Scintillating Scotoma

What is a scintillating scotoma?

A scintillating scotoma is a shimmering or glittering blind spot in your vision. “Scotoma” means “blind spot,” and scintillating scotoma is a specific type of blind spot. Certain types of migraines are the most common cause, but scintillating scotomas can happen with several kinds of disruptions in your retinas or brain.

Scintillating scotomas can be as short as five minutes or last several hours, but most usually stop within 60 minutes.

What do scintillating scotomas look like?

They can appear to be flickering, flowing, glimmering, glittering, pulsing, rippling, sparkling or wavy. Some people describe it like looking through a kaleidoscope or looking like heat ripples that distort air above a hot, paved roadway.

The patterns that scintillating scotomas can appear in can include:

• Rings or arcs. These are curved sections around the center of your vision. They can sometimes form a complete ring, or they can be incomplete with a crescent or C-like shape. These arcs may also separate, leaving small segments of scintillating scotoma until they fade and stop.
• Fortification patterns. These get their name from how they appear as jagged, zig-zagging distortions or lines. They often look similar to the teeth-like gaps at the top of a castle wall (which is how this pattern got its name).
• Checkerboard. These look like black-and-white squares.

What are the most common causes of this symptom?

The most likely causes of scintillating scotomas are two types of migraine:

• Migraines with auras.
• Retinal migraines (ocular migraines).

For your vision to work properly, your retinas have to convert what they detect into coded signals and send them to your brain. Your brain decodes those signals and “builds” the big-picture view of what you see.

Less commonly, other brain conditions can also cause scintillating scotomas or similar effects. These conditions include:

• Seizures.
• Strokes and transient ischemic attacks (TIAs).

How is scintillating scotoma treated?

Treating scintillating scotoma depends on treating the cause. Some conditions that cause it are very treatable. Others happen unpredictably, and treating them isn’t always possible.

Migraines are usually the more treatable causes of scintillating scotoma, and medications are the most common and effective treatment. Providers use a wide variety of medications to treat migraines.

Abortive medications (also known as “rescue” meds) stop migraines in progress. Some of the medication classes that can do this include:

• Triptans like sumatriptan (Imitrex®) or zolmitriptan (Zomig®).
• Calcitonin gene-related peptide (CGRP) blockers like ubrogepant (Ubrelvy®) or rimegepant (Nurtec®).
• Nonsteroidal anti-inflammatory medications (NSAIDS), including products that combine NSAIDs with caffeine and/or other medications.

Drugs in several other classes can sometimes also help stop migraines in progress, and there are nonmedication options, too. Your healthcare provider can tell you more about the treatment options that are most likely to help you.

What are the possible complications or risks of not treating scintillating scotoma?

Scintillating scotoma is a temporary issue when migraines are the cause. It may last several hours or even days, but this symptom — and the migraine — will eventually stop on its own.

But other migraine symptoms — like nausea and vomiting, light sensitivity and unbearable pain — are often extremely disruptive. Without treatment, you might find yourself unable to do anything but find a dark, quiet room and wait for it to stop. That can interfere with work, family time, hobbies, etc. That’s why migraine treatments can be so helpful (or even life-changing).

When scintillating scotoma is a symptom of a seizure (either before it starts or during), it can be an important warning sign. The warning is to stop what you’re doing and get to a safe place or notify someone that you may need help. Seizures are usually short-lived, but when they last more than five minutes, or you have another before you’ve fully recovered from the last one, they become status epilepticus. That condition is a life-threatening medical emergency.

In uncommon cases, scintillating scotomas can happen because of strokes. Delaying treatment for a stroke can lead to permanent brain damage and even death. That’s why getting emergency care for a first-time scintillating scotoma can be so important. Until a medical professional can rule out dangerous causes, there’s no way to know why you’re having a scintillating scotoma.

Can scintillating scotoma be prevented?

It’s often possible to prevent conditions that can cause scintillating scotoma. Several medications can keep migraines and seizures from happening, or at least reduce how often they happen.

Because there are so many medications and treatment approaches that can prevent conditions that cause scintillating scotoma, your healthcare provider is the best person to tell you more about your options.

When should a doctor or healthcare provider treat this symptom?

Scintillating scotoma always needs emergency medical care when you have it for the first time. That’s because some of the possible causes are dangerous, and there’s no way to tell what the cause is without seeing a healthcare provider.

Once you have a diagnosis, your healthcare provider is the best person to tell you when this symptom is something you can treat yourself. And when in doubt, getting medical care is the safest choice.

Can I drive while having a scintillating scotoma?

No, driving while having a scintillating scotoma is very dangerous. Even a partial loss of vision can put you and those around you in danger if you try to drive. And because they commonly expand across your field of vision, a small blind spot could easily become a large one in a matter of minutes.

If not being able to drive or do other activities like work is a concern, tell your healthcare provider about this. They may be able to help you find treatments that can stop the cause of a scintillating scotoma quickly and let you get back to what you were doing.