The Difference Between Migraines With Aura And Ocular Migraines
There’s nothing like it–the excruciating, throbbing pain in your head that can only be a migraine. If you suffer from migraines, you may have noticed some visual disturbances in addition to your headache. Most likely what you have experienced is a migraine with aura accounting for approximately 20% of all migraines. There is also another less common type of migraine with visual disturbance called an ocular migraine affecting only about one out of every 200 people who have migraines. These two types of headaches are very similar making it very confusing to tell which is which. Read on to learn the distinctions between the two.
What are the symptoms?
The symptoms of the two conditions are almost the same except for a few telltale signs. The main difference is a migraine with aura will affect both eyes while an ocular migraine affects only one. Both have visual disturbances such as:
- Flashes of light
- Shimmering, colored, or flickering lights
- Floating lines
The visual disturbances tend to go away before the headache begins for the migraine with aura but can last longer for the ocular headache. Also, the headache, which can also be accompanied by symptoms of nausea and severe light sensitivity, tends to be right behind the affected eye of an ocular migraine but can be more spread out for a migraine with aura.
What are the causes?
What to do about them?
Ocular Migraine And Visual Migraine Symptoms
Ocular migraine symptoms generally include a small blind spot that affects your central vision in one eye. This blind spot gets larger, making it impossible for you to drive safely or read with the affected eye.
In some cases, the entire visual field of one eye may be affected. Generally, the episode lasts less than an hour.
Visual migraine symptoms can vary, and may include:
Visual migraines often appear suddenly and may create the sensation of looking through a cracked window. The visual migraine aura usually moves across your field of view and disappears within 30 minutes.
A flickering blind spot in the center or near the center of your field of view
A wavy or zigzag ring of colored light surrounding a central blind spot
A blind spot that slowly migrates across your visual field
The symptoms of a visual migraine typically affect both eyes and last less than 30 minutes. A migraine headache may occur shortly after the symptoms of a visual migraine subside or no headache may occur.
If you’re experiencing a blind spot or other visual disturbance and you’re not sure if it’s an ocular migraine or a visual migraine , cover one eye at a time. If the visual disturbance affects just one eye, it’s probably an ocular migraine. If it affects both eyes, it’s likely a visual migraine.
A Potential Sign Of Something More Serious
Visual disturbances are sometimes representative of bigger dangers than they first appear.
As already discussed, floaters can sometimes represent serious eye disease or even retinal detachment. New visual disturbances, especially those that are only present in one eye, can also represent a serious problem.
Painless dark spots or floaters that are new, sometimes accompanied by flashes of light or loss of vision, may mean you have experienced a retinal or vitreous detachment. You should see an ophthalmologist right away, as vision loss may become permanent.
The transient loss of vision in one eye can be a warning sign of stroke or inflamed arteries. These episodes usually last 30 minutes, and they are not associated with headache. They are especially worrisome if you are over 45 years old. If you experience these symptoms, see an see an ophthalmologist, neuro-ophthalmologist, or neurologist immediately.
Tunnel vision, loss of one side of the visual field, or episodes of complete blindness can be signs of a stroke. They may or may not be accompanied by dizziness, imbalance, weakness, numbness, double vision, or headache. See a doctor promptly if these occur.
What Is A Headache
Those unpleasant pains in your head that feel like achy pressure are headaches. The pain can range from mild to severe, usually affecting both sides of your head. Some target areas include the temples, forehead, and upper neck. A headache can last anywhere from 10 minutes to several days.
Tension headaches are the most common type of headache, and patients say they feel like their forehead is being forcefully squeezed by a tight band. Eye pain commonly accompanies a tension headache. While the cause of tension headaches is unknown, visual misalignment can produce identical symptoms to a tension headache, as will be discussed below.
Why Can Covid
In an observational study from August 2020, researchers looked at the symptoms of 13 people with COVID-19 whose main symptom was a headache. Five of the 13 people were previously diagnosed with migraines and three of the people developed a headache as the first symptom.
According to the study’s authors, headaches may develop due to the coronavirus entering the trigeminal nerve, which could activate mechanisms known to cause migraine episodes and other types of pain. The trigeminal nerve is the largest of your 12 cranial nerves.
