Ocular Migraine

What is ocular migraine?

Ocular migraine (also known as retinal migraine) is a condition that involves attacks of visual issues that affect one eye and migraine headaches. Possible visual issues include:

• Scotoma (aura or blind spot).
• Scintillating scotoma (an aura that moves or “flickers” or looks like a wave that alternates between light and dark).
• Temporary.

These visual issues usually go away once the attack is over, and your vision returns to its usual state. In rare cases, visual problems can become permanent. The frequency of ocular migraines varies. But people who experience them usually have them more than once.

Ocular migraine can start as early as 7 years of age. But most people start experiencing them in their 20s, with a peak age of 40.

What’s the difference between ocular migraine and migraine with aura?

A retinal (ocular) migraine is a type of migraine aura. But it only affects one of your eyes. A migraine with aura affects both of your eyes. The visual symptoms during an ocular migraine usually don’t last as long as symptoms of a migraine with aura.

Another difference is that the headache pain tends to be right behind your affected eye in an ocular migraine. The pain can be more spread out in your head for a migraine with aura.

How common are ocular migraines?

Ocular migraines are rare, but researchers don’t know how rare they are due to a lack of reporting. Migraines, in general, affect about 18% of women and people assigned female at birth (AFAB) and 6.5% of men and people assigned male at birth (AMAB). Not everyone who has migraines experiences ocular migraines.

What are the symptoms of ocular migraine?

The symptoms of ocular migraine (retinal migraine) can vary. But the main symptoms are visual disturbances in only one eye and a migraine headache.

The visual symptoms of ocular migraine may include temporary:

• Blind spots that result in partial or total blindness.
• Zigzagging patterns.
• Shimmering or flickering lights.
• Floating lines.

These symptoms usually last 10 to 20 minutes before your vision gradually returns to its normal state. The attacks affect the same eye in almost all cases of ocular migraine.

The migraine headache can happen before, during or within an hour after the attack. Symptoms of a migraine headache include:

• Moderate to severe head pain that’s pounding, throbbing, pulsing or dull. The pain usually occurs behind your affected eye.
• Sensitivity to light, noise and/or odors.
• Nausea and vomiting.
• Loss of appetite.
• Feeling very warm (sweating) or cold (chills).
• Pale skin color (pallor).
• Feeling tired.

How long do ocular migraines last?

The visual issues of ocular migraines typically last five to 60 minutes. But the headache can last from four to 72 hours if it’s not treated.

What causes ocular migraines?

Researchers don’t know what exactly causes ocular migraines (retinal migraines), but they have theories. One of several theories is that it may be due to issues in blood vessels or blood flow that supports your retina. This issue in blood flow causes visual symptoms. Once your blood vessels relax, normal blood flow resumes and your sight returns.

Researchers believe there’s also a genetic component to ocular migraines, as 50% of people who experience them have a family history of migraine headaches.

What triggers ocular migraines?

Ocular migraines have similar triggers as migraine with aura. Common triggers include:

• Stress.
• Smoking.
• High blood pressure (hypertension).
• Hormonal contraceptive pills.
• Exercise.
• Bending over.
• High altitude.
• Dehydration.
• Low blood sugar (hypoglycemia).
• Excessive heat (hyperthermia).
• Alcohol and caffeine.

What are the complications of ocular migraine?

In rare cases, ocular migraine can lead to complications related to blood vessel and blood flow issues in and around your eye. They include:

• Central retinal artery occlusion (CRAO). This is also known as an eye stroke.
• Branch retinal artery occlusion (BRAO)/retinal infarction (when blood flow is blocked in your retina).
• Central retinal vein occlusion.
• Retinal hemorrhages (bleeding) that can lead to edema (swelling) of your retina and disc.
• Ischemia (blood flow restriction) of your choroid or optic nerve.
• Vitreous hemorrhage.

Certain medications may make these complications more likely. Always talk to your healthcare provider before starting or stopping any medications.

How is ocular migraine diagnosed?

If you’re able to see a healthcare provider during an ocular migraine, they may be able to see decreased blood flow to your eye using an instrument called an ophthalmoscope. This would help confirm the diagnosis of ocular migraine.

As attacks are usually brief, it’s more likely you’ll receive a diagnosis of ocular migraine based on your symptoms and medical and family history.

Your provider may recommend seeing an eye specialist, such as an ophthalmologist, to make sure you don’t have an underlying eye condition, which could be serious.

What is the treatment for ocular migraine?

If ocular migraines happen infrequently, such as once a month, healthcare providers generally don’t recommend treatment.

If you have frequent ocular migraines, the goal of treatment is to reduce the frequency of attacks. Treatment includes:

• Avoiding possible triggers: It’s helpful to know what situations trigger your ocular migraines. Keeping a journal of when and how your migraines happen can help with this. Lifestyle changes, such as avoiding dietary triggers, managing stressors like high blood pressure and quitting smoking, may help reduce the number of attacks you have.
• Medication: If lifestyle changes don’t help, medication that can help prevent ocular migraines (prophylaxis therapy) is the next step. Calcium channel blockers such as nifedipine and verapamil are the go-to medications. Aspirin and antiepileptic drugs may also help.

How can I prevent ocular migraines?

It may not always be possible to prevent ocular migraines. But avoiding potential triggers of them can help. Try to record what you were doing before you got an ocular migraine, such as activities, what you ate or drank, how you felt, etc. It may take time to figure out what triggers your migraines.

What is the prognosis for ocular migraine?

The prognosis (outlook) for ocular migraine is usually good. Although the attacks can be painful and disturb your vision, healthcare provider generally consider ocular migraine to be benign.

However, in rare cases, the attacks can lead to permanent visual issues.

When should I see my healthcare provider about ocular migraines?

If you experience an ocular migraine for the first time, it’s important to see your healthcare provider to make sure you don’t have a more serious eye or brain condition.

If you have an ocular migraine diagnosis and your symptoms change or get worse, talk to your provider.

Is ocular migraine a mini-stroke?

Ocular migraine isn’t a mini-stroke. They’re distinct conditions. However, stroke can cause vision problems that may be similar to ocular migraine. Because of this, it’s important to seek medical care if you experience sudden changes in your vision.

Other symptoms of stroke include:

• One-sided weakness or paralysis.
• Aphasia (difficulty with or loss of speaking ability).
• Slurred or garbled speaking (dysarthria).
• Loss of muscle control on one side of your face.
• Sudden loss — either partial or total — of one or more senses (vision, hearing, smell, taste and touch).
• Loss of coordination or clumsiness (ataxia).
• Dizziness or vertigo.
• Nausea and vomiting.
• Neck stiffness.

Seek immediate medical help if you or someone you know has these symptoms.

A note from Cleveland Clinic

Ocular migraine usually isn’t dangerous, but frequent episodes can disrupt your routine. If you experience sudden vision changes with a migraine, it’s important to see a healthcare provider. They’ll need to make sure it’s not a more serious underlying condition causing your symptoms. A provider can also recommend treatment options to better manage ocular migraines.