Ocular Migraines*

Sometime in our lives, we experience headaches that come and go and are often so severe that our daily routines are affected. Oftentimes, when these headaches occur, we also experience some form of visual changes. Then we say, “It’s probably just a migraine.”

1. What is a migraine?

Migraine is a recurrent type of headache that is severely painful and usually occurs only on one side of the head. An aura occurs right before one of these attacks. An aura could be manifested as visual flashes or spots or even ringing in the ears which is opposite of the side where the headache is about to occur. The migraine attack may also come with symptoms of dizziness, vomiting, nausea and double vision.

2. What is an optical migraine?

As opposed to a real migraine, an optical migraine also involves an aura that comes before a migraine attack, but there is the absence of pain. This is rarer than the migraine that comes with severe pain. It is also know as acephalgic migraine or visual or ocular migraine. It is a migraine aura unaccompanied by headache.

The visual disturbances that are experienced are flashing lights that look like zigzag or “fortress-like” lights. These auras usually begin as small visual marches crossing the field of vision that slowly fades away. Attacks like these last for several minutes to almost an hour.

If it will come with a headache, the pain will follow in an hour. An optical migraine can also be experienced as a blind spot in the field of vision.

3. How sure am I that I am experiencing an optical migraine?

Migraines are usually diagnosed if the same symptoms are experiences over and over in many years. It is optical migraine if the same aura is experienced. In case there is a change in the visual pattern, it might be something more serious. A doctor should be consulted in this case.

4. What could be the cause of these migraines?

The cause for migraine is not yet confirmed, it has remained unknown. However, there have been theories that these headaches are caused by allergies, temporary edema of the brain and even endocrine disturbances. One thing is for sure, it is due to disturbance in the blood circulation in the brain. It has been proven that the pain is associated with the narrowing of blood vessels in the brain followed by dilation.

5. What could be more serious causes of headaches if they are not migraines?

Not all headaches are migraines and not all visual disturbances are caused by migraines. There could be more serious causes that may force you to consult a doctor. Visual changes can also be caused by partial seizures, a retina in the eye could have been detached, a “mini-stroke” or a transient ischemic attack, multiple sclerosis or even a brain tumor.

6. Who is more likely to get an optical migraine?

Optical migraines are usually experienced by more women than men at a ratio of 3:1. This is an illness that is usually inherited.

7. What is the common treatment for optical migraines?

Sedatives and aspirin are common medications prescribed to patients with this illness. Resting or sleeping in a dark room usually relieves the symptoms. However, if the aural migraine is accompanied by severe headache, injection of triptans or ingestion or nasal spraying of the same drug gives relief. Beta-blockers, antidepressants and antiepileptic drugs are also effective for most patients.

It is important to recognize the aura that comes before the headache so that medication can be taken before the actual attack. This will prevent the pain from setting in. Biofeedback has been proven to be a good type of therapy for patients who get these attacks.

Having all these in mind, you would now know if you are experiencing an ordinary headache or a true-blue migraine. Now, you could also determine if those weird visual disturbances are auras previous to a migraine attack or if it is an optical migraine.

What is important here is for you to recognize the symptoms that go with the headache. Observation is the key. You must recognize the tell-tale sign that you are about to get a full-blown attack of a migraine or if you should seek medical help because it is a sign of something more serious. Never take these headaches for granted, they could mean your life.

Ocular, Optical, and Ophthalmic Migraines
by Teri Robert, MyMigraineConnection Lead Expert

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Migraine disease is not only painful and potentially debilitating, it can be confusing. There are different types of Migraine, and some should be approached and treated differently than others. That makes it important that Migraine be properly diagnosed.

In any health field, there needs to be standardization in diagnosing. If every doctor used different diagnostic criteria and classifications, there would be total chaos. It would be impossible to communicate with patients, other doctors, researchers, etc. In the field of Migraine disease and headaches, the gold standard for diagnosis and classification is the International Headache Society's International Classification of Headache Disorders, 2nd Edition (ICHD-II).
Click here to find out more!

Questions often arise about ocular, optical, and ophthalmic Migraines. These questions, however, are difficult if not impossible to answer because there are no such Migraine classifications in the ICHD-II, no such diagnosis listed there. Although there are doctors who use these diagnoses, they use them differently, making it difficult for anyone else to enter a discussion or answer questions.

Examples:

Mary Jane reports having been diagnosed with ocular Migraines. Her Migraines typically beginning with six to 18 hours of mood swings, excessive yawning, food cravings, and unusually frequent urination followed by tiny blind spots in her vision (scotoma) and extreme sensitivity to light (photophobia) and sound (phonophobia). These symptoms are followed by a headache that is on one side (unilateral), throbbing with her pulse (pulsatile), and moderate to severe in intensity. Here ICHD-II diagnosis? Migraine with aura. She sometimes has the same symptoms, but without the headache. The ICHD-II diagnosis for those Migraine attacks is still Migraine with aura, but the descriptive term acephalgic (meaning without head pain) is added, acephalgic Migraine with aura.

Lou has been diagnosed as having optical Migraines. She reports having quickly developing intense headaches on the right side of her head, focused around her eye. She also reports extreme nausea and vomiting. Her optometrist diagnosed her with optical Migraines. Her ICHD-II diagnosis? Migraine without aura.

Dianna was diagnosed with ophthalmic Migraines. Her first symptom was complete blindness in one eye (monocular). This was followed by phonophobia, nausea, and a mild headache. The blindness resolved by the time the headache was over. Her ICHD-II diagnosis? Retinal Migraine.

If you've been diagnosed with ocular, optical, or ophthalmic Migraines, you may encounter some confusion when talking with other Migraineurs or seeing doctors other than the doctor who diagnosed your Migraines. The examples above are not meant to be applied to anyone else, but to show how differently terms are used when they're not used with any established criteria. To better educate yourself about Migraine disease, particularly how it affects you, ask your doctor if he's familiar with the International Headache Society's International Classification of Headache Disorders. If he is, he should be able to give you an ICHD-II diagnosis. If not, you may want to seek a second opinion from a doctor who is familiar with the ICHD-II.

What is Migraine Aura?

Migraine 'aura' is what happens to optical migraine sufferers usually in the period of tiime leading up to a migraine attack. It is usually the first sign of an impending migraine episode and will often be accompanied by nausea and vomiting. Migraine aura is often described by sufferers as zig-zag lights or flashing lights and may also be characterized by visual symptoms such as blind spots. Migraine aura usually lasts from between a few minutes and 1 hour. Immediately after the aura stage, a terrible headache sets in and may last up to 3 days. But sometimes its just a migraine aura without the pain.

This is what an Aura looks like (sort of)
https://www.youtube.com/watch?v=ihgXA0nXmhU