Ocular Migraines

An ocular migraine can cause eyes' target='_blank' rel='noopener noreferrer' >vision loss or blindness in one eye for a short time -- less than an hour. This happens before or along with a migraine headache.

It's rare. Some research suggests that in many cases, the symptoms are due to other problems.

Regular migraine attacks can also cause vision problems, called an aura, which can involve flashing lights and blind spots. But these symptoms usually happen in both eyes.

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.

Symptoms

You may hear your doctor call ocular migraine by some other names, such as visual, retinal, ophthalmic, or monocular migraines. Warning signs include:

Vision problems that affect just one eye. These include migraine with an aura or a change in vision. It might happen for only a few minutes or up to 30 minutes.

It can be hard to tell whether you're having symptoms in one eye only. The flashing lights or blindness may be on one side of your vision but actually involve both eyes. If you're not sure, cover one eye and then the other.

A headache that lasts 4 to 72 hours. It tends to:

• Affect one side of your head
• Feel moderately or very painful
• Throb or pulsate
• Feel worse when you move around

Other symptoms may include:

• Nausea
• Vomiting
• Being sensitive to light or sound

Causes

Experts aren't sure what causes ocular migraine. Some think the problem is linked to:

• Spasms in blood vessels in the retina, the lining in the back of the eye
• Changes that spread across the nerve cells in the retina

It's rare, but people who have these types of migraine may have a higher risk of permanent vision loss in one eye. Experts don't know whether medications that prevent migraines -- such as tricyclic antidepressants or anti-seizure medications -- can help prevent that vision loss. But if you have ocular migraine, even if it goes away on its own, it's a good idea to talk to your doctor about your symptoms.

How It's Diagnosed

Your doctor will ask you about your symptoms and examine your eyes. They’ll try to rule out other conditions that could cause similar problems, such as:

• Amaurosis fugax, temporary blindness due to a lack of blood flow to the eye. It can happen because of a blockage in an artery that leads to the eye.
• Spasms in the artery that brings blood to the retina
• Giant cell arteritis, a problem that causes inflammation in blood vessels. It can lead to vision problems and blindness.
• Other blood vessel problems related to autoimmune diseases
• Drug abuse
• Conditions that keep your blood from clotting normally, like sickle cell disease and polycythemia
• Stroke or transient ischemic attack (TIA)

Treatment

The visual portion of an ocular migraine typically lasts less than 60 minutes, so most people don't need treatment. It's best to stop what you're doing and rest your eyes until your vision goes back to normal. If you have a headache, take a pain reliever that your doctor recommends.

If you have vision loss in one eye only, it could be due to a serious condition that isn't related to migraine. Get medical help right away.

There's been little research on the best way to treat or prevent ocular migraine. Your doctor may recommend one or more drugs:

• Drugs that treat epilepsy, such as valproic acid (Depakote, Depakene) or topiramate (Qudexy XR, Topamax, Trokendi XR)
• Tricyclic antidepressants such as amitriptyline (Elavil), nortriptyline (Pamelor), or venlafaxine (Effexor)
• Blood pressure medicines including beta-blockers like metoprolol (Lopressor) or propranolol (Inderal), and calcium-channel blockers such as nicardipine (Cardene) and verapamil (Calan)
• CGRP inhibitors, including eptinezumab (Vyepti), erenumab (Aimovig), fremanezumab (Ajovy), galcanezumab (Emgality)

A device called sTMS mini may be another option. You hold it at the back of your head at the first sign of a headache, and it gives off a magnetic pulse that stimulates part of the brain. Nerivio is a wireless remote electrical neuromodulation device that you put on your upper arm at the beginning of migraine headache.

In addition, a noninvasive vagus nerve stimulator called gammaCore sends mild electrical stimulation to the nerve's fibers to ease pain or to help prevent a migraine.

Ocular Migraine Prevention

The first step to preventing migraines is to avoid triggers. These often include:

• Stress
• Smoking
• High blood pressure
• Hormonal birth control pills
• Exercise
• Bending over
• High altitude
• Dehydration
• Low blood sugar
• Excessive heat

Although dietary triggers -- such as caffeine, alcohol, and artificial sweeteners -- can cause other types of migraines, they seem less likely to trigger ocular migraines.

If other treatments don’t work and you have four or more migraine days a month, your doctor may suggest preventive medicines. You can take these regularly to reduce the severity or frequency of headaches.

A device is also a treatment option. Cefaly is a portable headband-like tool for preventing migraines. You use it for 20 minutes once a day. It gives electrical impulses on the skin at the forehead and stimulates a nerve associated with migraine headaches. When it's on, you'll probably feel a tingling or massaging sensation.

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