Retinal Migraine (Ocular Migraine)
What is an ocular, or retinal migraine?
The term ‘ocular migraine’ causes a lot of confusion because it is not an official medical diagnosis. People often use it to describe a migraine with visual aura. About 25 to 30% of migraine sufferers have migraine with aura. And visual auras are the most common type of aura. They last anywhere from a few minutes up to an hour. Auras affect both eyes and can precede the headache phase or occur during it. Other terms people may use to describe visual problems with migraine include eye migraine, visual migraine, and ophthalmic migraine. However, the medical term for a migraine directly affecting the eye is retinal migraine.
The International Headache Society (IHS) classifies a retinal headache as a specific subtype of migraine. IHS describes it as repeated attacks affecting one eye. The attacks include seeing twinkling lights, areas of decreased vision, and temporary blindness. The headache phase can happen with these visual changes or within 60 minutes of them.
Retinal migraine is a relatively rare form of migraine. Like other forms of migraine, retinal migraine is more common in women of childbearing age.
Due to the rarity of this type of migraine, doctors are still exploring the best way to treat it. In general, pain relievers and rest may help during an episode. Prevention strategies include avoiding triggers and using medication, even if attacks are infrequent.
Blindness or vision changes in one eye can be a symptom of a potentially serious or life-threatening condition, such as stroke. Seek immediate medical care (call 911) if you experience sudden one-sided vision loss or changes. See your doctor promptly for any other unexplained vision changes.
What are retinal migraine symptoms?
Retinal migraines are monocular, meaning they only affect one eye. This is one way to distinguish them from other subtypes of migraine, such as migraine with visual aura. A visual aura will involve both eyes. Auras can also occur without an associated headache. However, headache occurs during or within 60 minutes of the visual symptoms of a retinal migraine. Like other forms of migraine, retinal migraines occur in repeated attacks.
The symptoms of retinal migraine include positive and negative visual changes that are fully reversible. Positive visual changes are things you see that aren’t there. Negative visual changes are losses. Symptoms can last a few minutes up to an hour. In some cases, symptoms can persist for several hours or longer.
Common symptoms of ocular migraine
Symptoms of retinal migraine are:
Scintillations, which is seeing twinkling, sparkling or flashing lights
Scotoma, which are areas of decreased vision and may include blurring, blank areas, or black spots
Serious symptoms that might indicate a life-threatening condition
Sudden vision loss in one eye can be a symptom of a serious or even life-threatening condition, even if you’ve experienced retinal migraine before. Immediate medical care is necessary to rule out serious causes of monocular vision loss.
It can be hard to tell the difference between migraine with aura and retinal migraine. If you think you have retinal migraine, it’s important to see a doctor who specializes in headache. Ideally, people with retinal migraine should consult an ophthalmologist or neurologist with headache expertise.
What causes retinal migraine?
Doctors do not have a full understanding of migraines and their cause. Migraine aura is likely the result of changes in electrical activity in the brain’s cortex—or outer layer. Retinal migraine may involve similar disturbances, but at the back of the eye. Reduced blood flow to the retina also likely plays a role in retinal migraine.
The difference in the location of the root cause helps explain the differences between visual auras and retinal migraine. Because the brain is the source of migraine aura, visual changes will affect both eyes. However, the eye is the source of the problem with retinal migraine. So, visual problems will only affect that eye.
Like other forms of migraine, there are likely factors that trigger an attack. Triggers vary from person to person and may include hormonal changes, stress, smoking, low blood sugar, and high blood pressure. Exercise, dehydration, excessive heat, and high altitude can be triggers as well.
What are the risk factors for retinal migraine?
Several factors increase the risk of developing retinal migraine. These risk factors are similar to other forms of migraine. Retinal migraines are more common in women. They can begin at any age, but typically start during adolescence and peak during childbearing years. Retinal migraines are also more common in people with a family history of migraine.
It may not be possible to lower your risk of retinal migraine. However, you may be able to prevent or reduce the frequency of attacks by avoiding triggers. If you smoke, quitting is one step you can take. Ask your doctor about other strategies, including stopping hormonal contraceptives. Your doctor may also recommend medicines to prevent attacks.
How is retinal migraine treated?
Treatment of retinal migraine attacks is a current area of exploration. No clear-cut guidelines exist. Today, treatment primarily relies on NSAIDs (nonsteroidal anti-inflammatory drugs) and antinausea medicines to manage pain and other symptoms. No treatments are available to restore vision during an attack. Doctors avoid typical migraine treatments, such as triptan drugs and ergot alkaloids. These drugs have constrictive effects on blood vessels, which may worsen retinal migraine.
Medications may be helpful to prevent attacks. This includes drugs that help prevent other forms of migraine, such as tricyclic antidepressants and antiseizure drugs. Doctors may also use drugs to help the blood vessels stay relaxed, including beta blockers and calcium channel blockers. Daily aspirin therapy may be helpful as well.
What are the potential complications of retinal migraine?
With retinal migraine, reduced blood flow to the retina may eventually cause damage. This can result in permanent partial or complete vision loss in the eye. It is unclear how often this happens or if there are factors that can predict it. Seeing your doctor for regular follow-up appointments can help identify potential problems with the retina. Most doctors also recommend preventive medications, even if attacks are infrequent.