Diagnosing Migraine Aura Without Pain
Migraine aura without pain can be hard to diagnose. It can be confused with stroke or seizures. Your doctor will have to rule out other, more common, health conditions before diagnosing you with migraine aura without pain. A migraine diary is an important tool in helping your doctor accurately diagnose silent migraine.1,,2
Can I Have A Visual Migraine Without A Headache
Definitely. It is actually very common to have a visual migraine without any headache. The medical term for this is acephalgic migraine, which literally means migraine symptoms without headache. Except for the absence of a headache, the visual symptoms in acephalgic migraine are identical to the episodes that accompany a classic migraine aura.
Causes Of Migraine Aura
Migraines generally have four phases: prodrome, aura, headache attack, and postdrome. Not everyone with migraines experiences all four phases. The aura phase, which usually lasts an hour or less, is when visual disturbances are experienced. It can also coincide with headache and other migraine symptoms.
Different types of brain activity have been measured during migraines with aura. They show changes in blood flow and metabolism in the occipital cortex, an area of the brain that affects vision. Cortical spreading depression is a slowly spreading wave of changing brain activity. It has been associated with visual aura in migraines. The slow spread of brain disturbance is believed to correspond with the gradual onset and duration of aura.
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Causes Of Ocular Migraine
An ocular or ophthalmic migraine is hold your breath a painless migraine! These are, however, associated with visual disturbances in both eyes. You may experience flickering or flashing lights, lines, stars, or blind spots that deter your vision. About 35 percent of migraine sufferers experience this kind of an aura, visual or otherwise. A painless migraine such as an ocular migraine is considered a migraine equivalent.1
Causes And Risk Factors
Although the exact physiology of retinal migraine is unknown, one theory is that it may result from vasospasm, a narrowing of vessels that supply blood to the retina or that are part of the ciliary body of the eye.
Whatever the mechanism, like all types of migraine headaches, retinal migraines tend to be brought on by specific triggers such as stress, high blood pressure, smoking, and more.
Retinal migraines, in particular, may be triggered by:
- Staring at a screen for long periods
- Spending time in fluorescent or other harsh lighting
- Driving long distances or participating in other taxing visual activities
People believed to be at increased risk of retinal migraine headaches include those who:
- Are in their 20s or 30sin particular women, due to hormonal changes related to the menstrual cycle
- Have a history of other types of migraine
- Have a family history of migraine headache
- Have lupus, atherosclerosis, or sickle cell disease
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Migraine Aura Without Pain
A migraine aura without pain is usually called typical migraine aura without headache pain. The symptoms usually build up from 5 to 20 minutes and dont last that long. This is usually called the march of symptoms. To clarify, this is where symptoms gradually increase until they reach the maximum level. After that, they decrease until they go away.
However, most of the time, there is no headache pain associated with the other symptoms. However, because no other disorder can be blamed for the offset of symptoms, the patients are successfully diagnosed with this condition.
When Should You Worry About An Ocular Migraine
Although the symptoms of ocular migraines can be frightening, the condition is harmless and short-lived in most cases. However, ocular migraines can indicate serious health problems, such as increased risk for stroke or severe carotid artery disease.
Its essential to see an eye doctor when you lose your eyesight suddenly for the first time or if your eyesight deteriorates to check for any serious conditions.
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Migraine Aura Symptoms Vs Ocular Migraine Symptoms
Ocular migraine symptoms include a small blind spot that affects vision in just one eye. This blind spot can grow larger and larger, which might result in temporary vision loss. This is different than a visual migraine. In a visual migraine, you might notice a flickering blind spot, a wavy ring of light, or a blind spot that moves across the visual field. Sometimes this is called a migraine aura, and it usually affects both eyes.
Some migraine sufferers experience an aura before a migraine sets in. This aura can appear between 10 and 30 minutes before a migraine sets in. Ocular migraines can include some or all of these symptoms. These symptoms can include:
- Numbness and tingling in the hands and face
- Feeling foggy
- Blind spots, shimmering spots, flashing lights, or wavy lines in the vision
- Disrupted sense of smell, taste, or touch
Because the term ocular migraine is often used to describe the more common migraine aura or visual migraine, there has been some confusion as to what an ocular migraine is. If your vision is affected in only one eye, then you might be suffering from an ocular migraine. If you are not sure if you are suffering from an ocular migraine or a visual migraine, cover one eye at a time to determine if the visual disturbance is affecting only one eye or both. If you experience any sort of visual disturbance, its always a good idea to consult your doctor immediately to determine if its something harmless like a visual migraine or something more serious.
Stay Calm This Shouldn’t Last Long
One of the best things which you can do is to stay calm.
Typically the ocular migraines last ten minutes to an hour and are not known to have long lasting effects.
The more you can relax and avoid stress until the symptoms disappear, the better off you will be.
