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How To Treat Visual Migraine

Treatment Options For Ocular Migraine

How to Treat Migraines & Head Colds : How to Get Rid of a Visual Migraine

When visual disturbances with ocular migraine occur without head pain, symptoms usually resolve within an hour and do not require much treatment. People with migraine aura tend to benefit from basic remedies, such as:

  • Rest
  • Over-the-counter analgesics, such as Advil or Motrin or Tylenol
  • Eating or having some caffeine
  • Anti-nausea medication such as Reglan or Compro , if nausea or vomiting occur

More acute ocular migraine with headache is generally treated the same as migraine without visual symptoms, with some notable exceptions. Two types of drugs that are often used to treat acute migraine are not recommended for retinal migraine.

  • Triptans, sometimes called abortives, such as Imitrex and Maxalt , should be avoided for retinal migraine.
  • Dihydroergotamines, also called ergot alkaloids, such as Migranal and D.H.E.45 , should also be avoided by people with retinal migraine.

Preventive treatments that are typically used for other types of migraine may also be beneficial for preventing ocular migraine.

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.

Diagnosis Of Ocular Migraine

Ocular migraines, like other migraines, are diagnosed by neurologists, based on symptoms, medical history, family history of migraine, and physical, eye, and neurological exams. When symptoms are unusually severe or complex, a brain scan may be required to rule out other problems that may be causing pain, such as a tumor or infection.

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Stay Calm And Avoid Stress

While it can feel stressful when you notice the warning signs of an ocular migraine, its important to stay calm and avoid stress. If you let the symptoms upset you, the stress may make the symptoms even worse and result in adding pain to the episode.

Work to recognize and learn the early warning signs of ocular migraines so you know how to relax until the symptoms subside.

Remember, emotional and physical stress will only make any migraine worse. In fact, stress is known to trigger migraines. If you need help staying calm, try learning relaxation skills, such as progressive muscle relaxation or deep breathing techniques.

A Guide To Healing Ocular Migraines

How To Get Rid Of A Migraine Fast

    One in every 200 migraine patients experiences ocular or retinal migraines that can significantly affect their vision. These attacks are often preceded by aura, which typically affects both eyes. Patients might see spots, patterns or flashes of light before a headache develops, and symptoms range from light sensitivity to temporary vision loss. The worst ocular migraines can cause temporary blindness episode lasting several minutes, although the duration is usually less than an hour.

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    What Are Migraine Treatments

    Most ocular and retinal migraines dont require treatment. They will go away on their own. It helps to rest and avoid triggers such as loud noises or bright lights.

    If ocular or retinal migraines occur frequently, your eye doctor may suggest medications, including those used to treat other forms of migraines. Beta blockers, antidepressants and anticonvulsants sometimes are helpful, although more research is needed to determine the most effective treatments.

    Join A Supportive Community

    At MyMigraineTeam, you can join a community of more than 65,000 people who are sharing experiences with migraine. More than 17,000 members have reported having migraine with aura, and another 5,800 members report having retinal migraine. Ask questions, share tips, and learn how others are managing ocular migraine.

    Add your comment below, or go to MyMigraineTeam now and start a new conversation today.

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    Massage The Bridge Of Your Nose Drilling Bamboo Point

    This acupressure point is great to treat headaches too. Its located at the very top of your nose, just above and right between your eyes. Its on either side of the spot where the bridge of your nose meets the inside of your eyebrows.

    1.Using both hands, instead of making small circles just use your index fingers to apply firm but gentle pressure to both points at once.

    2.Hold the pressure to at least 10 seconds, maximum 15.

    3.Release the point, wait a few seconds and repeat. You can do this for about 10 minutes, or more if the pain is escalating.

    If the pain is escalating, and it feels like a migraine is imminent, be sure to take action.

    Papers Of Particular Interest Published Recently Have Been Highlighted As: Of Importance Of Major Importance

    What do I do to treat an ocular migraine?
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    Rabkin R, Stables D, Levin N, et al. The prophylactic value of propranolol in angina pectoris. Am J Cardiol. 1966 18:37083.

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    Quirke V. Putting theory into practice: James black, receptor theory and the development of the beta-blockers at ICI, 19581978. Med Hist. 2006 50:6992.

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    Sprenger T, Viana M, Tassorelli C. Current prophylactic medications for migraine and their potential mechanisms of action. Neurotherapeutics. 2018 15:31323 A recent and comprehensive review of prophylactic migraine medications and their possible mechanism of action related to migraine pathophysiology.