Research has shown that parts of the trigeminal nerve lack the protective blood-brain barrier that prevents microorganisms from entering the central nervous system.
Autopsy studies have found evidence of degeneration of the trigeminal nerve in people with COVID-19, suggesting either direct damage from the coronavirus or damage from the body’s immune response.
COVID-19 is thought to get into your body’s cells through receptors for an enzyme called angiotensin converting enzyme 2 . ACE2 receptors have been found in neuronal cells of the trigeminal nerve as well as in many other parts of the body.
Effects Of The Pandemic On People With Migraines
Various factors related to the COVID-19 pandemic that are not related to direct viral infection may have increased the frequency or severity of migraines in some people.
A September 2020 study found that in a group of 1,018 people with migraines in Kuwait, more than half reported an increase in migraine frequency or severity from before the pandemic.
Factors such as lack of communication with a neurologist and increased stress could have played a role.
Only 4 percent of study participants developed COVID-19, but 63.4 percent of those people said their migraines got worse.
It is possible that ocular migraines may persist in some people even after recovering from COVID-19.
Some people develop headaches that last for months after COVID-19. For example, in one case study, a woman experienced persistent loss of smell and headache 80 days after the onset of symptoms.
During her COVID-19 illness, she suffered from migraine-like headaches, but reported that her subsequent headaches felt different.
Researchers are still trying to understand why some people develop long-lasting COVID-19 symptoms after recovering from their initial infection. Increased inflammation and neurological damage may play a role.
Eye migraines often refer to headaches that cause visual disturbances. It can also refer to a specific type of migraine that causes vision loss called a retinal migraine.
from American Chiropractors Directory and News – Feed
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 3–5 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.
Common Symptoms Of Ocular Migraines
The symptoms of an ocular migraine are the same as a migraine with aura and can go through the entire process of;
Prodrome => Aura => Attack => Postdrome
But may not include an actual headache.
Common symptoms beside the visual ones included above are:
- Pain in your head on one or both sides
- Pain or stiffness in neck, shoulders or face
- Constipation or diarrhea
How Can I Treat Migraines Without Using Medicines
It is very important to remember that many of the most effective preventive treatments for migraines do not require any medications. Frequent aerobic exercise is an excellent example of an effective way to improve headaches. Other strategies may include better sleep habits, stress reduction, , , and .
How Can I Tell If My Headache Is Vision
The only way to properly determine whether vision is at the root of a common headache or migraine is to have Dr. Patrick Quaid, Dr. Hadassah Rutman, & Dr. Daniel Cunningham assess your condition with a complete functional vision evaluation. Patients who suffer from headaches and seek our treatment are usually experiencing one or more of the following symptoms:
- Stabbing or dull pain around the eyes
- Headache that impairs your ability to perform daily tasks or remember things
- Throbbing pain in the head or around the eyes
- Sensitivity to light
- Frontal headache
Whether you experience one or more of the above symptoms regularly or occasionally, know that treatment is available.
What Are Migraine Triggers
A number of factors can trigger a migraine, whether it’s ocular, retinal or classic migraine. The reasons can vary from person to person. If you have ocular migraines, pay attention to these possible triggers:
- Stress and anxiety
- Relaxation after a stressful time
- Loud sounds or bright lights
- Strong odors
- Changes in weather
Retinal migraines are more likely to be triggered by other factors: intense exercise, dehydration, low blood sugar, high blood pressure, hot temperatures and tobacco use.
Certain foods can trigger both types of visual migraines:
- Red wine or other alcohol
- Food and drink with caffeine
- Hot dogs, sausage and other processed meats that contain nitrates
- Chips, fast foods, broths and other products with the flavor enhancer monosodium glutamate
- Artificial sweeteners
- Food with the naturally occurring compound tyramine, including smoked fish, cured meats and some soy products
How Common Are Ocular Migraines
They are more common in women and have a genetic link to them.
It’s always more important to focus on the epigenetic and exposomic links because you can change those and they will affect your health far more.
Below is a great video representation of the migraine as it grows.
