG)
  • Artificial sweeteners
  • Food with the naturally occurring compound tyramine, including smoked fish, cured meats and some soy products

What Are Migraine Treatments?

Most ocular and retinal migraines don’t require treatment. They will go away on their own. It helps to rest and avoid triggers such as loud noises or bright lights.

If ocular or retinal migraines occur frequently, your eye doctor may suggest medications, including those used to treat other forms of migraines. Beta blockers, antidepressants and anticonvulsants sometimes are helpful, although more research is needed to determine the most effective treatments.

Source: Healthline, National Headache Foundation

What causes ocular migraines?

They’re thought to originate in a similar way as migraine headaches, by irregular electrical activity in the brain. Genetics play a role in who experiences migraines, and they’re also more common in women. Potential triggers include certain MSG-containing foods, harsh light, stress and changes in weather.

Although the root cause is the same, it is not known why some people experience migraine pain after visual disturbances and others don’t – or why the same person might experience both on different occasions.

“It is quite common that as women get older, they might have fewer headaches and less pain but more of these auras,” Dr. Estemalik says.

What they mean

While ocular migraines themselves aren’t harmful, Dr. Estemalik cautions that other medical conditions can cause vision disturbances, so if anyone experiences this as a new symptom, they should get it checked out by their doctor.

“It can be quite concerning,” he says. “A patient may think something is wrong with their eye, or if it’s an elderly patient, they might worry they are having a stroke.”

If potential eye and heart problems are ruled out, people can think about ocular migraines as a temporary inconvenience.

“Over-the-counter magnesium tends to help ocular migraines and auras in general,” Dr. Estemalik says. “There are other drugs we can prescribe, but this is one simple strategy that can help.”

Guide to Ocular Migraines (Visual Headaches): Treatment & More

Table of Contents

  • Ocular Migraines Explained
  • Recognizing an Ocular Migraine
  • What to Do
  • Treatments and Prevention

Impacting between 15 and 20 percent of the adult population, the Journal of Stroke reports that a migraine is the most frequently encountered neurological disorder. The U.S. National Library of Medicine (NLM) publishes that a migraine is a form of headache that is recurring. It can cause pain in the head, nausea, sensitivity to light and sound, and weakness.

An ocular migraine, or a visual headache, is when visual disturbances accompany a migraine. (Learn More) Flashes of light, blind spots, zigzag patterns, shimmering stars, and spots are common symptoms of an ocular migraine. It may be triggered by hormones, stress, nutrition, environmental, or genetic causes. (Learn More)

Generally, an ocular migraine is not a serious medical condition. It can usually be managed with calming techniques, resting, and some lifestyle changes. (Learn More)

An ocular migraine may be more serious and require medical attention in some cases. Medications, natural remedies, and over-the-counter products may all be useful in treating and preventing an ocular migraine. (Learn More)

Ocular Migraines Explained

Mayo Clinic publishes that “ocular migraine” may be a term that is used to describe two different conditions: a migraine aura or a retinal migraine. A migraine aura is a form of visual headache that is identified by changes in vision in tandem with a headache. This is not generally thought of as a serious medical condition.

A retinal migraine is rarer and significant. It may occur with a headache or before one, and it includes short bursts of blindness or impaired vision. It typically only affects one eye.

Migraine aura is a more common form of an ocular migraine. It is caused by chemical changes in the visual cortex of the brain, Mayo Clinic explains. This electrical wave flows through the part of the brain that processes visual signals (the visual cortex) and activates the region, which in turn impairs normal visual functions. The aura may move and grow as it progresses and typically lasts between 10 and 30 minutes on average.

The American Migraine Foundation reports that about a quarter to a third of all people who struggle with migraines suffer from visual aura symptoms. An ocular migraine can also be called an ophthalmic migraine, or an eye-related migraine, that has visual symptoms and may also come with a headache. A migraine is not just a headache, however. It often involves a debilitating throbbing or pounding in the head.