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    Schoenen J, Ambrosini A, Sandor PS, et al. Evoked potentials and transcranial magnetic stimulation in migraine: published data and viewpoint on their pathophysiologic significance. Clin Neurophysiol. 2003 114:95572.

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    Nyrke T, Kangasniemi P, Lang AH, Petersen E. Steady-state visual evoked potentials during migraine prophylaxis by propranolol and femoxetine. Acta Neurol Scand. 1984 69:914.

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    Gehrwig M, Niehaus L, Stude P, et al. Beta-blocker migraine prophylaxis affects the excitability of the visual cortex as revealed by transcranial magnetic stimulation. J Headache Pain. 2012 13:839.

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    Johnson KW, Phebus LA, Cohen ML. Serotonin in migraine: theories, animal models and emerging therapies. Prog Drug Res. 1998 51:21944.

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    What Causes Ocular Migraines

    Theyre 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 theyre 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 dont 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.

    Diagnosis Of An Ocular Migraine

    The diagnosis of an ocular migraine is often made by comparing the patients symptoms to the criteria established by the IHS. Migraines can be difficult to diagnose other conditions that could be causing the symptoms need to be ruled out.

    The potential difficulties of making a diagnosis is the reason the IHS have established criteria to help clinicians to make a proper diagnosis.

    The diagnostic criteria for the diagnosis of an ocular migraine from the IHS Classification ICHD-II are:

  • Two attacks in which the patient experiences the symptoms outlined in B and C.
  • The patient sees flashing lights , a blind spot , or experiences blindness in one eye. A healthcare professional must be able to confirm these symptoms with an examination or a detailed drawing/description.
  • The patient experiences a headache, meeting criteria for a migraine without aura. The headache may begin at the same time as the visual symptoms, but must begin within an hour after the symptoms start.
  • An eye exam performed when there are no ocular or migraine symptoms turns up no evidence of any disease.
  • There is no other explanation, such as another disease or disorder, for the symptoms.
  • There are several other conditions that should be ruled out when symptoms of an ocular migraine are present. These other conditions may have similar symptoms, but will require different treatments.

    Unfortunately, there is a long list of other causes of ocular symptoms that should be ruled out, including:

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    Deterrence And Patient Education

    It is critical to educate the patients about the red flags of vision loss. A visual loss that patients describe as darkness requires immediate medical attention and an emergency room visit. Patients must understand that this could be a sign of a stroke or an irreversible eye condition. Visual changes that are more consistent with migraine phenomenon are usually positive such as flashing light. Patients must also be taught that those could come without a headache or any pain. Preventive therapy is important to reduce the frequency of attacks and severity and must be taken on a daily basis.

    Prescription Medications For Ocular Migraine Treatment

    Ocular Migraine: What You Should Know
    • Blood pressure medication

    Beta-blockers are the first line treatment to prevent the occurrence of ocular migraine. These drugs were originally developed for the treatment of high blood pressure. They are thought to be effective in preventing migraine by restricting the blood flow to the brain and by inhibiting the waves of electric current that move across the brain to form the auras that accompany ocular migraine or migraine with aura.

    Two beta-blockers are FDA- approved for the treatment of migraines. These are propranolol and timolol . Propranolol has been reported to reduce migraine occurrence by up to 50 percent and it is considered to be the most effective.

    The most common side effects of beta-blockers are feeling dizzy, fatigue, tingling or cold hands and feet, weight gain or sexual dysfunction. Beta-blockers can interact with other medications like anti-depressants, insulin and cholesterol lowering drugs, so if you are already taking one of these medications, be sure to inform your doctor.

    Some side effects of calcium channel blockers include dizziness, feeling drowsy, nausea, rash, constipation or low blood pressure. This class of medication can be a good choice for migraine treatment for patients who are not able to take beta- blockers due to other health reasons.

    CGRP inhibitors

    Tricyclic Anti-depressants

    If you have tried other OTC migraine medications and found that they dont work for you, then your doctor may have you try anti-depressants.

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    Risk Factors And Complications

    Like migraines without aura, migraines with aura dont appear to cause lasting damage, although they can be painful and disruptive.4 However, people who experience migraines with aura may have a slightly higher risk of stroke, and so should be aware of the signs.2,5

    You should also consult a doctor when you first experience aura symptoms, as some of these can also be caused by a stroke, retinal tear or other serious conditions.2

    Migraines are also more common in women than in men, and in people who have a family history of the condition.2

    How Can I Prevent An Ocular Migraine

    Making sure youre well hydrated, eating a balanced diet, and are in overall good health when it comes to your blood pressure and blood sugar levels, should go a long way to helping reduce the occurrence of ocular migraines. In terms of treating any pain that comes with the ocular migraine, you can take pain relief such as paracetamol or ibuprofen, as well as reduce your exposure to the triggers we discussed earlier in this blog post. You may also be able to have anti-epileptic medication prescribed to you, which can help prevent migraines. However, there is still plenty of research to be done when it comes to treating ocular migraines.