Visual Aura Symptoms In A Clinical Context
MA is a risk factor for several serious cardiovascular conditions, including ischemic and haemorrhagic stroke , myocardial infarction , atrial fibrillation and perioperative stroke . Moreover, the risk of vascular incidents increases up to 13 fold with the use of combined oral contraceptives , which is important considering that the majority of migraine patients are women of reproductive age . Furthermore, the differential diagnosis includes cerebrovascular disorders, epilepsy, and other life-threatening neurological conditions. In clinical practice, MA can be very difficult to distinguish from transient ischemic attacks and stroke. Migraine is the third most common stroke mimic, following seizures and psychiatric disorders, and accounts for 18% of all improper thrombolytic treatment . Vice versa, patients with overlooked strokes in an emergency department setting most often receive an initial misdiagnosis of “migraine” .
Therefore, it is of utmost importance to correctly diagnose patients with MA in order to effectively distinguish MA from other, potentially life-threatening, conditions. Indeed, the quality of VASs is one of the most important features and we believe that establishing a consensus in the form of an official list of all MA visual symptoms is essential.
How To Treat An Ocular Migraine
Ocular migraines are treated the same way as other migraines, and both medications and lifestyle changes may help to cut down symptoms and reduce the number of migraines you have.
Migraine medications fall into two categories: drugs that help stop migraines when they happen and drugs that prevent migraines.
you can take when you get a migraine include:
Non-steroidal anti-inflammatory drugs like ibuprofen or acetaminophen
NSAIDS with like Excedrin
Prescription triptan drugs like sumatriptan or rizatriptan
Medications you can take daily to prevent migraines include:
Beta-blocker medications like propranolol
Certain like amitriptyline
Anti-seizure drugs including topiramate and Valproate
There are also new prescription monoclonal antibody drugs which may be self-injected monthly or every few months which have been effective for many people in preventing migraine.
Lifestyle changes are also a key way to prevent migraines. “I generally recommend that people maintain a routine lifestyle because the brain thrives on a regular routine,” Hindiyeh says.
Hindiyeh recommends several helpful lifestyle changes, including:
Sleeping and waking up at the same time every day and avoiding naps
Eating regular meals
Doing some aerobic exercise every day where you get your heart rate up and sweat, like or
It’s also important to avoid ocular migraine triggers like bright digital screens as much as possible.
How Are Visual Migraines Treated
Migraine auras typically disappear on their own within 30 minutes. If you have an accompanying headache, it is best to take a pain reliever before the headache worsens. In the meantime, during an episode of a migraine aura, try to just relax and close your eyes until the aura passes.
Retinal migraines may be caused by a more serious condition, and should be treated right away.
Seek emergency medical care if you experience a retinal migraine, or any type of vision loss.
Articles On Migraine Types
It’s rare. Some research suggests that in many cases, the symptoms are due to other problems.
Regular attacks can also cause problems, called an aura, which can involve flashing lights and blind spots. But these symptoms usually happen in both .
Talk to your doctor to find out if you have ocular migraine. They can rule out other conditions that can cause similar symptoms. Be ready to describe what you went through as completely as you can to help them figure out what’s really going on.
Visual Disturbance Of Migraine Is Short
The visual disturbances of migraine generally last less than an hour, most commonly 10-30 minutes. Sometimes they only last seconds. They may or may not be associated with a headache, and some individuals only experience the visual symptoms without headaches. The visual symptoms usually start before the headache but may occur during the headache.
To complicate the issue, migraine may change throughout life. The character of the headache may change, and the visual symptoms may change. The most common pattern is for the headaches to become less severe or even go away, with episodes of visual aura persisting. Some people only experience migraine-related visual symptoms, often without headache, starting at age 50 or later.
Causes Of Visual Migraines
Some researchers believe ocular migraines are caused by changes or spasms in the retinal blood vessels or nerves, however the exact cause is still unknown.
