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:
How Are Ocular Migraines Treated
Treatment for migraines, in general, may include medication , injections, lifestyle changes , and biofeedback, also known as progressive muscle relaxation training, which often provides immediate relief, explains Dr. Sodhi.
As for ocular migraines, specifically, both Dr. Sodhi and Dr. Wang say treatment highly depends on an individual person’s symptoms. Again, sometimes treatment isn’t even necessary, as ocular migraine symptoms tend to resolve on their own, explains Dr. Sodhi.
In terms of finding relief for ocular migraines: “Closing and resting your eyes can help, as well as avoiding harsh, bright light and tech screens,” says Dr. Sodhi. Dr. Wang also recommends remaining in a dark room to prevent triggers from light. In some cases, anti-nausea medications and/or nonsteroidal anti-inflammatory drugs , such as ibuprofen, can target certain symptoms and provide relief as well, adds Dr. Sodhi.
Of course, if you experience a sudden loss of vision in one eye or both or any troubling symptoms you haven’t experienced before, you’ll want to see a doctor ASAP to rule out a more serious condition like a stroke or a seizure, which both require immediate medical attention. Your primary care doc is a good place to start, as they can refer you to a specialist as needed. Regardless, checking in with your doctor is the best way to determine the cause of your symptoms and how to alleviate them as quickly as possible.
Symptoms Of Ocular Migraines
Q: I have had ocular migraines for many years. I have the classic jagged strobe effect. No big deal usually.
But last year I had a weird and different thing happen that still worries me. All of a sudden my eyes crossed and stuck that way. My fingertips went sort of numb, and the side of my tongue and bottom lip went numb. When I tried to explain this to the nurse, I sounded like a stroke victim.
I saw a neurologist, and he felt it was just a more intense type of ocular migraine. Have you ever heard of this? The MRI showed nothing significant. S.
A: By definition, this would not be a classic ophthalmic migraine, because the symptoms are outside of what is seen. Therefore, I personally would not classify it as a “more intense type of ophthalmic migraine.” These symptoms could be associated with some of the more common non-ophthalmic migraine phenomena. Dr. Slonim
Q: My husband began having symptoms of something very strange. We looked online and found your site. It turns out he was having an ocular migraine.
Your explanation and even better the visual little flash movie explained exactly what he was having and put our minds at ease. We were both thinking brain tumor or aneurysm . So thank you for putting together such an amazingly informative website.
In reviewing your log, you or your doctor may find a consistent pattern of triggers related to your episodes. Avoiding these triggers might help reduce the frequency of your episodes. Dr. Slonim
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Treatment Options For Ocular Migraines
Ocular migraine is not well understood, and some treatments are supportive in nature, meant only to help deal with symptoms.
Certain medications can also be helpful in preventing an episode. Triptans, which are sometimes used to treat other types of migraines, are not typically used to treat ocular migraines. Some of the medications that may be used to treat ocular migraine include:
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.
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What Are The Best Questions To Ask A Neurologist
Common Questions to Ask a Neurologist about: a) Headaches. What types of headaches usually indicate serious brain ailments? Can headaches related to neurological conditions have specific triggers? How Can I see treatment for such headaches? Do I need to make any change to lifestyle/ diet to combat such headaches? b) Multiple Sclerosis
Are Ocular Migraines Harmful
In general, ocular migraines are not considered harmful. Most people have no symptoms other than blindness or blind spots. Neither retinal migraines nor full ocular migraines are, in and of themselves, harmful. However, in some cases, retinal or ocular migraines may be a sign of a more serious problem. If you have a retinal or ocular migraine, its important to consult with a doctor as soon as possible to undergo an evaluation and ensure your symptoms dont signal a larger problem.
Most of the time, ocular migraines are not caused by actual visual symptoms nor is their trigger within the eye. Instead, they are caused by migraine activity within the visual cortex of the brain.
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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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Proactively Dealing With Known Ocular Migraine Triggers
If during diagnosis, a doctor is able to identify a trigger for ocular migraine, he or she will advise that the affected person actively avoids all that are within their own control in order to reduce risk or prevent potential attacks in the future. Reducing exposure to a particular trigger, such as specific food, smoke, lack of sleep, dehydrated state or strenuous exercise, can considerably alleviate the possibility of future migraine attacks.
Making an effort to maintain a nutritious and balanced diet, and get plenty of sleep and regular exercise will not only improve a persons overall health condition, but can also contribute to keeping future ocular migraines at bay .
