Ocular Migraines

Medically Reviewed by Zilpah Sheikh, MD on July 03, 2024
Written by Eric Metcalf, MPH, Lori M. King, PhD
9 min read

An ocular migraine (also called a retinal migraine) is a rare type of migraine headache that causes visual symptoms in one of your eyes. The problem isn't with your eyes; it's a problem with the way your brain is processing visual signals from your eyes. You may be able to tell if you close your eyes. If you still have symptoms with your eyes closed, then the problem is likely coming from your brain, not your eyes. 

Migraine visual aura vs. ocular migraine

People sometimes mistake an ocular migraine for migraine visual aura. Both cause similar symptoms, such as flashing lights and blind spots, but with migraine visual aura, you usually have visual disturbances in both eyes. With ocular migraine, you usually only have symptoms in one eye. 

Talk to your doctor if you think you have ocular migraine. Any changes in your vision, even if only temporary, warrant a trip to the doctor. They will need to rule out other conditions that cause similar symptoms. Be ready to describe your symptoms and any patterns you notice to help them figure out what's really going on.

An ocular migraine usually starts with vision symptoms in one of your eyes. These visual symptoms will generally last 5-60 minutes. Your visual symptoms may include:

  • Areas of lower or lost vision (also called scotoma) that may cause partial or total blindness in that eye
  • Seeing shimmering or twinkling lights
  • Seeing zigzag patterns
  • Seeing floating lines 

These symptoms may increase over time. You may also have a headache at the same time, or your headache may start within an hour of your visual symptoms. Untreated, your headache may last between 4 and 72 hours. 

Symptoms of migraine headache include:

  • Moderate-to-severe pain that's pounding, throbbing, pulsing, or dull. The pain may also happen behind your affected eye.
  • Sensitivity to light, noise, and smells
  • Nausea and vomiting
  • Loss-of-appetite
  • Feeling very tired (fatigue)
  • Pale skin (pallor)
  • Sweating a lot or having chills

 

Experts aren't sure exactly what causes ocular migraine, but they have some theories, including:

  • Spasms in the blood vessels in your retina that decrease blood flow in your optic nerves. Your retina is the light-sensitive layer of tissue at the back of your eye that converts images into electrical signals and sends them to your brain via the optic nerve.
  • Pressure on the neuron in your retina that spreads.
  • Possibly genetics because about 50% of people with ocular migraines have a family history of them.

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.

In general, migraines are more common in women and people assigned female at birth (AFAB) than in men and those assigned male at birth (AMAB). It's also most common in White people compared to Black people and people of Asian ancestry. And Black people tend to get them more often than people of Asian ancestry.

Children as young as 7 can get ocular migraine, but most people start getting them in 20s and have them until their 40s.

Migraine triggers include:

  • Stress
  • High blood pressure
  • High heat
  • Smoking
  • Alcohol
  • Caffeine
  • Birth control pills
  • Dehydration (not enough water in your system)
  • Low blood sugar
     

There's no test that can diagnose ocular migraine. Your doctor will need to rule out other primary headache disorders and conditions that may cause visual symptoms. They may refer you to an ophthalmologist to screen you for eye conditions before they diagnose you. 

Your doctor will likely start by asking about your symptoms and your personal and family medical history. They’ll likely perform a physical exam to assess for other medical issues, such as a stroke that affects blood flow to one of your eyes.

Other conditions that could cause similar symptoms include:

  • 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)

Ocular migraine and retinal migraine are used interchangeably. The older term is "ocular migraine," and doctors used it to refer to any migraine that had visual symptoms. They would call a migraine with a visual aura and a retinal migraine an ocular migraine. 

The newer term is "retinal migraine," and doctors may prefer this term because it specifically refers to the type of migraine where visual symptoms occur in one eye.

 

The visual symptoms of an ocular migraine usually last less than 60 minutes. If you get them less often than once a month, you probably won't need specific treatment.  In this case, 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. 

To help prevent your migraines, avoid triggers. For instance:

  • Stop smoking.
  • Avoid foods and drinks that trigger your migraines.
  • Stay hydrated.
  • Follow your doctor's advice for managing your blood pressure.
  • Manage your stress in a healthy way.
  • Change to a different method of birth control if you take birth control pills.

