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What Happens During An Ocular Migraine

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What happens to your brain during a migraine – Marianne Schwarz

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The visual cues are hard to ignore: shimmering or flashing lights, zigzagging lines or stars, black spots. All make it difficult to read, write, or drive. If you experience these symptoms, youre most likely having an ocular migraine. It can occur with or without the pain of a migraine headache.

For people prone to migraines, one of every five has this visual aura before the headache pain begins. An ocular migraine by itself lasts anywhere from 10 minutes to an hour and isnt considered a serious condition.

Headache specialist Richard Kim, MD, describes a migraine with aura.

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What is a migraine with aura?

Although some doctors think ocular migraines are caused by the same factors that create classic migraines, no one knows for certain. Ocular migraines seem to run in families. They have been linked to estrogen, a female hormone that fluctuates during menstruation, pregnancy, and menopause, or with use of oral contraceptives or hormone replacement therapies.

Most ocular and retinal migraines dont require treatment.

What Is The Main Cause Of Migraines

Researchers and doctors are trying to understand more about how our brain and nervous system work. Migraines are still mysterious. In the early days, medications only targeted the blood vessels, aiming to minimize the pain. Then, new data comes into the light, allowing the medical community to understand that migraines also involve the nerve pathways and the chemicals in the brain.

In addition, migraines have a genetic link, as proven by at least half of migraine patients who have family members with the condition. However, this is just the tip of the iceberg. The other 50% of migraineurs do not have a genetic link. What might their migraine source be then? It means the environment plays a critical role in migraines as well.

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. Its not uncommon for a single patient to experience a wide range of visual symptoms. Heres what you need to know to better understand the migraine subtypes that affect vision.

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Theories About Migraine Pain

Older theories about migraines suggested that symptoms were possibly due to fluctuations in blood flow to the brain. Now many headache researchers realize that changes in blood flow and blood vessels don’t initiate the pain, but may contribute to it.

Current thinking regarding migraine pain has moved more toward the source of the problem, as improved technology and research have paved the way for a better understanding. Today, it is widely understood that chemical compounds and hormones, such as serotonin and estrogen, often play a role in pain sensitivity for migraine sufferers.

One aspect of migraine pain theory explains that migraine pain happens due to waves of activity by groups of excitable brain cells. These trigger chemicals, such as serotonin, to narrow blood vessels. Serotonin is a chemical necessary for communication between nerve cells. It can cause narrowing of blood vessels throughout the body.

When serotonin or estrogen levels change, the result for some is a migraine. Serotonin levels may affect both sexes, while fluctuating estrogen levels affect women only.

For women, estrogen levels naturally vary over the life cycle, with increases during fertile years and decreases afterwards. Women of childbearing age also experience monthly changes in estrogen levels. Migraines in women are often associated with these fluctuating hormone levels and may explain why women are more likely to have migraines than men.

Causes Of Visual Migraines

Ocular migraine: Everything you need to know

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

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An Ocular Migraine Is A Rare Condition Characterized By Temporary Vision Loss Or Even Temporary Blindness In One Eye

Ocular migraines are caused by reduced blood flow or spasms of blood vessels in the retina or behind the eye.

In an ocular migraine, vision in the affected eye generally returns to normal within an hour. Ocular migraines can be painless or they can occur along with a migraine headache.

Unfortunately, the term ocular migraine is often used to describe a much more common condition called a visual migraine or migraine aura characterized by temporary visual disturbances that generally disappear within 30 minutes.

Unlike ocular migraines, a visual migraine typically affects both eyes.

Treating An Ocular Migraine

Because ocular migraines are short lived in their symptoms, the best thing you can do is to rest your vision immediately. This may mean pulling over if you are driving, resting your eyes if you are working, or moving away from a trigger . For those who suffer from ocular migraines frequently, there may be medications that can aid in the prevention of frequent migraines. If you do suffer from migraines in general, seeking medical guidance is important, as there could be other things going awry in your health. If things like blue light are common triggers for your migraines, or if you want to help protect your eyes from strain, you can schedule an appointment with a Valley Eyecare Center eye doctor today to talk about what you can do. Call us at 602-955-2700 or schedule your next appointment online.

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What Type Of Doctor Do You See For Ocular Migraines

If you have ocular migraines, you can see an ophthalmologist oran optometrist.

Optometrists are eye care specialists who offer primary vision care services, including:

  • Vision testing
  • Correction of visual problems
  • Treatment and management of visual issues and eye diseases

On the other hand, ophthalmologists are medical practitioners who specialize in eye and vision care. They differ from optometrists in their degrees of schooling as well as what they can diagnose and cure.

An ophthalmologist is a healthcare professional who has finished college and has at least eight years of further medical studies. He or she is licensed to practice medicine and surgery. Ophthalmologists hold a Doctor of Medicine degree.

