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Understanding Ocular Migraine: Symptoms, Diagnosis, and Treatment

“Ocular migraine” can be a confusing term to understand. Here's what to know.
Eyes react to light with constricting pupils. If this person has ocular migraine they could also experience vision changes.
What does the term “ocular migraine” even mean? The answer is complex.Jonathan Storey / Getty Images

While head pain is the most common migraine symptom, visual disturbances are another defining feature for some. This might make you wonder about a phenomenon sometimes called "ocular migraine." What makes this somewhat confusing is that even though "ocular migraine" is a popular colloquial term to describe a specific type of migraine with visual disturbances, it's not a strict medical term with a clear definition. But it is true that there's more than one way to experience the hell that is a migraine, and some migraine experiences can be especially perplexing thanks to the in-your-face visuals that literally no one asked for. Here's everything you need to know about this phenomenon sometimes known as ocular migraine, from symptoms and causes to how to deal when one strikes.

What is an ocular migraine? | What is an ocular migraine aura? | Symptoms of ocular migraine | What causes ocular migraine? | Ocular migraine triggers | Ocular migraine treatment | Ocular migraine prevention

What is an ocular migraine?

Honestly, it depends on who you ask. “Ocular migraine” can be a confusing term, according to the Mayo Clinic1. Some experts use the term “ocular migraine” to describe when you experience the visual disturbances (known as aura) that can come with migraine, but not necessarily the achiness most people envision when they think of the condition, neurologist Andrew Charles, M.D., director of the UCLA Goldberg Migraine Program, tells SELF. So, in that instance, having an ocular migraine is like experiencing all the trippy visuals you might catch at a concert or music festival—but at the most inopportune times (and…minus the music). Obviously, this isn't something you want popping up out of the blue.

While ocular migraine isn't necessarily a specific type of migraine, the phrase refers to a unique experience that some people with migraine have: a migraine with aura but without pain. You might also hear this type of migraine referred to as an acephalgic migraine (cephalgia means head pain2, so acephalgic is the lack of it). While a migraine without pain may sound like no big deal, the visual disturbances that accompany an ocular migraine can interfere with your life in very real ways.

Ocular migraine is a type of silent migraine, which is a catch-all description experts sometimes use for migraine attacks that don’t necessarily cause pain. While an ocular migraine is one form of silent migraine, these terms aren’t interchangeable, Ilan Danan, M.D., M.Sc., a neurologist at the Center for Sports Neurology and Pain Medicine at Cedars-Sinai Kerlan-Jobe Institute in Los Angeles, tells SELF. (For example, if you have other sensory disturbances like hearing music but don’t have head pain, that counts as a silent migraine but not an ocular one.)

As if migraine lingo isn’t confusing enough, sometimes people use the term “ocular migraine” to refer to what doctors call a retinal migraine. A retinal migraine is a rare condition in which a person with migraine has repeated bouts of reduced vision or even blindness in one eye, which could happen before or alongside head pain, according to the Mayo Clinic3. It's crucial to note that a loss of vision in one eye is more often caused by other things than retinal migraine, so it's important to seek medical attention if you're not sure it's a migraine.

All of this is to say that if you're experiencing these kinds of issues, it's good to be as specific as possible when talking about this issue with your doctor since “ocular migraine” may mean different things to different people. For the purposes of this article, when discussing ocular migraine, we're referring to a migraine that comes with visual disturbances without the pain.

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What is an ocular migraine aura?

So, let’s talk aura, those sensory changes that can accompany migraine (but don’t always). Aura most often manifests as visual disturbances, according to the Mayo Clinic4. But you could also experience different sensations, like hearing music or feeling like someone is touching you. When we're talking about an ocular migraine, we're only talking about the visual symptoms.

While some people experience an aura before their migraine headache strikes, an ocular migraine refers to the experience of only experiencing visual disturbances—without the stereotypical migraine head pain.

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Symptoms of ocular migraine

An ocular migraine can have you seeing stars...literally. Or you might get squiggles, or blind spots, or other visual mayhem that makes it very difficult—if not impossible—to see. As you might imagine, this can make it hard to do pretty much anything, so an ocular migraine can really ruin your day.

Here are some of the common visual disturbances that happen with a migraine aura, according to a review article published in the Journal of Headache and Pain5:

  • Bright flashes of light
  • Foggy or blurred vision
  • Zigzag lines in your vision
  • Blind spots
  • Several bright dots or stars
  • Distorted vision that's almost like looking through water or oil
  • Tunnel vision

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What causes ocular migraine?

The cause of ocular migraine is “complicated and often debated,” Ann Morrison, O.D., a clinical instructor at the Ohio State University College of Optometry, tells SELF.

One potential factor is misfiring electrical activity in your brain. “An electrical impulse causes abnormal electrical activity that spreads over the surface of the brain, triggering the migraine,” says Dr. Danan. The thinking is that if that waves of abnormal activity travel across your visual cortex, the part of your brain that processes visual signals, you can wind up with an ocular migraine, according to the Mayo Clinic6.

It's worth noting that the causes of migraine, in general, aren't well understood. According to the National Institute of Neurological Disorders and Stroke7 (NINDS), researchers once thought that migraine was caused by the dilation and constriction of blood vessels in the brain, new research suggests that migraine is tied to our genetics, which could explain why having a family history of migraine can up your own risk of experiencing it.

