Ophthalmic migraine
Ophthalmic migraine can cause visual impairment for short periods of time, or even temporary blindness. This problem is caused by decreased blood flow, or spasms of the blood vessels behind the eye and in the retina.
Vision usually returns to normal within an hour. Very rarely, vision problems are permanent.
Medical treatment is not usually necessary, but if episodes are frequent, you should consult an ophthalmologist.
What is ophthalmic migraine?
Today, the term “ophthalmic migraine” is used to describe what is known in specialist terms as “migraine with ophthalmic aura”. Wrongly, “ophthalmic migraine” is also used to refer to “retinal migraine”, when in fact the two health problems are completely different.
- Migraine with ophthalmic aura is often not severe and affects both eyes.
- Retinal migraine is a more severe disorder. Visual impairment occur in only one eye and an emergency examination is mandatory.
Characteristics of migraine with ophthalmic aura
The migraine aura is a wave of activity in the brain. The location of the wave determines the type of aura. The most common type of aura is visual (about 90% of cases).
If the wave of activity were to pass through other areas of the brain, such as the sensory or language centers, then the patient might have sensory auras (e.g. tingling on the tongue, face or arm) or vocabulary auras.
- The effect usually lasts from five minutes to one hour.
- Aura can sometimes occur without a headache.
- The frequency of ophthalmic migraines varies.
- They can start at the age of 7, but most experience them around the age of 20. Peak incidence is at the age of 40.
What causes ophthalmic migraine?
The exact cause of ophthalmic migraines has not been established, but research to date points to problems with blood vessels and blood flow in the retina.
They cause visual disturbances. Once the blood vessels relax and blood flow returns to normal, the patient regains clear vision.
Researchers also believe there is a genetic component to ophthalmic migraines. 50% of patients who suffer from it have relatives in their family who suffer from migraine.
What are the symptoms of ophthalmic migraine?
The symptoms of ophthalmic migraine can vary. However, the most common ones involve visual disturbances and headaches.
The visual symptoms of ocular migraine are temporary and can be:
- Blind spots, leading to partial or total blindness
- Zigzag patterns
- Bright or flickering lights
- Floating lines
These symptoms usually last between 5 and 20 minutes before vision gradually returns to its normal state.
Migraine headaches can occur before, during or within an hour of visual impairment. Symptoms of a migraine headache include:
- Moderate to severe headache
- Dull, throbbing or pulsing headache
- It’s felt behind the eyes
- Sensitivity to light, noise and certain odors
- Nausea
- Vomiting
- Loss of appetite
- Chills
- Sweating
- Paleness of the skin
- Feeling tired
What causes an ophthalmic migraine?
There are several factors that can cause a migraine with ophthalmic aura. Among the most common are:
- Stress
- Smoking
- High blood pressure (hypertension)
- Hormonal contraceptive pills
- Intense exercise
- Leaning forward
- High altitude
- Dehydration
- Low blood sugar (hypoglycemia)
- Excessive heat (hyperthermia)
- Alcohol
- Caffeine
How is ophthalmic migraine diagnosed?
Because the episodes are usually short, the diagnosis is made based on your symptoms and medical and family history.
As part of the basic ophthalmological examination, the doctor may assess the blood flow in the eye using an ophthalmoscope. This is the first step in confirming the diagnosis of ophthalmic migraine.
It will also ensure that you don’t have other underlying ophthalmological disorders that could cause similar problems, such as:
- Amaurosis fugax: temporary blindness caused by lack of blood flow to the eye. It can happen because of a blockage in an artery leading to the eye.
- Spasm in the artery: which brings more blood to the retina.
- Giant cell arteritis: a problem that causes inflammation in blood vessels. It can lead to severe vision problems and even blindness.
- Other blood vessel problems related to autoimmune diseases.
- Disorders that prevent normal blood coagulation, such as sickle cell disease and polycythemia.
- Stroke or transient ischemic attack (TIA).