Plus, once you learn your early warning signals of your ocular migraine symptoms, you will know what to do and feel more in control.
You can take action to take care of yourself faster.
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Ocular Migraine Treatment Options
For symptoms that are infrequent or less severe, treatment options can range from lifestyle adjustments to over-the-counter medications. Symptoms of migraine aura are generally considered less serious and, while they can certainly be disorienting at the time, are always reversible.
A doctor may work with you to identify triggers of migraine attacks to see if addressing these can decrease or resolve migraine aura. In more serious cases, such as with retinal migraines, your doctor may want to explore additional options to see if these symptoms are a signal of something more serious.
Your neurologist should provide an individualized treatment plan with an emphasis on non-invasive approaches and aiming for a full recovery.
Treating Migraine Aura Without Headache
When migraine aura without headache is frequent or severe, your doctor can recommend treatment options, such as low dose aspirin, calcium channel blockers or other medications.
My favorite treatment has been baby aspirin, if they dont have any contraindication for baby aspirin, says Dr. Digre. Calcium channel blockers often will treat aura without headache if its frequent.
For people who experience onset of migraine aura later in life, the symptoms can be very severe and last for several days. In that case, Dr. Digre usually prescribes a calcium channel blocker, but other medications can be used.
There arent any specific lifestyle adjustments to treat migraine aura without headache. However, taking steps like getting adequate sleep, decreasing stress and avoiding known migraine triggers may help prevent aura without headache.
The American Migraine Foundation is committed to improving the lives of those living with this debilitating disease. For more of the latest news and information on migraine, visit the AMF Resource Library. For help finding a healthcare provider, check out our Find a Doctor tool. Together, we are as relentless as migraine.
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Is Retinal Migraine Dangerous
Most often, a retinal migraine attacks will subside after a short time with no lasting harm, though it can affect your ability to drive safely.
Still, its worth discussing with your doctor and potentially getting an eye examination to look into potential causes and rule out more serious concerns, such as a stroke in the eye.
If its never happened before, losing vision in both eyes at the same time may also be a sign of a more serious problem.
Your head may start to hurt at the same time a retinal migraine affects your vision or up to 1 hour later, or you may not experience a headache at all.
The same is true for the more common migraine with aura.
Retinal migraine is considered relatively rare. Its more common for a different type of migraine to affect vision in both eyes, not just one.
Older research from 2005 puts the frequency at about
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 difficultif not impossibleto 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
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The Confusing Migraine: Aura Without Pain
Bottom Line: Whats behind sudden and frightening vision changes
Nada Hindiyeh, MD, director of clinical research and clinical assistant professor of neurology and neurological sciences, Stanford University, Stanford, California, and principal investigator of many studies on migraine.
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Its one of the scariest experiences youre likely to havesuddenly and for no apparent reason, you see a blank, black area in your vision. Then come black zigzag lines, sparklers, brilliant globes of color or some other sort of light show. Next, these strange visual disturbances start moving to your other eye. You might think youre losing your vision. But within an hour, the show is over, your vision is back to normal and you feel fine again.
Whats going on?
What you just experienced is the most common symptom of migraine headaches with aurathe aura itself. Whats confusingand can be scaryis that without the usual head pain that follows, you might be wondering whether theres something wrong with your vision or, worse, that youre having some sort of stroke, such as a TIA. One difference: An aura can last anywhere from 15 to 60 minutesthe visual symptoms of a TIA generally last between three and 10 minutes. Heres what else you need to know
Diagnosing And Treating Ocular Migraines
When you visit your doctor, they will ask about your symptoms, examine your eyes, and order additional tests to rule out other serious conditions such as:
- Amaurosis fugax
- Giant cell arteritis
- Spasms in the blood vessels that carry blood to the eye
- Autoimmune diseases
- Stroke or transient ischemic attack
- Drug abuse
If you have been diagnosed with retinal migraines, consult your doctor about the best treatment options. There is no one recommended treatment regimen since it varies from person to person.
If you dont experience ocular migraines very frequently, your doctor may advise you to use over-the-counter NSAIDs like aspirin and ibuprofen when the episodes occur.4
Your doctor may also recommend the following:
- Anti-nausea medication to reduce nausea and related symptoms
- Calcium channel blockers to lower blood pressure
- Anti-epileptic medications to prevent seizures
- Tricyclic antidepressants to alter the brains chemistry
Doctors dont usually use traditional migraine treatments such as triptans and ergotamines for people with ocular migraines.5
Triptans, for example, arent safe if youre at risk for a stroke, which may be the case for people experiencing temporary blindness in one eye.
A recent technique for treating or preventing ocular migraine is to use a self-administered device that delivers electrical stimulation to the forehead or back of the head. These devices include:
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The Aica Orthopedics Experience
AICA Orthopedics offers multiple locations in the Atlanta area with each housing a team of multi-specialty doctors and medical professionals to address all our patients needs in one convenient location.
