Ocular migraines: Causes, symptoms and treatment
Reviewed by our clinical team
Although all types of migraines can be uncomfortable and disruptive, ocular migraines can be particularly debilitating, and sometimes even frightening. Manifesting with ocular disturbances such as flashing or shimmering lights, these visual migraines can make focusing on basic tasks difficult and, depending on their regularity, make day-to-day life impossible.
In this article, we’ll take a look at the workings behind ocular migraines, including the potential triggers, symptoms, and the treatments available to help minimise the impact they have on the lives of those who experience them.
What is an ocular migraine?
Of the many different types of migraine, ocular migraines are unique in that they generally manifest with distracting and sometimes scary visual disturbances, known as an ‘aura’. Migraine specialists generally don’t use the term ‘ocular migraine’ anymore, instead preferring the term ‘migraine with aura’.
Ocular migraines can occur with or without a headache, however when no headache is present, they’re usually called ‘silent migraines’, or ‘migraine aura without headache. Migraine with aura is thought to be one of the most common types of migraine, according to research by the International Classification of Headache Disorders.
Ocular migraines with head pain are especially difficult to live with as the headache and visual disturbances can combine to be particularly disabling, often lasting for hours up to an entire day. Some studies have also shown a stronger association between ocular migraines and stroke in later life than with other types of migraine.
‘Ocular migraine’ is also sometimes used to refer to another type of migraine, now called ‘retinal migraine’, a much rarer condition where visual changes occur only in one eye. In this article, we’ll be talking specifically about migraine with aura and may use the term interchangeably with ocular migraine. If you’re instead experiencing visual disruption in one eye only, you should speak to your doctor as soon as possible, as a retinal migraine could mean something more serious is going on.
Ocular migraine symptoms
When most people hear the word migraine, they generally think of head pain, however ocular migraines can be very complex and come with a wide range of symptoms.
Auras - the medical term for visual disturbances during a migraine - are a very complex phenomenon, and we don’t really understand how they work. We do know that they manifest gradually, usually taking about five minutes to fully develop, and can last around an hour. Those with experience of migraines will often use auras as a warning sign that a migraine headache is coming on.
Although auras are most commonly associated with visual disturbances, they can also affect speech and induce sensations like numbness or dizziness. In rare instances, they can even cause fainting or confusion.
As well as severe head pain, ocular migraines might also cause the following symptoms:
- Visual disturbances - auras commonly interfere with sight, making you see things like coloured spots or lines, flashing or flickering lights, ‘zigzag’ patterns or ‘floaties’, and other visual effects. You might also experience tunnel vision, blind spots, or even temporary total blindness.
- Speech impairment - some people experience difficulties with speech during an aura episode, slurring their speech or struggling to speak at all.
- Sensory issues - numbness or a tingling sensation resembling pins and needles may occur in various parts of the body.
- Muscle weakness - some individuals report feeling muscle weakness in their extremities during ocular migraines.
- Equilibrium issues - dizziness or feeling off-balance is another potential symptom of ocular migraines.
If you experience any of these symptoms out of the blue, or if they continue for longer than usual, you should seek medical advice to rule out a more serious condition.
Ocular migraine causes
Migraines, including ocular migraines, are very complex, and we don’t yet really understand why they happen or why they cause the symptoms they do.
Some types of migraine, like CGRP migraines are caused by the release of certain chemicals in the brain, which tell blood vessels to expand very quickly, leading to inflammation in the brain tissue. Ocular migraines might be triggered in a similar way.
We also know very little about auras, however some migraine specialists believe they might be caused by a type of altered brain activity called ‘cortical spreading depression’, which triggers changes in the chemicals, nerves and blood flow in the brain, causing the various visual disturbances associated with aura.
Although there’s no medical consensus on the exact cause of migraines, there are a few anecdotal migraine triggers reported by people who regularly experience them. These vary from person to person, and there’s no solid data, but people often find that by removing certain commonly reported migraine triggers from their life, they can reduce the regularity and intensity of their migraines.
