What Are Ocular Migraines?
An ocular migraine can cause vision loss or blindness for a short time -- less than an hour. This happens before or along with a migraine headache.
It's rare. Some research suggests that in many cases, the symptoms are due to other problems.
Other migraine attacks can also cause vision problems. An aura migraine can involve flashing lights and blind spots. These symptoms usually happen in both eyes.
Talk to your doctor to find out if you have ocular migraine. They can rule out other conditions that can cause similar symptoms. Be ready to describe what you went through as completely as you can to help them figure out what's really going on.
Ocular Migraine Symptoms
You may hear your doctor call ocular migraine by other names, such as visual, retinal, ophthalmic, or monocular migraine. Warning signs include:
A headache that lasts 4 to 72 hours. It tends to:
- Affect one side of your head
- Feel moderately or very painful
- Throb or pulsate
- Feel worse when you move around
Other symptoms may include:
- Blind spots or colored halos in your vision lasting about 30 minutes or less
- Being sensitive to light or sound
Ocular Migraine Causes
Experts aren't sure what causes ocular migraine. Some think the problem is linked to:
- Spasms in blood vessels in the retina, the lining in the back of the eye
- Changes that spread across the nerve cells in the retina
It's rare, but people who have these types of migraine may have a higher risk of permanent vision loss in one eye. Experts don't know whether medications that prevent migraines -- such as tricyclic antidepressants or anti-seizure medications -- can help prevent that vision loss. But if you have ocular migraine, even if it goes away on its own, it's a good idea to talk to your doctor about your symptoms.
Ocular Migraine Diagnosis
Your doctor will ask you about your symptoms and examine your eyes. They’ll try to rule out other conditions that could cause similar problems, such as:
- Amaurosis fugax, temporary blindness due to a lack of blood flow to the eye. It can happen because of a blockage in an artery that leads to the eye.
- Spasms in the artery that brings blood to the retina
- Giant cell arteritis, a problem that causes inflammation in blood vessels. It can lead to vision problems and blindness.
- Other blood vessel problems related to autoimmune diseases
- Substance use disorder or overusing illicit drugs
- Conditions that keep your blood from clotting normally, like sickle cell disease and polycythemia
- Stroke or transient ischemic attack (TIA)
What’s the Difference Between Ocular Migraines and Retinal Migraines?
You might hear people use the terms ocular migraine and retinal migraine interchangeably.
Ocular migraine generally means any headache that causes temporary changes in vision. Retinal migraine describes a more specific condition: it’s monocular, which means that it affects just one eye. So a retinal migraine is actually a kind of ocular migraine.
Retinal Migraine Symptoms
Some symptoms specific to retinal migraine may include:
- Vision problems that affect just one eye
- Seeing twinkling lights, also known as scintillations
- Areas of lessened vision, also called scotoma
- Temporary loss of vision or blindness
- Any of the above happening repeatedly
The headache part of the migraine can start within an hour of the visual symptoms. But some people don’t have a headache with the visual symptoms.
It can be hard to tell whether you're having symptoms in one eye only. The flashing lights or blindness may be on one side of your vision but actually involve both eyes. If you're not sure, cover one eye and then the other.
If you have symptoms in both eyes, you don’t have retinal migraine. It’s important to make sure of this so you can move forward with the right treatment.
Ocular Migraine Treatment
The visual portion of an ocular migraine usually lasts less than 60 minutes, so most people don't need treatment. It's best to stop what you're doing and rest your eyes until your vision goes back to normal. If you have a headache, take a pain reliever that your doctor recommends.
If you have vision loss in one eye only that does not go back to normal within an hour, it could be due to a serious condition that isn't related to migraine. Get medical help right away.
There's been little research on the best way to treat or prevent ocular migraine. Your doctor may recommend one or more drugs:
- Drugs that treat epilepsy, such as valproic acid (Depakene, Depakote) or topiramate (Qudexy XR, Topamax, Trokendi XR)
- Tricyclic antidepressants such as amitriptyline (Elavil), nortriptyline (Pamelor), or venlafaxine (Effexor)
- Blood pressure medicines including beta-blockers like metoprolol (Lopressor) or propranolol (Inderal), and calcium-channel blockers such as nicardipine (Cardene) and verapamil (Calan)
- CGRP inhibitors, including eptinezumab (Vyepti), erenumab (Aimovig), fremanezumab (Ajovy), galcanezumab (Emgality)
The market also offers various devices to prevent ocular migraine. The sTMS mini gives off a magnetic pulse that stimulates part of the brain. You hold it at the back of your head at the first sign of a headache. Nerivio is a wireless remote electrical neuromodulation device that you put on your upper arm at the beginning of migraine headaches. Cefalys is a portable headband-like tool that you use for 20 minutes once a day. It gives electrical impulses on the skin at the forehead and stimulates a nerve associated with migraine headaches. When it's on, you'll probably feel a tingling or massaging sensation.
In addition, a noninvasive vagus nerve stimulator called gammaCore sends mild electrical stimulation to the nerve's fibers to ease pain or to help prevent a migraine.
Ocular Migraine Prevention
The first step to preventing migraines is to avoid triggers. These often include:
- High blood pressure
- Hormonal birth control pills
- Bending over
- High altitude
- Low blood sugar
- Excessive heat
Although dietary triggers -- such as caffeine, alcohol, and artificial sweeteners -- can cause other types of migraines, they seem less likely to trigger ocular migraines.
A device is also a treatment option. Cefaly is a portable headband-like tool for preventing migraines. You use it for 20 minutes once a day. It gives electrical impulses on the skin at the forehead and stimulates a nerve associated with migraine headaches. When it's on, you'll probably feel a tingling or massaging sensation.