Ocular Migraines: Causes, Symptoms, Treatment

Genetics

There is a genetic link to migraine. A family history of migraine or ocular migraine increases your chances of having them.

Hormone levels

Migraines have been linked to the hormone estrogen. Estrogen controls chemicals in the brain that affect the sensation of pain. In women, hormones fluctuate due to the menstrual cycle, pregnancy, and menopause. Hormone levels are also affected by oral contraceptives and hormone replacement therapies.

Triggers

Many people are able to identify individual migraine triggers, but research has shown that it is more likely a combination of factors that trigger migraine. Triggers vary from person to person and may include:

• bright lights
• loud sounds
• powerful odors
• stress, anxiety, relaxation after a period of stress
• changing weather
• alcoholic beverages, especially red wine
• too much caffeine or withdrawal from caffeine
• foods containing nitrates (hot dogs, luncheon meats)
• foods containing monosodium glutamate, also known as MSG (fast foods, seasonings, spices, broths)
• foods containing tyramine (aged cheeses, hard sausages, smoked fish, soy products, fava beans)
• artificial sweeteners

You can try to identify your migraine triggers by keeping a headache diary. The diary should include notes on diet, exercise, sleep habits, and menstruation.

Ocular migraines and aura

There are two types of migraines that are referred to as ocular migraines. Some people refer to migraines with auras as ocular migraines.

Some people experience an aura approximately 10 to 30 minutes before a migraine sets in. Aura symptoms can include:

• numbness or tingling in the hands or face
• feeling mentally foggy or fuzzy
• disrupted sense of touch, taste, or smell
• seeing blind spots, shimmering spots, flashing lights, or zig-zag lines

Not all people with migraines will experience auras.

Ocular migraines may also refer to eye-related migraines that come with visual disturbances that may or may not come with a headache pain. These are known as ophthalmic migraines. Ocular migraines can include some or all of the aura symptoms listed above. Ocular migraines are typically the result of migraine activity in the visual cortex of the brain.

Migraines vs. headaches

Some people use the terms “migraine” and “headache” interchangeably, but there is a difference between tension headaches and migraines. The pain from a tension headache will be mild to moderate (contrary to cluster headaches, which can be severely painful). Tension headaches tend to be distracting but not debilitating. Only in rare cases will there be light or sound sensitivity.

In a migraine, however, the pain is moderate to severe. Many patients experience a persistent, intense pounding or throbbing. The pain is often debilitating. Some patients will experience nausea or vomiting, and light and sound sensitivity. Some patients will also experience an aura before the onset of a migraine.

Secondary headaches

Sometimes, headaches with aura are a symptom of an underlying condition. These can include:

• hemorrhagic stroke (a burst artery in the brain)
• ischemic stroke (blocked artery in the brain)
• arteriovenous malformation (abnormal tangle of veins and arteries in the brain)
• inflammation due to meningitis, encephalitis, or other infections
• seizures
• trigeminal neuralgia
• aneurysm (widening or bulging of part of an artery due to weakness in the wall of the blood vessel)
• head injury
• brain tumor
• structural abnormalities of the head, neck, or spine
• hydrocephalus (excessive buildup of cerebrospinal fluid in the brain)
• spinal fluid leak
• exposure to or withdrawal from toxic substances
• arterial dissection (a tear in an artery that supplies blood to the brain)
• cerebral vasculitis (inflammation of the blood vessel system in the vein)

Treatments and coping with migraines

Even if the migraines exist alone and are not a symptom of an underlying condition, they can still be debilitating and impact your life. If you’re experiencing blind spots or vision disturbances, for example, you will want to wait until they pass before driving.

Ocular migraines will typically go away on their own within 30 minutes. You should rest and avoid triggers such as bright lights until the vision disturbances are gone.

There are both over the counter treatments and prescription medications that can be used to treat recurring migraines. Over-the-counter drugs like ibuprofen or Excedrin migraine can be used to reduce the symptoms of a migraine once you already have them. Your doctor can prescribe you:

• calcium channel blockers, which can prevent the blood vessels from constricting
• beta blockers, to relax blood vessels
• anti-epileptics or antidepressants, which are sometimes used to treat and prevent migraines

Some of these prescription medications will be taken on a regular basis instead of an as-needed basis when you get the migraines.

If you’re experiencing ocular migraine pain, you can:

• lie down or sit in a dark, quiet room
• massage your scalp with a lot of pressure
• put pressure on your temples
• put a damp towel over your forehead

Outlook for Ocular Migraines

While ocular migraines may not need treatment, you should consult your doctor if you have them frequently. You should also call your doctor if they are increasing in frequency. Your doctor can make sure there’s no serious underlying condition, and can also prescribe you medications that can reduce the frequency or intensity of the symptoms.

If you experience drastic vision loss, vision loss in one eye, or have trouble thinking, seek immediate medical attention.