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What is an ocular migraine?

When we think of a migraine, we usually associate it with a headache. But migraines can vary in symptoms and triggers. For example, ocular migraines are a subtype that involves visual changes and disturbances. A range of visual changes can develop, which may or may not accompany a headache.

Ocular migraines can vary in frequency and severity. Learning more about how to manage the condition can help you develop treatment and prevention strategies. 

Forms 

Everyone may experience symptoms of ocular migraines differently. There are also a couple of types, including:

Ophthalmic migraine: This is a visual aura that manifests in many different ways and does not have a headache and typically lasts about 20 minutes. It is like a classic migraine which has the aura but does not have the headache afterwards.

Migraine with an aura: This is a common form of migraine. The aura tends to only last a short time and may occur with or without head pain. In many cases, the aura occurs before head pain starts and acts as a warning that a headache is about to start. 

There are four different types of migraine aura that may overlap but generally occur in the following order:

Visual aura,usually begins as either a bright spot or small area of vision loss near the center of vision and expands out to peripheral vision over time

Sensory aura, typically follows the visual aura and begins as a tingling in a limb or on one side of the face that leads to numbness

Language aura, causes temporary speech impairments and difficulty understanding language

Motor aura, the least common among the four auras, characterized by weakening of the limbs, and possibly face, on one side of the body

Visual Disturbances 

Many people associate “migraine” with “headache,” but this complex condition can affect the body in wide-ranging ways, including causing a visual disturbance just before the headache starts. This visual disturbance is often termed “the aura,” though, technically, the migraine “aura” includes any type of neurological symptoms at the onset of migraine, such as tingling of a limb or dizziness.

For up to one-third of people with migraine who experience aura, the most common neurological symptom is a temporary vision disturbance. These disturbances can be classified as “positive” (with symptoms that occur in the visual field), “negative” (with symptoms that cause temporary loss of vision) or “distorted” (with symptoms that alter the vision). Here’s what you need to know about these common migraine visual disturbances that occur just before or during the headache phase.

1. Flashes of Light (Photopsia)

In this type of positive migraine visual disturbance, you may see brief flashes of light in the field of vision of one or both eyes. These flashes often are very rapid and may last for a few minutes to an hour. You can determine if both eyes are affected or not by covering one eye at a time to see if the flashes occur on both sides. If your migraine history does not include photopsia, and it suddenly occurs and does not resolve within an hour or so, you should contact an optometrist or ophtalmologist immediately. Persistent flashes of light can signal a detached retina or a problem with the eye’s vitreous (gel) humor.

2. Jagged Lines (Teichopsia or Fortification Spectra)

If your visual aura consists of shimmering zig zag lines, then you are experiencing teichopsia. This is one of the more common types of positive migraine visual disturbances. In teichopsia, a small area of jagged, pulsating lines appears, often at the edge of the peripheral vision of one or both eyes. This area of disturbed vision gradually expands and then recedes, leaving the vision normal again. Teichopsia generally does not occur outside a migraine episode. In fact, teichopsia is considered the “classic” migraine vision disturbance.

3. Vision Loss or Tunnel Vision

These two types of “negative” visual disturbances in migraine are characterized by a temporary loss of vision in one or both eyes. The visual field may become narrower (tunnel vision), or you might lose vision entirely for a brief period of time. As with other types of migraine visual disturbance, these symptoms should clear up within an hour or so. If your vision loss occurs suddenly, does not clear up within about 60 minutes, and is not accompanied by the headache phase of migraine, you should seek medical attention—especially if the vision loss  is accompanied by one-sided weakness or other signs of stroke.

4. Visual Distortion (Metamorphopsia)

Migraine can cause many weird visual distortions. These distortions are called metamorphopsia because they change (morph) the appearance of everything you view. When you are experiencing migraine metamorphopsia, you may feel as if you’re viewing the world through:

  • Cracked glass
  • Heatwaves
  • Kaleidoscope
  • Petroleum jelly smeared over a lens

In metamorphopsia, you can temporarily lose your color vision or be unable to accurately perceive how close or distant objects are. Small objects may look very large, or large objects may appear smaller than they really are. Like other types of migraine visual disturbances, metamorphopsia should clear up within an hour or so.

Causes

The exact cause of migraines, including ocular migraines, is not entirely clear, but it appears to involve a change in the chemicals in the brain or abnormal electrical activity in certain parts of the brain. Why some people develop visual symptoms and others don’t is not understood.

In general, certain risk factors have been identified for increasing your chances of having migraines and include:

  • Having a family history of migraines
  • Fluctuating hormone levels, such as with pregnancy and menopause
  • Lack of sleep
  • Dehydration
  • Allergies


In addition, certain things may trigger migraines in some people. If you are prone to migraines, possible triggers, especially for ocular migraines, include:

  • Driving long distances
  • Spending time under fluorescent lights
  • Excessive screen time 

Treatment 

There is no one size fits all treatment for ocular migraines. Treatment may involve a combination of things to ease migraine pain. There is also no specific treatment to stop visual disturbances that can occur with a migraine. But possible treatments to reduce migraine frequency and severity include:

Identifying triggers: One of the best ways to reduce migraine frequency is to identify triggers. In some cases, such as fluctuating hormone levels, it may be challenging to reduce the risk. But in other instances, reducing triggers may include limiting certain foods or alcohol.

Medication: Different types of medication can help treat migraines. In some cases, it is trial and error to see what works best for you. Possible types of medications include calcium channel blockers, low-dose aspirin, and triptans, which target serotonin receptors.

Hot or cold: Although it does not work for everyone, some people find a decrease in symptoms when applying a hot or cold pack to their head. Applying hot or cold provides a natural way to reduce pain without medication. 

Prevention 

Prevention is always your best bet when it comes to migraines. Consider some general prevention tips: 

  • Get enough sleep
  • Give your eyes a break from screen time
  • Drink plenty of water
  • Avoid too much harsh lighting
  • Wear sunglasses to avoid too much sunlight on the eyes


If you have ocular migraines and have any questions, we are happy to help. Also, consider having regular eye exams to rule out any other causes of visual disturbances.

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