Commonly reported migraine triggers include:
- Sleep - too much or too little sleep is often reported as a migraine trigger.
- Hormones - dramatic fluctuations in hormones, often near the start of a menstrual cycle or during menopause in women, could potentially be a migraine trigger.
- Sensory stimuli - sensory overstimulation from loud noises, flashing lights, or strong smells have been reported as migraine triggers. Stress is also a regularly cited factor in migraine research.
- Physical exertion - sudden or high intensity exercise may cause migraines in some people.
- Weather - high altitude, humidity, and even storms can sometimes trigger migraines in some people.
- Medication - certain medicines like the contraceptive pill or vasodilators have all been anecdotally reported as migraine triggers.
- Alcohol - many people report that even small amounts of alcohol can trigger their migraines. Red wine in particular contains tyramine, a chemical often linked to migraines.
- Diet - tyramine is also present in some cheeses, and other ingredients such as caffeine, MSG, nitrates, and artificial sweeteners are also often highlighted as migraine triggers.
It’s important to keep in mind the things on this list have not been proven to cause migraines, only reported as common factors by people who regularly experience them.
Doctors will often recommend you try removing these factors from your lifestyle to minimise or mitigate your migraines before attempting other treatments, so it’s worth keeping them in mind and seeing if changing your diet, reducing your stress levels, or drinking less alcohol results in fewer migraines.
Ocular migraine vs retinal migraine
As mentioned above, although they were once both referred to as ‘ocular migraines’, migraine with aura and what we now call retinal migraines are different.
Although they share some symptoms, the most obvious difference between the two is that retinal migraines occur only in one eye. Retinal migraines can be a sign of a more serious condition, so if you experience the below symptoms in just one eye, you should seek medical advice immediately.
Retinal migraine symptoms
- Vision problems such as flashing or shimmering lights
- Blind spots
- Temporary loss of vision
- Total blindess
To check whether your symptoms are in one or both eyes, you should cover one eye with your hand and switch to the other eye intermittently. If you’re still unsure, call 111 for advice.
Ocular migraine treatment
Although we don’t yet know the exact causes of migraine with aura, we do know that most migraine treatments work effectively for different types of migraine. There are several common migraine treatments available, both through your GP and our online service. These include:
Vydura (Rimegepant)
Vydura, also known as rimegepant, is a wafer-style medicine designed to prevent and treat migraines. It belongs to a group of medicines called gepants, which help by blocking absorption of a neurotransmitter known as CGRP. One study found that people taking Vydura cut their total number of monthly migraine days in half. However, Vydura isn’t suitable for everyone, so you’ll need to speak to your GP to see if it’s right for you.
Sumatriptan
Sumatriptan is part of a category of migraine medications known as triptans. It works by narrowing blood vessels in the brain and bringing down inflammation in the surrounding tissue, helping to relieve migraine symptoms like aura and nausea. You can usually find Sumatriptan in tablet form, and it’s available through our online service.
Rizatriptan
Rizatriptan, another triptan medication, works much like sumatriptan, narrowing blood vessels and reducing brain tissue inflammation to ease severe migraine symptoms. Available in tablet form, rizatriptan is one of the most user-friendly and accessible options we offer through our online doctor.
Conclusion
Like other types of migraine, ocular migraines can be very uncomfortable and disruptive, but it’s important to know that treatment is available, and there’s no need to deal with the problem on your own.
By understanding the distinctive symptoms of migraine with aura, as well as the potential triggers, you can take steps to manage your migraines effectively. The best thing to do, as always, is to speak to your doctor to find the best course of action for you, helping you minimise the impact migraines have on your life.
For more information on other types of migraines, click below.
References
https://ichd-3.org/1-migraine/
https://migrainetrust.org/wp-content/uploads/2021/08/State-of-the-Migraine-Nation-impact-rapid-review.pdf
https://www.nhs.uk/conditions/retinal-migraine/
https://migrainetrust.org/understand-migraine/types-of-migraine/migraine-with-aura/