Medications for ocular migraine

There hasn't been much research on the best way to treat or prevent ocular migraine. Your doctor may recommend one or more drugs, such as:

Devices to prevent ocular migraine

The market also offers various devices to prevent ocular migraine. For instance:

  • 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.
  • gammaCore is a noninvasive vagus nerve stimulator that sends mild electrical stimulation to your vagus nerve. This helps ease pain or helps prevent onset of a migraine.

Some lifestyle habits and home remedies and that may help you manage your symptoms include:

Get enough sleep. Good sleep habits can help you avoid migraines and ease your symptoms. Experts suggest you go to bed and wake up at the same time every day, avoid screen time before you go to bed, and spend some time in natural light during the day. If you feel a migraine coming on during the day and you're able to, try to take a nap.

Get enough exercise. Obviously, don't exercise while you have a migraine, but getting some regular light impact exercise may help prevent attacks and lessen symptoms when you do have them. Experts suggest that walking and yoga are good options for a light-impact exercise. If you feel a migraine coming on, some people say that doing a bit of light exercise can stop their migraine before it gets bad.

Stay hydrated. Dehydration can cause a regular headache, and many people say that it can trigger a migraine, as well. Try to regularly drink about 64 ounces of water a day. If you feel a headache coming on, it may be a sign that you're becoming dehydrated. If you're able to, keep water with you and sip on it throughout your day.

Dim your lights. Light sensitivity is a common symptom of a migraine. Keeping the lights in your living space and office dim may help prevent migraine attacks. Other ideas for when you're feeling sensitive to light include:

  • Use blackout curtains on your windows so you can block light.
  • Wear sunglasses when outside.
  • Add anti-glare screens to your computer.
  • Use daylight-spectrum fluorescent bulbs indoors.

Use a cold or hot compress when you have a migraine. Keep a cold compress or bag of ice nearby and press it to your temple or neck when you feel an attack coming on. Some people may prefer a hot compress or heating pad. Whether it's hot or cold, don't leave a compress on for more than 15 minutes because it can injure your skin.

Get a scalp massage. A massage can help relieve tension and promote blood circulation in the muscles of your scalp and neck. This may help ease your pain.

Try essential oils. There's no scientific evidence that it can relieve your pain. However, if your favorite essential oil helps you relax, then it may be worth a try. Some people like peppermint and lavender for their ability to ease stress. However, many people find that they're more sensitive to smells during a migraine and some find that strong smells can trigger a migraine.

The first step to preventing migraines is to avoid your triggers. To do that, you must know what your triggers are. To help determine what your triggers are, try keeping a journal with:

  • What you were doing before you got an ocular migraine
  • What you ate or drank before your migraine
  • How you felt before your migraine

If you have migraines regularly, ask your doctor about preventive medicines such as calcium channel blockers. Nifedipine or verapamil seem to work the best for people with ocular migraine.

 

 

Having migraines can really effect your quality of life. If you have vision problems, you need to avoid driving until your headache passes. You also need to avoid your triggers and be prepared to deal with a migraine if it happens. However, there are ways of preventing attacks and easing your symptoms. Take care of yourself and talk to your doctor about your medication options and any lifestyle changes you can make.

An ocular migraine is a migraine headache that causes visual symptoms, such as blind spots or flashing lights, in one eye. Your doctor may also call it a retinal migraine. The other symptoms, triggers, prevention strategies, and treatments are the same as for any type of migraine. The best way to avoid migraines is to understand your triggers and avoid them. You can ease your symptoms by taking an NSAID and lying down in a cool, dark room. 

What are the four stages of ocular migraine?

Ocular (retinal) migraine doesn't necessarily have four stages. However, migraine with visual aura does often proceed through four phases: prodrome, aura, headache, and postdrome. For instance:

  1. Prodrome phase is usually about 24-48 hours before your migraine. You may feel irritable or euphoric (intense happiness or excitement), have a stiff neck, crave certain foods, or yawn a lot.
  2. Aura may happen before your headache or during it. This generally lasts about an hour and you may have ringing in your ears, see bright lights, or have tingling sensations.
  3. Headache usually happens on one side of your head and may be throbbing. It tends to get worse over several hours and you may feel nauseated, vomit, and feel sensitive to light, noise, and smells.
  4. Postdrome is when the throbbing of your headache stops, but you may have short bursts of pain when you move your head. Most people will feel exhausted during this phase. Some people also feel euphoric during the prodrome.