Recognizing an Ocular Migraine

A migraine aura can often begin before the actual headache or head pain sets in; however, it can occur at the same time as well. An ocular migraine typically impacts both eyes simultaneously, though it can affect only one eye and not the other.

Symptoms of a migraine aura can be both positive or negative in nature. Positive symptoms include things that you can see, whereas negative symptoms involve missing portions of vision. For example, positive symptoms of an ocular migraine include zigzagging lines that may seem to shimmer and be either colorful or black and silver and move across your field of vision. Flashbulbs, spots, stars, and shimmering spots are signs of a migraine aura. Negative symptoms include tunnel vision, blind spots, or loss of vision in one or both eyes.

Other signs of an ocular migraine, or migraine aura, can include changes or loss of color vision, blurred vision, a kaleidoscope-like fracturing of images, heat waves, distortion in objects (making them seem closer, further away, or bigger or smaller than they really are), or an appearance of seeing things as if one were looking through water. Numbness or tingling in the hands or feet, nausea, dizziness, sensitivity to light and sound, weakness, and head pain are additional possible effects of an ocular migraine.

The National Headache Foundation publishes that visual auras typically precede an actual headache or migraine by about 20 minutes to an hour, although the symptoms can persist with the headache itself. Visual impairments that accompany an ocular migraine can make it difficult to function normally and do things like drive safely or read.

The American Migraine Foundation reports that migraines are highly heritable and have a significant genetic link. You are between two to three times more likely to suffer from migraines if one of your parents does. Ocular migraines can also be linked to and potentially triggered by stress, anxiety, bright and harsh lights, loud noises, electronic screen time, not enough or too much sleep, intense smells, too much physical exertion, caffeine or caffeine withdrawal, food additives, medications, tobacco, skipping meals, and changes in the weather or environment.

Women tend to suffer from migraines more often than men do. The Migraine Research Foundation publishes that while only about 6 percent of men generally struggle with migraines, about 18 percent of women battle them. This can be partly due to changing levels of estrogen that can come with menstruation, pregnancy, contraceptive medications, and menopause. Medical conditions, such as anxiety, depression, bipolar disorder, epilepsy, and sleep disorders, can also contribute to the onset of an ocular migraine.

What to Do in the Event of an Ocular Migraine

The American Heart Association publishes that migraine aura and visual disturbances occur about 20 percent of the time in the event of a migraine and can be a possible risk factor for ischemic stroke. Research findings show that if you suffer from migraine with aura, you are more than two times more likely to suffer from a blood clot or mass that clogs the blood vessel and leads to an ischemic stroke.

An ocular migraine can interfere with blood vessels in the brain, which in turn may raise the odds for clots and strokes. For this reason, if you suffer from ocular migraines, you should contact your health care provider to get it checked out and ensure that your risk factors are identified and addressed.

When suffering from an ocular migraine, it is important to take care of yourself. Try to manage the pain and symptoms as best you can. This may include:

  • Moving to a quiet and dark room.
  • Laying down and resting your eyes.
  • Drinking a lot of water.
  • Placing a cool compress on your head.
  • Taking over-the-counter anti-inflammatory or anti-nausea medications.

Try to stay still in a safe place while the visual headache passes. Don’t attempt to read, drive, or do anything else that requires extreme focus, concentration, or visual attention.

Ocular Migraine Treatments and Prevention

Migraines may not always be predictable, but they can be triggered by environmental, emotional, and physical aspects. They can therefore be treated and minimized by paying attention to these things. It can be helpful to keep a journal of your migraines to better understand when they occur in an effort to pinpoint potential triggers.

Birth control pills, medications, nutritional factors, caffeine, and tobacco are known to increase the rate of migraines. It can be beneficial to talk to your health care provider about making changes to your diet and medications as well as cutting out smoking and caffeine to possibly prevent an ocular migraine. Acupuncture, massage, and relaxation techniques can also help to potentially minimize an ocular migraine by alleviating stress and enhancing blood flow. Women may benefit from hormone therapy to control migraines.