Optometrists are healthcare professionals who complete four additional years of school after finishing undergraduate studies. They hold a Doctor of Optometry degree.

What Is An Ocular Migraine Aura

Ocular Migraines

So, lets talk aura, those sensory changes that can accompany migraine . Aura most often manifests as visual disturbances, according to the Mayo Clinic4. But you could also experience different sensations, like hearing music or feeling like someone is touching you. When we’re talking about an ocular migraine, we’re only talking about the visual symptoms.

While some people experience an aura before their migraine headache strikes, an ocular migraine refers to the experience of only experiencing visual disturbanceswithout the stereotypical migraine head pain.

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Headaches Behind The Eye Or Ocular Migraines

Its important not to confuse ocular migraines with generalised headaches behind the eye. Ocular migraines happen as a result of reduced blood flow to the eye, due to a sudden narrowing of the blood vessels, and usually occur in just one eye.

On the other hand, headaches behind the eyes are usually a symptom of traditional headache-type migraines, which can be caused by a number of conditions and external stimuli. Sensitivity to bright light , some prescription medications or simply staring at digital screens for too long can all lead to migraines and headaches behind the eyes.

Serotonin And Other Brain Chemicals

People with migraines tend to have abnormal levels of serotonin, but what role this neurotransmitter plays in this condition isnt exactly clear. It could be that serotonin activates the release of CGRP, which affects the blood vessels and causes pain, or simply plays a role in activating the parts of the brain before an attack. Glutamate is another neurotransmitter that plays a role in migraines. People who have auras during migraines have trouble regulating glutamate, causing it to build up and activate the occipital cortex, the visual-processing center of the brain.

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What Is A Visual Migraine

Visual migraines can mimic other serious conditions, making it very important to see an eye doctor as soon as possible if you experience any sudden vision loss or changes to your vision.

A visual migraine, also known as an ocular migraine, causes temporary visual disturbance. This disturbance often appears suddenly and may create a blind spot moving across the visual field or the sensation of looking through a cracked window.

There are two types of ocular migraines:

  • migraine auras

Migraine auras are very common, affecting 1 in 5 migraine sufferers.

Migraine auras cause binocular visual distortions, affecting both eyes simultaneously. They may also cause:

  • Numbness or tingling
  • Mental fog
  • Changes in taste, smell, or sense of touch.

An aura can occur with or without a migraine, and may sometimes precede a headache. The visual distortions are temporary and usually last around 30 minutes. They can impact performance in certain activities, such as driving and reading.

The most common visual symptoms of migraine auras include:

  • Flashes of light

How Does Migraine Affect The Brain

Ocular migraine: Everything you need to know

Now that we have an idea of how migraines work and how they affect people, lets look at how it can affect the brain. A study tried to know how migraine attacks affect the specific parts of the brain. Its objective was to see the difference between the brains of people with migraines and those without migraines. They used the upright MRI machine invented by Dr. Raymond Damadian. Were there any abnormalities in the brains of people with migraines?

According to the research, migraines are possibly progressive brain diseases. What happens to the brain during a migraine? There was an increase in white matter hyperintensities discovered with each migraine attack.

They observed 28 patients and identified specific regions of brain abnormalities in each individual with migraines. These particular brain regions included:

  • The brainstem
  • Frontal lobes
  • Cerebellum

They also found that both migraine duration and attack frequency are indicators of damage in people with migraines.

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Medications And More About Migraine Care

Doctors typically prescribe tryptamine-based drugs or triptansto people with acute migraines. They are first introduced in the 1990s to calm overactive nerves that produce pain by stimulating the production of serotonin. They come under many types of prescriptive medications, including:

  • Almotriptan
  • Monosodium glutamate
  • Red wine

Triggers vary from patient to patient, and the only way to identify which ones can affect someone is through observation and elimination. A patient should take note of situations, activities, weather conditions, food, drink, or external stimuli that precede the onset of each migraine episode. Over time, a pattern should emerge that would identify the relevant triggers for that patient, and avoiding them should minimize migraines for the patient.

Ocular Migraine Treatment And Prevention

Because they generally are harmless and typically resolve on their own within a half hour, ocular migraines usually require no treatment.

If you are performing tasks that require good vision when an ocular migraine occurs, stop what you are doing and relax until the visual disturbance passes. If you are driving, pull off to the side of the road as soon as you can safely do so, and wait for your vision to return to normal.

There is no test to confirm the diagnosis of ocular migraine. Nonetheless, whenever you are experiencing unusual visual symptoms such as those described here, it is recommended that you undergo a comprehensive eye exam with an eye doctor. This is important so as to rule out sight-threatening conditions such as a retinal tear or detachment, which require urgent attention and/or treatment. Rarely, ocular migraine symptoms can also be associated with stroke.