Most eye doctors believe they are caused by the same factors that lead to classic migraines, including:
- Family history of migraines
- Foods containing nitrates, MSG, or tyramine
Treating And Preventing Migraine With Aura Or Retinal Migraine
For infrequent attacks, medications that target symptoms can be effective, from NSAIDs for pain to anti-nausea medications. Preventative therapies including calcium channel blockers, antiepileptic or tricyclic medications. Quitting smoking is recommended and cessation of oral contraceptives may be advised in certain circumstances. Some options for relief without drugs can include resting your eyes, removing yourself from bright sunlight or other harsh lighting, and taking a break from looking at a screen. As with all types of migraine, try to avoid triggers like stress, dehydration, high altitude, low blood sugar, excessive heat and extensive time spent staring at a screen.
While the symptoms can be disorienting and distressing, they are often short-lived, and almost always reversible. Take some time away from triggers and wait for the symptoms to fade. For more information, visit the American Migraine Foundation’s resource center, which includes content specifically related to Migraine with Aura, Retinal Migraine and . The American Migraine Foundation is committed to providing comfort and information to people living with this disease. You are not alone: find your support network today.
Visual Disturbances Can Occur In Both Eyes
Migraine-related visual symptoms are usually seen in BOTH eyes. Sometimes this is hard to determine, as the symptoms may occur only on ONE SIDE of the visual field. Covering one eye, and then the other, helps to figure out whether the symptoms come from the brain , or the eye .* The visual symptoms of migraine fall under three general categories: positive symptoms, negative symptoms and altered/distorted vision.
Inborn Errors Of Metabolism
A handful of inborn errors of metabolism may cause visual hallucinations. While these are quite rare, they are nonetheless important to consider because patients with inborn errors of metabolism may present with hallucinations at a time when their disease is treatable and when serious neurologic damage has not yet occurred. Specific inborn errors of metabolism that may present with visual hallucinations include homocysteine remethylation defects, urea cycle defects, GM2 gangliosidosis, Neimann-Pick disease type C, and ?-mannosidosis.
What Are My Treatment Options
Medications may be prescribed to prevent episodes if avoiding triggers does not help control symptoms. Preventative mediations can include a beta-blocker , calcium channel blocker , antidepressant , and/or an anticonvulsant . Treatment with an antidepressant or anticonvulsant does not mean you have depression or seizures; they are intended to stabilize the central nervous system and raise the threshold at which attacks are triggered. Medication regimens may be tailored to your existing medical conditions. Once symptoms are controlled, medications may be weaned off and do not necessarily need to be taken forever.
Vestibular rehabilitation is a type of physical therapy that may also be recommended to treat chronic balance dysfunction. Vestibular therapy will train your brain to desensitize itself to common sensory triggers. The course of therapy is often gradually increased in its intensity and can be widely varied to combat multiple types of triggers that include movement, visual perceptions, and posture instability.
Treatment to help stop a vestibular migraine attack once it begins includes rest, observation, hydration, and medications such as anti-nausea, antihistamine, or sedatives if needed. However, the most effective way to treat vestibular migraine is preventing an attack as described above, and it is critical to recognize your triggers. Many cases can be treated with trigger avoidance alone.
Common Headaches And Migraines
Pinpointing the cause of a headache can be difficult because headaches are a symptom of a multitude of conditions, rather than a disease itself. What many don’t know is that headaches can actually be rooted in visual dysfunction, especially following a traumatic brain injury or stroke. And while migraines are a more severe form of headache, they too can be related to visual dysfunction. If you suffer from sporadic headaches or migraines, make an appointment with Dr. Patrick Quaid, Dr. Hadassah Rutman, & Dr. Daniel Cunningham to rule out visual dysfunction as the cause or contributing factor.
What Causes Ocular Migraines
They’re thought to originate in a similar way as migraine headaches, by irregular electrical activity in the brain. Genetics play a role in who experiences migraines, and they’re also more common in women. Potential triggers include certain MSG-containing foods, harsh light, stress and changes in weather.
Although the root cause is the same, it is not known why some people experience migraine pain after visual disturbances and others don’t – or why the same person might experience both on different occasions.
“It is quite common that as women get older, they might have fewer headaches and less pain but more of these auras,” Dr. Estemalik says.