Eating healthy and balanced meals, getting enough sleep, exercising regularly, and drinking plenty of water can help. Natural supplements may be useful in preventing an ocular migraine, and these can be discussed with your health care provider.

If you suffer from ocular migraines, it is important to pay attention to your body’s cues and work to keep yourself as balanced as possible to minimize these events. Your doctor can help you come up with a strategy to improve your health as well as the severity and incidence of ocular migraines.

The Migraine-Stroke Connection. (May 2016). Journal of Stroke.

Migraine. (December 2018). U.S. National Library of Medicine.

Ocular Migraine: When to Seek Help. (May 2018). Mayo Clinic.

Video: Migraine Aura. (June 2016). Mayo Clinic.

Visual Disturbances: Related to Migraine or Not? American Migraine Foundation.

Visual Disturbances. (2018). National Headache Foundation.

The Genetics of Migraine. American Migraine Foundation.

Migraine is a Women’s Health Issue. (2019). Migraine Research Foundation.

Migraine With Aura Linked to Clot-Caused Strokes. (February 2016). American Heart Foundation.

Understanding Ocular Migraine

Visual impairments associated with migraine can happen with or without a headache

“Ocular Migraine” is a term that has been used to refer to a number of migraine subtypes that are characterized by a variety of visual disturbances including visual loss, blind spots, zig-zag lines, or seeing stars. Unlike other forms of migraine, they may occur without any accompanying head pain. It’s not uncommon for a single patient to experience a wide range of visual symptoms. Here’s what you need to know to better understand the migraine subtypes that affect vision.

Types of Ocular Migraine

Migraine with Aura

Migraine with Aura impairs vision, with symptoms like flashes of light, blind spots, seeing stars or patterns and other minor sight issues that go away after a short period. While the most noticeable symptoms are visual disruptions, aura can also affect other senses and interfere with speech, motor skills or other central nervous symptoms. Migraine aura can occur with headache or without, and is typically short in duration. When aura symptoms appear in conjunction with head pain, they usually occur between the premonitory phase and the peak pain phase of migraine, between the symptoms that warn of an impending attack and when the head pain itself hits. They may, however, last more than 1 hour in about 20% of individuals and may follow the onset of head pain in some instances. Migraine with Aura occurs in 25-30 percent of people with migraine, and less than 20% of individuals with migraine visual aura have the aura phase with every migraine attack.

Retinal Migraine

Retinal Migraine refers to visual symptoms that occur in only one eye before or during the headache phase of a migraine attack. Retinal Migraine symptoms tend to be more intrusive than aura symptoms, and include decreased vision, the appearance of twinkling lights and temporary blindness. It can be difficult for patients to distinguish between Migraine with Aura and Retinal Migraine, so it’s important to consult a doctor if you think you may be experiencing Retinal Migraine symptoms. Irreversible visual loss may be a complication of Retinal Migraine.

What Causes These Migraine Subtypes with Vision Disturbance?

Migraine aura is considered to be a result of abnormal electrical activity involving certain regions of the cortex (outer surface) of the brain. This abnormal activity spreads across the cortex at a slow rate of about 3mm per minute and this spread is responsible for the growth and movement of the visual disturbance over the 20-60 minutes that the visual aura lasts. Retinal migraine may be due to the same type of disturbance except occurring at the back of the eye in the retina, or it may be due to a reduction in blood flow to the retina.

Like other types of migraine, harsh lights and electronic screens can be triggers. Straining your eyes by staring at a screen for long periods of time, spending time in fluorescent or other harsh lighting, driving long distances and other taxing visual activities can increase your risk for attacks. Talk to your eye doctor about how to avoid attacks.