    To help with the pain, you might find it useful to:

    • Lie down in a dark room
    • Massage your scalp or temples
    • Sit in a quiet environment
    • Drink water

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    Warning Signs Of A Migraine

    Many people who have migraines with auras have what are called prodromal symptoms, hitting up to 72 hours in advance. You may notice a predictive pattern of irritability, euphoria, thirst, hunger, or simply feeling off, explains Dr. Wall. In that case, he doesnt suggest taking medication that far in advance, but make sure youre ready for one by carrying your medications with you and responding quickly, he says.

    Pearls And Other Issues

    Ocular Migraine – Self-Help, Self-Cure Through Trial and Error
    • A retinal migraine a rare phenomenon that usually affects monocular vision transiently.
    • Duration of symptoms on average is 5 to 20 minutes.
    • The prognosis for an ocular migraine is good.
    • The frequency and intensity of the headache typically decrease.
    • During prolonged periods of retinal, choroidal, or optic nerve hypoxia, permanent visual loss may occur.

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    Headaches Behind The Eye In People Over 40

    In particular, people over the age of 40 may begin experiencing headaches behind the eyes more frequently as they get older due to a condition called presbyopia. As the eyes age, it can become more difficult for them to focus on objects up-close, causing them to squint and strain in order to see more clearly. This strain can lead to feelings of pain behind the eyes, alongside soreness and redness.

    With other common conditions such as blurry vision, digital eye strain, and difficulty seeing up-close, its best to have your eyesight checked by an optician if youre concerned.

    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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    What Are The Red Flags That My Visual Symptoms Are Not Due To Migraine

    The typical symptoms of a visual migraine are positive, meaning that there is something shimmering or sparkling that is disrupting the vision. Migraines are less likely to cause negative symptoms of pure visual darkness. An episode of visual darkness typically requires additional evaluation for other conditions, including a mini-stroke .

    Propranolol For Migraine Prevention: A Complete Guide

    Learn how to do anything: How to Treat an Ocular Migraine

    Those who struggle with migraines understand that they can be absolutely debilitating and have a huge negative impact on your day to day quality of life. While many people have infrequent bouts with migraines, some have to endure long term migraines that can last for days and come on without warning or apparent cause. While there are multiple medication types used to treat and prevent migraines, beta blockers are a common choice due to their ability to prevent migraines from occurring in the first place with a relatively benign side effect profile.

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    A Pain Score Reduction Of Four Points Occurred In 82% Of Timolol


    Oral ?-blockers have been used for migraine headache prevention, but they havent been shown to effectively treat acute pain. Some small case series, however, have suggested that topical ?-blockers might help when an acute migraine strikes.

    To better investigate topical ?-blockers short-term efficacy and safety, a recent randomized clinical trial compared topical timolol maleate ophthalmic solution 0.5% with placebo eyedrops for acute migraine attacks. The crossover trial included 50 patients with migraine, randomized to receive either timolol eyedrops or a placebo . The three-month treatment period was followed by a one-month washout. After the washout, patients received the opposite treatment for another three months.

    The 50 patients suffered a total of 619 migraine attacks during the study, of which 284 were treated with timolol, 271 with placebo and 64 occurred during the washout period and received no study medications. Seven patients withdrew from the trial after randomization.

    The researchers found that 233 timolol-treated migraine attacks were associated with a reduction in pain score by four points, or to zero, after 20 minutes, compared with the 38 placebo-treated attacks. Overall, the pain score reduction after 20 minutes was significantly greater in the timolol group.

    Kurian A, Reghunadhan I, Thilak P, et al. Short-term efficacy and safety of topical ?-blockers in acute migraine: A randomized crossover trial. JAMA Ophthalmology. October 1, 2020. .

    What Causes Migraine With Aura

    It is not known exactly what causes auras.

    Scientists have looked into it and found that it may be caused by a slow wave of altered brain activity called cortical spreading depression. This leads to temporary changes in the chemicals, nerves and blood flow in the brain that affect how it works and could be related to pain.

    Improving understanding of how these changes in the brain can lead to headache will help with the discovery of new drugs that could prevent migraine attacks.

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    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.


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