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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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What Are The Symptoms
Loss of vision
Some people with retinal migraine will completely lose their vision in one eye for a short period of time, typically 10-20 minutes.
Others will only partially lose their sight in one eye vision may slowly become blurred or dimmed, or there may be flashes of light.
Some people see a mosaic-like pattern of blank spots , which enlarge to cause total loss of vision.
Vision then gradually returns. It’s unusual for an episode to last longer than an hour.
In almost all cases, the same eye is affected every time.
Not everyone with retinal migraine will develop a headache. If they do, it may happen before, during or after the vision attack.
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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.
Other Specialists Who Diagnose And Treat Migraine
Migraine can be a hard condition to correctly diagnose and treat. You may need to see other medical specialists to rule out conditions that cause migraine or migraine-like symptoms. These doctors include:2-4
- Neurologists: Doctors who diagnose and treat disorders of the nervous system. These include migraine, stroke, concussion, epilepsy, Parkinsons disease, Alzheimers, and multiple sclerosis.
- Ophthalmologists: Specialists who treat eye disease. Many people with migraine have vision changes, loss of vision, and sensitivity to light. This means some people go to an eye doctor first. An ophthalmologist can help decide if symptoms are caused by an eye disorder or migraine.
- Obstetrician/gynecologists: An OB/GYN treats issues of the female reproductive system, such as pregnancy and childbirth. Women whose migraines are tied to their menstrual cycle may first talk to their OB/GYN before seeing a headache specialist.
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.
How Are Visual Migraines Diagnosed
Visual migraines are diagnosed based on the symptoms you report to your doctor. Before confirming a diagnosis, your doctor will rule out other serious conditions that may cause similar symptoms, such as:
- Amaurosis fugax- a temporary blindness from a blocked artery
- Spasms in the artery that carries blood to the retina
- An autoimmune disease that causes blood vessels to swell
- Giant cell arteritis- a condition that causes the blood cells to swell, leading to vision loss and blindness
- Sickle cell disease and polycythemia- inhibit normal blood clotting
- Drug abuse
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Women Are More Likely To Experience Neurological Problems Such As Migraines And Multiple Sclerosis With Ophthalmic Complications
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When women enter an ophthalmologists office complaining of headaches or sudden visual problems, the physician must be aware that these symptoms can be indicators of neurological conditions that target women. Ophthalmologists are often the first physicians to see patients who are experiencing migraines or the onset of multiple sclerosis, experts say.
Most neurological conditions that have ophthalmic manifestations are symptomatic with symptoms such as pain, diplopia, redness and visual loss, Deborah I. Friedman, MD, told Ocular Surgery News in an e-mail interview. Most often, the patient will have a complaint that will guide the history and exam.
Its important to do a good exam, Jacqueline S. Winterkorn, MD, PhD, said. If the doctor is not comfortable handling neurologic visual fields and looking for an afferent pupillary defect, he should refer the patient to a neuro-ophthalmologist, she said.
Drs. Friedman and Winterkorn, along with Joseph F. Rizzo III, MD, spoke with OSN about neurological disorders with ocular complications that are commonly seen in women.
One neurological disorder that shows a definite predominance of women is multiple sclerosis, which often initially presents with visual symptoms.
Jacqueline S. Winterkorn
Thyroid eye disease
|Deborah I. Friedman|
Giant cell arteritis
Risk Factors And Triggers For Ocular Migraines
Genetics, family history, and environmental factors are thought to play a role in an individual’s susceptibility to migraines. Research has shown that there are common triggers that may cause any type of migraine:
- Stress or anxiety
- Certain foods and additives
- Alcoholic drinks
- Exposure to bright sunlight or artificial lights
- Loud noises
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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.
Treatment Options For Migraine
You should always talk to your GP if youre having frequent and/or severe migraines, as they can help you find an effective treatment and manage your symptoms. The exact type of treatment youll need will depend upon a few factors, including the type of migraine you have and the severity of your symptoms.
Over-the-counter painkillers like ibuprofen and paracetamol can be helpful for moderate symptoms. For more severe symptoms, your GP might recommend prescription painkillers, or a medication like triptans. Sometimes, a combination of medicines will be needed.
If these kinds of treatments dont work for you, your GP might refer you to a specialist for a treatment like transcranial magnetic stimulation. This is where an electrical device is strapped to your head and delivers small magnetic pulses through your skin.
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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.
What Are Migraine Triggers
A number of factors can trigger a migraine, whether its 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
Dr. Kim discusses common triggers for migraine headaches.
Click play to watch the video or read video transcript.
What are some triggers for migraines?
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
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