Treating and Preventing Migraine With Aura or Retinal Migraine

For infrequent attacks, medications that target symptoms can be effective, from NSAIDs for pain to anti-nausea medications. Preventative therapies including calcium channel blockers, antiepileptic or tricyclic medications. Quitting smoking is recommended and cessation of oral contraceptives may be advised in certain circumstances. Some options for relief without drugs can include resting your eyes, removing yourself from bright sunlight or other harsh lighting, and taking a break from looking at a screen. As with all types of migraine, try to avoid triggers like stress, dehydration, high altitude, low blood sugar, excessive heat and extensive time spent staring at a screen.

While the symptoms can be disorienting and distressing, they are often short-lived, and almost always reversible. Take some time away from triggers and wait for the symptoms to fade. For more information, visit the American Migraine Foundation’s resource center, which includes content specifically related to Migraine with Aura, Retinal Migraine and more. The American Migraine Foundation is committed to providing comfort and information to people living with this disease. You are not alone: find your support network today.

Ocular Migraine:  What You Should Know

Many people are surprised to learn that there is more than one type of migraine. Typically, the throbbing, insistent pain that’s characteristic of most migraine events is what comes to mind. However, a relatively small portion of migraine sufferers – about one out of every 200 – will experience visual symptoms without headache. This is known commonly known as an ocular migraine.

An ocular migraine causes vision loss or visual disturbance that lasts less than an hour and typically affects only one eye. It has also been called optical migraine, visual migraine, retinal migraine, ophthalmic migraine, or visual aura; however, the correct name and classification according to the International Headache Society is migraine aura without headache.

At Axon Optics we receive numerous emails and social media queries about ocular migraines. This has raised our awareness that our precision tinted lenses are of interest to a wide reader base and we are committed to providing the most current research findings on a broad spectrum of migraine related disorders, including ocular migraines. This guide is designed to help those suffering from this relatively uncommon condition.

Page Contents

  • 1 What You Should Know About Ocular Migraine
    • 1.1 Migraine Aura Without Headache: The Symptoms
    • 1.2 What Causes Migraines?
    • 1.3 What Causes Visual Aura?
    • 1.4 Who is at Risk?
    • 1.5 Why Do Some People Have Ocular Migraines With No Headache?
    • 1.6 Diagnosing Ocular Migraine
    • 1.7 Do You Have Migraine Aura Without Headache?
    • 1.8 Finding Ocular Migraine Relief

Migraine Aura Without Headache: The Symptoms

Migraine with aura refers to visual symptoms that occur before a headache and other migraine symptoms develop, sometimes up to several hours before onset of a migraine. Aura occurs in about 20 percent of all migraine sufferers, and most of those people go on to develop the throbbing, deep headache that is often associated with the migraine experience.

In individuals who experience ocular migraines, or migraine aura without headache, the visual symptoms still occur, but they are not followed or accompanied by headache. Visual symptoms of an ocular migraine can include the the following:

Appearance of twinkling or shimmering lights;

starbursts or zigzagging lines in your visual field;

areas in the visual field where vision is reduced or completely absent (blind spots);

tunnel vision;

and even complete temporary blindness.

Some patients may also experience additional symptoms of migraine, including nausea, fatigue, confusion and irritability, while others may experience only the visual symptoms.

Retinal migraine is sometimes referred to as an ocular migraine, but they are not the same. While the two conditions do share some symptoms, the nature of the attack itself and how the vision is affected are the most telling ways to distinguish between the two.

Retinal migraine vs ocular migraine:

  • Retinal migraine – Vision disturbance occurs in both eyes which may lead to temporary blindness.
  • Ocular migraine – Vision disturbance occurs in just one eye and may include zig zag lines, blind spots, flashing lights, visual blurring, “seeing stars,” or visual dimming.

There has long been controversy in the medical community about retinal migraine. Some researchers even question it as a valid condition or accurate diagnosis. Ocular migraine, on the other hand, has been widely accepted as a type of migraine. There is evidence, though, that there are two distinct conditions, each with its own symptoms.As you can imagine, when an ocular or ophthalmic migraine occurs, the visual symptoms can be quite worrisome for those who don’t realize the symptoms’ association with migraine. And because ocular migraines don’t receive nearly as much attention in the literature as migraines with painful headaches, many people who experience a visual migraine mistakenly attribute their symptoms to a problem with their vision or even with serious medical events like stroke.