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Should I Be Concerned About Ocular Migraines

Q: I recently found out by looking on the Web that my symptoms point to ocular migraines. I have also discovered that flashing lights sometimes bring these on. I am an intensive care unit nurse who believes in not running to doctors for every little thing, but should I be concerned?

Dr. Jerry W. Swanson responds:

Not necessarily, but here’s what you should know. Ocular is a term that usually refers to a condition known as migraine visual aura, which involves episodes of passing visual disturbances, such as bright spots, affecting both eyes. Visual aura usually precedes a migraine . However, it may also occur during a headache. In some cases, as with ocular migraine, people experience the symptoms of visual aura without getting a headache. The symptoms of an aura usually begin slowly and last 15 to 30 minutes, although they sometimes persist for up to an hour.

Often, the symptoms of ocular migraine begin near the center of vision as either a bright spot or area of visual loss that spreads to involve one-quarter or one-half of the visual field. Zigzag lines or other shapes may also appear. For some people, these shapes resemble the walls of a medieval fortress. In fact, the term “fortification spectrum” is used by neurologists to describe it.

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A Trigger Starts A Reaction

Migraine aura

First, nerve cells within your brainstem are activated or triggered. This activation can occur for a variety of reasons, including lack of sleep, food or water, for example. A drop in magnesium levels, abnormal calcium channels on the surface of the neuron, mitochondrial changes or other genetic abnormalities are all possible factors.

Once activated, the neurons send messages along the trigeminal nerves, a major pathway that starts in the brain stem and travels along your face, teeth, eyes, sinuses and forehead, as well as to blood vessels on the surface of the brain. These blood vessels expand or dilate in response.

Activity then occurs across the surface of the brain, called a spreading cortical depression. This spread moves like a slowly advancing thunderstorm, traveling from the back to the front of your brain. As it passes over the brain, blood vessels constrict, limiting oxygen flow.

Researchers believe the cortical may be the cause of the visual auras that some people with migraine experience. These auras result in people seeing dark or colored spots, sparkles, or other visual disturbances.

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Ocular Migraine Vs Visual Migraine Whats The Difference

Not all migraine sufferers experience the head pain commonly associated with migraine attacks. Some people experience a type of silent migraine with visual disturbance but no head pain. Ocular migraine also known as retinal migraine is often confused with visual migraine which is a symptom of visual changes or vision loss resulting from the aura phase of the common migraine.

However, for people who experience ocular migraines, the visual changes are a little different and can be very frightening as they most often include temporary vision loss that can last up to an hour. Both ocular migraines and visual migraines can occur with or without a headache.

Ocular Migraine vs. Visual Migraine

Ocular or retinal migraines happen in the eye, so only affect the vision in that eye, while visual migraines occur in the brain, so affect the vision in both eyes together.

Visual Migraine or Migraine with Aura

  • · A typical migraine accompanied by aura
  • · Visual disturbances usually affect both eyes
  • · Aura usually occurs before the migraine head pain attack
  • · Condition isnt serious but can make it difficult to function and complete tasks

Ocular or Retinal Migraine

Temporary Vision Loss

What causes ocular/retinal migraines? Ocular migraines occur when the blood vessels to the eyes start to constrict, or narrow. This reduces the blood flow to one of your eyes. When the migraine ends, the blood vessels relax and open up, allowing blood flow to resume and vision is restored.

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Aphasia Is A Migraine Symptom That Affects Language

Why does it happen? During a Migraine attack, explains neurologist Dr. Amaal Starling from the Mayo Clinic, when someone is having a Migraine attack:

  • They often feel like they aren’t thinking clearly. There’s some slowing of cognition.
  • Other people may experience speech symptoms, a symptom called Aphasia: difficulty understanding language or expressing words
  • Some people may have Dysarthria: slurred, garbled speech

Never ignore Migraine speech problems. If you’re experiencing speech issues or trouble word-finding for the first time, contact a doctor to make sure it’s not related to a more serious issue, such as a stroke.

If your friends tell you that you’re talking gibberish, or if you find you can’t get the words out, it could very well be a Migraine symptom, regardless of whether or not you’re having head pain at that time.

Treatment For Retinal Migraine

Ocular Migraines and Stroke Risk: Is There a Connection?

Treatment for retinal migraine usually just involves taking pain relief for any headaches and reducing exposure to anything that might be triggering the retinal migraine.

Your doctor may sometimes prescribe preventative medication to try and reduce how often you get a migraine. Your doctor will discuss the best way to treat your symptoms with you.

There is no one best way to treat retinal migraine. Your doctor may have to try several different medications to see what works best for you.

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