- Problems caused by the use of illegal substances.
How is migraine with ophthalmic aura treated?
If ophthalmic migraines are rare (once a month), your specialist doctor may not recommend any treatment.
If, however, episodes are frequent, treatment may include the following:
- Avoiding triggers: It’s helpful to know what situations cause your ophthalmic migraines. To this end, it can be useful to keep a diary in which you note when and how these episodes occur. Lifestyle changes, managing stressors and high blood pressure, and quitting smoking can help reduce the ophthalmic migraines you are facing.
- Medication: If lifestyle changes don’t help, medication is the next step. Your doctor can recommend:
- Antiepileptic medicines
- Tricyclic antidepressants
- Medicines for blood pressure
- Calcium channel blocking medicines
- CGRP inhibitors (monoclonal antibody medicines for migraine)
What are the complications of ophthalmic migraine?
In extremely rare cases, migraine with ophthalmic aura can lead to complications in the blood vessels and blood flow in and around the eye. These can be:
- Retinal artery occlusion (also known as “ocular stroke”)
- Retinal infarction (when blood flow is blocked in the retina)
- Retinal vein occlusion
- Retinal hemorrhages, which can lead to inflammation of the retina and optic disc
- Ischemia (restriction of blood flow) of the choroid or optic nerve
- Vitreous hemorrhage
Certain medicines can increase the likelihood of these complications. Always talk to your family doctor before starting or stopping any medication.
How can you prevent ophthalmic migraine?
The best thing you can do to avoid migraine with ophthalmic aura is to avoid triggers.
- Manage and reduce stress levels as much as possible.
- Quit smoking.
- Maintain a healthy blood pressure.
- Avoid hormonal contraceptive pills.
- Exercise moderately if you know it causes your ophthalmic migraines.
- Avoid high altitudes if you have a problem with that.
- Hydrate properly.
- Avoid low blood sugar. Eat small, regular and healthy portions.
- Maintain an optimal body temperature in summer.
- Some people have noticed food triggers such as caffeine or artificial sweeteners. Consider whether you should give them up.
Certain medicines can help prevent ophthalmic migraines:
- Calcium channel blockers open blood vessels.
- Sometimes non-steroidal anti-inflammatory medicines may be used.
- Doctors may also prescribe medicines used to treat depression, epilepsy and blood coagulation.
Preventive medication is usually recommended for patients who experience ophthalmic migraines more than 4 days per month, and who do not respond to other treatments.
Frequently asked questions
What is the difference between migraine with ophthalmic aura and retinal migraine?
Sometimes the term “ophthalmic migraine” is used as a synonym for the medical term “retinal migraine”.
Retinal migraine is a rare ophthalmological disorder that occurs in a person who has also experienced other symptoms of migraine. Retinal migraine involves repeated episodes of decreased quality of vision or short-term blindness. These episodes may precede or accompany a headache.
In retinal migraine, unlike migraine with ophthalmic aura, only one eye is affected, not both. Loss of vision in one eye is not usually related to migraine, but is caused by another more severe disorder. See your specialist doctor if you notice the following symptoms:
- Visual impairment in one eye
- The onset of headaches or visual disturbances after the age of 50.
- New weakness on one side of the body
- Changes in speech
Is ophthalmic migraine a minor stroke?
No. The two are different. However, a stroke can cause vision problems that can be similar to those in ophthalmic migraine. For this reason, it’s important to make an appointment for an ophthalmological examination if you notice sudden major changes in your vision.
Other symptoms of stroke include:
- Weakness or paralysis on one side of the body
- Difficulty speaking or loss of ability to speak (aphasia)
- Slurred or slow speech (dysarthria)
- Loss of muscle control on one side of the face
- Sudden loss, either partial or total, of one or more senses (sight, hearing, smell, taste and touch)
- Loss of coordination (ataxia)
- Dizziness or vertigo
- Nausea and vomiting
- Neck stiffness
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