What Causes Migraines?

Not that long ago, researchers believed migraines were related to problems with blood flow in the brain. But more recent advances have led to a much more comprehensive understanding of migraines and the underlying processes that cause them to occur. Now, medical researchers and doctors believe migraines are caused by an interaction between the nerves and the blood vessels in the brain, classifying them as neurovascular events that occur when nerve activity causes changes in the circulation in the brain.

Whether they cause headache or not, migraines are usually triggered, or precipitated, by specific stimuli, including illness, stress, food sensitivities or allergies, sleep problems, exposure to bright lights or loud noises, or consuming caffeine or alcohol.

What Causes Visual Aura?

Most migraines occur in different “phases,” with the aura phase occurring prior to the development of a headache (when headaches occur), nausea and other symptoms. Researchers believe auras develop when the nerves in the brain are first hyper-stimulated and then enter a depressed state of low activity called “cortical spreading depression,” which spreads throughout the top layer (cortex) of the brain. As this wave of activity spreads, it travels through different parts of the brain, including the part responsible for vision. It’s this wave of altered neural activity that researchers believe is responsible for the visual symptoms present during the aura phase, as well as symptoms affecting hearing that may also be present during the aura phase.

Who is at Risk?

There are several factors that can put a person at a higher risk for ocular migraine. They tend to be more prevalent in women than men and typically occur in people who are younger than 40. Other risk factors for ocular migraine include:

  • Genetics – A family history of ocular migraine, migraine, or chronic headache
  • History of Migraine – A personal history of migraine or chronic headache
  • Medical Conditions
    • High blood pressure
    • Hardening of the arteries
    • Epilepsy
    • Lupus
  • Lifestyle factors
    • Smoking
    • High stress
    • Physical exertion (overheating, dehydration, etc.)
    • Oral contraceptives

Why Do Some People Have Ocular Migraines With No Headache?

The reason why some migraine sufferers may experience visual symptoms without any associated headache either following or before a visual symptom is unknown. What researchers do know is that light plays a role in most migraine events, and that this role can be played out even in patients who are blind. That suggests additional nerve pathways play a role in migraine symptoms, pathways that are not associated with vision. It also underscores the need for further research into migraines to examine the differences that exist between migraine sufferers, including why some patients have a migraine aura without a headache.

The good news is, today’s research has begun focusing on migraine pain and aura as two disparate events, leading to more studies focusing on migraine aura without headache (ocular migraine) to improve physicians’ and patients’ understanding of these events.

No matter what the underlying cause of these relatively unusual “silent” migraines, the symptoms of ocular migraines still can cause an interruption in daily activities as well as concern and stress for the people who suffer from them. Even though there may be no associated pain, migraine aura without headache still requires optimal treatment to reduce the occurrence of the events as well as to reduce the severity or duration of events that do occur.

Diagnosing Ocular Migraine

Historically, getting appropriate and effective treatment for ocular migraines has not been an easy task, due in part to some issues that arise in diagnosing the condition. Just as most patients associate migraines with headache, many healthcare practitioners also have a low level of awareness of the symptoms of migraine aura without headache. In the absence of headache symptoms, some healthcare practitioners seek other possible causes, including ocular problems and even chronic stress, resulting in delayed care for many sufferers.

The generally accepted diagnostic criteria for ocular migraine is as follows:

  1. At least 2 attacks that meet criteria B through D.
  2. Aura consisting of at least one of the following, with or without speech disturbances but no motor weakness.
    1. Fully reversible visual symptoms including positive features (eg. flickering lights, spots, or lines) and/or negative features (ie. loss of vision).
    2. Fully reversible sensory symptoms including positive features (ie. pins and needles) and/or negative features (ie. numbness).
  3. At least two of the following:
    1. Homonymous visual symptoms and/or unilateral sensory symptoms.
    2. At least one aura develops gradually over > 5 minutes and/or different aura symptoms occur in succession over > 5 minutes.
    3. Each symptom lasts > 5 minutes or < 60 minutes.
  4. Headache does not occur during aura nor following aura within 60 minutes.
  5. Not attributed to another disorder.