Each AICA location boasts a team of orthopedic doctors, neurologists, physical therapists, chiropractors, and more who work together on individualized treatment plans for each patient to ensure the swiftest, safest road to recovery.
If you are experiencing changes in your vision, perhaps accompanying migraine attacks, and are concerned about how this may impact any daily activities, then speak with one of our neurologists today.
We offer consultations with diagnostic image testing often available the same day so we can provide you with as much information as possible so you can experience symptom relief as soon as possible. Visit any of our clinics near you.
How Is Retinal Migraine Diagnosed
There arent any specific tests to diagnose a retinal migraine.
If you see a doctor or optometrist during a retinal migraine attack, they may use a tool called an ophthalmoscope to check for decreased blood flow to your eye, but this generally isnt feasible because attacks are usually brief.
Doctors typically diagnose a retinal migraine by investigating the symptoms, conducting a general examination, and reviewing a personal and family medical history.
Retinal migraine is usually diagnosed by a process of exclusion, meaning that symptoms such as transient blindness cant be explained by other serious eye diseases or conditions.
If you need help finding a primary care doctor or optometrist, you can browse doctors in your area through the Healthline FindCare tool.
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Migraine With Brainstem Aura
People who have migraine with brainstem aura experience visual symptoms that are similar to migraine aura. However, symptoms can also occur in just one eye. The condition is characterized by headaches in the back of the head that span both sides of the head. The condition is rare and occurs more commonly in adolescent girls.
What Else You Should Know About Ocular Migraines
An ocular migraine is short-lived and may not be painful, but it can be debilitating you have to be careful while doing daily activities like driving, reading, or writing. The chance of permanent vision loss due to an ocular migraine is rare but the reduced blood flow for a prolonged time can damage your retina. So it is a good idea to make an appointment with your ophthalmologist to check your condition.
Since hormones play such a big role in causing migraines, declining estrogen levels as women age and enter menopause is a reason why migraines usually reduce in severity in older women.11
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Diet Nutrition & Lifestyle Choices
Evidence is beginning to support the idea that migraine headaches are associated with mitochondria dysfunction. Supplements such as riboflavin , coenzyme Q10, magnesium3, niacin, carnitine, and lipoic acid, which support mitochondrial function, have been shown to help alleviate migraine headaches.2
- Be sure to also read our lifestyle recommendations for migraine headaches.
- See our essential visionwellness tips for this eye condition.
- Stress. Manage stress – meditate, take cool walks in the morning, do yoga … whatever works well for you.
- Computer. Avoid long hours on the computer and take frequent breaks.
- Exercise regularly, at least 3x weekly. Exercise reduces the amount of pain from migraines although it does not directlystop migraines by itself.
- Pay attention to what you eat in the event that the ocular migraines are tied to an allergy.
- Sleep routine. Wake up at the same time each morning, and get plenty of sleep at night
- Finally, acupuncture is worth considering.
What Is Migraine Aura Without Headache
For most people, a headache follows the aura. But some people dont get the headache they just get the aura, says Dr. Digre. That is what is known as migraine aura without headache.
Migraine aura without headache is not very common. Only about 4% of people with migraine have aura without headache. It commonly occurs in two age groups: young adults in their 20s and 30s, and older adults between 40 and 60 years old.
People who have migraine with aura with headache, sometimes will lose their headache as they get older. So the headache part goes away, and the aura continues, says Dr. Digre. Almost 40% of people whove had migraine with aura in later life will get aura without headache.
Migraine aura without headache is sometimes referred to as ocular migraine, a common misnomer. Ocular migraine is not even in the International Classification Of Headache Disorders, explains Dr. Digre, It doesnt exist.
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Taking Medication Is One Way To Stop Them Quickly
The first symptoms occurring can appear to be like flashing lights, blind spots or zig-zag patterns.
When these start, taking a pain reliever can help relax the nerves in the brain and can possibly help prevent a headache from accompanying the ocular migraine.
See your physician to find the best medication to take to stop your ocular migraine symptoms with your unique body. You may need a stronger medication if this progresses to the nasty pain phase.
Diagnosing An Ocular Migraine
If you are experiencing any kind of impairment to your vision similar to the symptoms above, it is always important to discuss those with your doctor. A neurologist can help a patient distinguish between whether they are experiencing migraine aura or more serious retinal migraines.
Neurologists use advanced technologies and state-of-the-art equipment to assess the electrical activity of the brain and how it is communicating with the eyes. Irregular electrical activity in the brain can be affected by a variety of environmental factors, such as times of extreme stress or spending a significant amount of time staring at a screen each day. Your neurologist will speak with you regarding your symptoms, your daily experiences, and utilize diagnostic tests when necessary to establish an accurate diagnosis.
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