What Causes Visual Hallucinations
Numerous hypotheses have been suggested to explain the genesis of visual hallucinations. These have been summarized and categorized by Asaad and Shapiro: psychophysiologic , psychobiochemical , and psychodynamic . Visual hallucinations can be the result of all 3 processes, given the interplay among disturbances of brain anatomy, brain chemistry, prior experiences, and psychodynamic meaning.
To date, no single neural mechanism has explained all types of visual hallucinations; however, the similarity of visual hallucinations that are associated with seemingly diverse conditions suggests a final common pathway. Manford and Andermann summarized 3 pathophysiologic mechanisms thought to account for complex visual hallucinations.
The first mechanism involves irritation of cortical centers responsible for visual processing. Irritation of the primary visual cortex causes simple elementary visual hallucinations, while irritation of the visual association cortices causes more complex visual hallucinations. These data are supported by both electroencephalographic recordings and direct stimulation experiments.
Ocular Migraine Is A Common Cause Of Visual Disturbances
For the majority of the time we see clearly in any given circumstance and often we don’t give our sight a second thought! Occasionally, we experience an episode which makes us sit up and take notice.
A commonly reported symptom in many optical practices is that of a painless, temporary disturbance in vision. This can be quite disconcerting, or even frightening if experienced for the first time. These symptoms are often caused by an ocular migraine.
What Does An Ocular Migraine Feel Like
An ocular migraine begins with a sparkling and shimmering area that has a jagged border and that gradually spreads outward. It causes a small blinding spot that enlarges and blocks your vision temporarily. The brightness begins at the edge of your field of vision and gradually spreads to your line of vision. Zigzag lines or stars may also be seen. It is almost like looking through a broken window. Scotoma is the area where vision is disrupted and the whole episode is called a positive aura.
An ocular migraine is often referred to differently by different experts. While many call it a visual migraine or a typical aura without headache, the International Headache Society classifies such a migraine as a silent or acephalgic migraine.
Though it seems serious since you lose your vision partially, the condition is usually harmless and will resolve on its own within 20–30 minutes without any medical intervention. Complete visual darkness, or a negative aura, is not a symptom of an ocular migraine, but of some other underlying condition that needs to be investigated.
Retinal Migraine Occurs In One Eye
Retinal migraine usually occurs in one eye, and there may be an abnormal spread of electrical activity in the retina. The migraine may also be caused by the sudden constriction or blockage behind, or in, an eye. It may occur with, or without, a throbbing headache at the side of the head. The patient may also simultaneously experience sensitivity to light or nausea. The temporary loss or distortion of vision in one eye makes it difficult to conduct close visual work and makes it dangerous to drive. This type of migraine is generally of short duration, an hour or less, and then vision returns to normal. However, some researchers have found that irreversible vision loss is also possible.
Retinal migraine, as defined by the International Headache Society, is actually fairly uncommon. Most cases are diagnosed as ophthalmic migraine.
When To Call The Doctor
- A change in migraine features, how often a migraine happens, or how severe it is
- A headache that lasts days, getting worse as it goes
- A headache brought on by , , bearing down, or straining while on the toilet
- The worst headache youâ€™ve ever had, especially if it started very quickly
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Mayo Clinic: “Migraine Aura.â€?
American Migraine Foundation: “Chronic Migraine — The Basics.â€?
Bisdorff, A. Therapeutic Advances in Neurological Disorders, May 2011.
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Cleveland Clinic: “A Migraine Without Pain? Yes, It Can Happen, and Itâ€™s Called an Ocular Migraine.â€?
Yale Medicine: “Abdominal Migraine: Symptoms, Diagnosis & Treatment.â€?
Cephalalgia: “Abdominal migraine.”
Visual Impairments Associated With Migraine Can Happen With Or Without A Headache
“Ocular Migraine” is a term that has been used to refer to a number of migraine subtypes that are characterized by a variety of visual disturbances including visual loss, blind spots, zig-zag lines, or seeing stars. Unlike other forms of migraine, they may occur without any accompanying head pain. It’s not uncommon for a single patient to experience a wide range of visual symptoms. Here’s what you need to know to better understand the migraine subtypes that affect vision.