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Ocular migraine triggers

What experts do know is that the same triggers that cause regular migraine attacks can prompt an ocular migraine as well, Ahmara Ross, M.D., Ph.D., an assistant professor of ophthalmology at the University of Pennsylvania Scheie Eye Institute, tells SELF.

Here are a few common migraine triggers, according to the NINDS:

  • Stress
  • Hormonal changes
  • Anxiety
  • Bright or flashing lights
  • Not getting enough sleep
  • Skipping meals
  • Certain foods or drinks (like alcohol, caffeine, or aged cheeses)

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Ocular migraine treatment

All right, how do we get your regular vision back, stat? Treatment for ocular migraine is similar to treating other types of migraine episodes, and there are plenty of options out there.

The first step is seeing a health care provider to make sure that you're really dealing with an ocular migraine and not something else. Vision changes can be caused by so many different things, so your provider will likely take inventory of your symptoms and may recommend that you see an eye doctor, just in case.

“We don’t see any changes [from an ocular migraine] during an eye exam,” Colleen Halfpenny, M.D., a cornea surgeon at Wills Eye Hospital, tells SELF. But, she says, she usually encourages people with symptoms to come into the office to make sure they don’t have any issues such as retinal detachment (when the thin, light-sensitive layer of tissue at the back of your eye becomes dislodged), since it can cause similar symptoms and damage your vision if left untreated.

If you are, in fact, dealing with ocular migraine, you can ride it out, or you can ask your doctor what kind of treatment might be available. It really depends on how much the ocular migraine impacts your life. If you just have visual disturbances every so often, for example, you might decide to deal with them as they come. Of course, that can be easier said than done. Ocular migraine doesn't really care about your schedule, your job, or that exam you have to study for, so it might strike at the worst possible moment. This might mean pulling over to the side of the road if you're driving, or taking a sick day if you're at work and can't function properly.

If you're experiencing ocular migraine on a regular basis and it's interfering with your life, it's a good idea to talk to your doctor about various migraine treatment methods. Migraine treatments are typically split into abortive and preventive therapies.

Abortive therapies include things like:

  • Pain relievers: Nonsteroidal anti-inflammatories like ibuprofen and aspirin are helpful for some people at halting a migraine episode, but they may not work for severe or chronic migraine.
  • Triptans: These are prescription drugs that block the pain pathways in the brain.
  • Dihydroergotamine: This medication comes in a nasal spray or an injection, and it works on the blood vessels in the brain to counteract swelling.
  • Lasmiditan: This is an oral medication that works on the brain's serotonin receptors.

Preventive therapies include things like:

  • Blood pressure medications: Beta-blockers, angiotensin-converting enzyme inhibitors, and angiotensin receptor blockers have been shown to reduce migraine frequency.
  • Antidepressants: By working on the level of serotonin and norepinephrine in your brain, certain types of antidepressants can actually curb migraine episodes.
  • Anti-seizure medications: These medications are among the most common migraine preventives.
  • Calcitonin gene-related peptide (CGRP) antagonists: These are typically injected medications that include monoclonal antibodies that work against a specific protein released around the brain (which causes a migraine).
  • Magnesium supplements: Supplementation with this mineral may help prevent aura.
  • Botox injections: Yep, Botox is actually an approved therapy for chronic migraine.

So, yes, it may take some trial and error to find the right fit. Interestingly, a 2019 review article8 published in the Journal of Headache and Pain found that the treatments that work best for migraine with aura may not be the same ones that work best for migraine without aura.

As you can see, it's crucial to have a detailed conversation about your symptoms (including how severe your migraine is, how long it lasts, and how frequently it happens) with your provider so they can help pinpoint the best option for you. Your primary care provider may even refer you to a neurologist who specializes in diagnosing and managing migraine.

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Ocular migraine prevention

If you've ever had an ocular migraine, you would probably do just about anything to make sure it never happens again. Depending on how often you get an ocular migraine and how severe it is, your provider may suggest a preventive treatment option, or they may prescribe you an abortive treatment to have on hand the next time one hits.

Beyond that, it’s smart to try to avoid your triggers if you know what they are, Dr. Ross says. If you're not sure exactly what your migraine triggers are, it's time to start journaling. Try to keep a diary of your migraine attacks, along with what you eat and drink (and when), how much sleep you're getting, how much stress you're under, and anything else that might be relevant (like your period, your workouts, etc.). This can help you and your provider figure out what triggers may be rudely summoning those ocular migraine attacks.

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Sources:

  1. Mayo Clinic, Ocular Migraine: When to Seek Help
  2. National Institute of Neurological Disorders and Stroke, Headache: Hope Through Research
  3. Mayo Clinic, Ocular Migraine: When to Seek Help
  4. Mayo Clinic, Ocular Migraine: When to Seek Help
  5. The Journal of Headache and Pain: Clinical Features of Visual Migraine Aura: A Systematic Review
  6. Mayo Clinic, Migraine With Aura
  7. National Institute of Neurological Disorders and Stroke, Migraine Information Page: What Research Is Being Done?
  8. The Journal of Headache and Pain: Differences in treatment response between migraine with aura and migraine without aura: lessons from clinical practice and RCTs

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