Even when a correct diagnosis of ocular migraine is made early on, treatment options are often limited.

Do You Have Migraine Aura Without Headache?

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Finding Ocular Migraine Relief

There are several medications on the market that have been developed to aid in the treatment of migraine symptoms, as well as to potentially prevent migraines from occurring or reduce the severity of migraines when they do occur. Many of these are used to treat ocular migraine as well. However, finding the right combination of medications has proven problematic, and for some people, medications are ineffective, and long-term use may cause side effects including rebound headaches.

More recently, studies have focused on the effects of light as a migraine trigger, using special lenses to mitigate the light that enters the eye, filtering out the wavelengths that have been identified with an increase in migraine symptoms and activity. Studies dating back to the mid-1980s have demonstrated that lenses with a type of tinting have proven very effective in reducing the occurrence of migraines and limiting the symptoms and duration of migraines when they occur.

Axon Optics is a leading provider of these lenses thanks in part to the rigorous quality control standards it implements. If you have migraine aura with or without headache, Axon Optics’ migraine glasses could be just what the doctor ordered for helping you reduce your symptoms. To learn more about Axon Optics, explore our website, like us on Facebook or ask your eye doctor if Axon Optics’ therapeutic lenses are right for you.

Resources: This article is based on academic articles and interviews.

Expand References & Resources

The Difference Between Migraines with Aura and Ocular Migraines

There’s nothing like it–the excruciating, throbbing pain in your head that can only be a migraine. If you suffer from migraines, you may have noticed some visual disturbances in addition to your headache. Most likely what you have experienced is a migraine with aura accounting for approximately 20% of all migraines. There is also another less common type of migraine with visual disturbance called an ocular migraine affecting only about one out of every 200 people who have migraines. These two types of headaches are very similar making it very confusing to tell which is which. Read on to learn the distinctions between the two.

What are the symptoms?

The symptoms of the two conditions are almost the same except for a few telltale signs. The main difference is a migraine with aura will affect both eyes while an ocular migraine affects only one. Both have visual disturbances such as:

  • Flashes of light
  • Zigzagging patterns
  • Blind sponts
  • Shimmering, colored, or flickering lights
  • Floating lines

The visual disturbances tend to go away before the headache begins for the migraine with aura but can last longer for the ocular headache. Also, the headache, which can also be accompanied by symptoms of nausea and severe light sensitivity, tends to be right behind the affected eye of an ocular migraine but can be more spread out for a migraine with aura.

What are the causes?

The underlying cause for migraines of all kinds have not been definitively established. Many researchers believe the symptoms are caused by a reduction in blood-flow to the brain which is possibly caused by a spasm in the blood vessels. The source of the visual disturbances is different for the two types of headaches. In migraine with aura, the occipital cortex of the brain located at the base of the skull is the source. For ocular migraines, the retina, or specifically the retinal blood vessels, is the source. Because the source of the problem for a migraine with aura is the brain, not the eyes, you would still be able to see the disturbance if you cover your eyes. Not so with an ocular migraine.

What to do about them?

The first thing to do about both kinds of migraines is to seek medical help, especially if you’re experiencing visual problems in just one eye which could mean a different, much more serious medical problem such as stroke or retinal detachment.

There are some known triggers for migraines that if avoided could help keep them from happening: stress, smoking, dehydration, red wine, change in barometric pressure and lack of sleep are just a few. The visual disturbances are temporary and harmless to the eye. However, they can interfere with regular daily activities, so best to take good care of yourself until the symptoms pass and get some medical help to keep them from coming back.

Ocular migraines without headaches

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