What an ocular migraine looks like, the difference between migraine with aura and retinal migraine, the common triggers, the red flags, and what helps.
An ocular migraine is a migraine that plays with your sight. You are reading, and a shimmering spot spreads across the page. Zigzag lines. A blind patch where the words should be. It most often passes in 5 to 60 minutes. Your sight comes back on its own. The name covers two different things: migraine with aura, which hits both eyes, and retinal migraine, which hits one. Both eyes is the common one. One eye alone needs a doctor soon.
The Name Two Things Hide Behind
Headache doctors have dropped the term ocular migraine. It got stretched over two problems. Both of them change what you see.
What People Mean Today
Most people who say ocular migraine mean migraine with aura. A few mean retinal migraine, which is rare. In the moment, the two feel much alike. They are not the same thing. And the difference changes what you should do next. One eye or two: that is the question your doctor asks first.
Migraine With Aura: Both Eyes
An aura is a warning wave before the pain. Only about 30% of people with migraine get one. Most auras are visual. About 9 in 10 people with aura see things.
An aura in your sight affects both eyes. It often starts 10 to 15 minutes before the headache. It can come a few minutes ahead, or up to 24 hours. Most episodes run 5 to 60 minutes. And sometimes no headache follows at all. Your sight then goes back to normal by itself.
Retinal Migraine: One Eye
Retinal migraine is the rare one. It hits one eye, not both. It brings short bouts of partial sight loss, like a blind spot. The bouts can come before the headache, or during it. The eye part most often lasts 5 to 20 minutes, sometimes up to an hour. In almost every case, it is the same eye each time.
The Difference That Matters
Both eyes points to aura, and aura is usually harmless. One eye alone is different. Changes in one eye are usually not retinal migraine at all. They can come from something more serious. So they need a doctor soon.
What It Looks Like
The list is oddly pretty for something so unwanted. Here is what women report seeing.
The Visual Part
You may get:
- Flashes of light
- Zigzag patterns
- Blind spots, from a patch to total loss in that eye
- Shimmering or flickering spots, like stars
- A spot that flickers like a wave, between light and dark
- Floating lines, or coloured spots and lines
- Blurred vision
- Tunnel vision, where only the middle of the view is left
- Eye pain
How Long It Lasts
The eye part of a retinal migraine usually lasts 10 to 20 minutes. Then your sight comes back, bit by bit. Twenty minutes feels much longer when you cannot read your own phone. Most auras run 5 to 60 minutes. Rarely, an aura goes past 60 minutes, or lasts a week or more. That one needs a call to your doctor the same day.
The headache is the long part. Untreated, it can last 4 to 72 hours.
The Headache, and Where It Sits
In a retinal migraine the pain sits right behind the eye that went dark. With aura, the pain spreads wider through your head. It can come before, during, or within an hour of the eye symptoms. It pounds, throbs or pulses.
Light, noise and smells get harder to bear. You may feel sick, or be sick. Chills, sweating, pale skin, no hunger and plain tiredness come along too.
When There Is No Headache
The eye symptoms can arrive with no headache behind them. That is unsettling the first time. It is a known pattern, so you are not imagining it. It is also on the list of things a doctor should look at.
What Triggers an Ocular Migraine
Triggers vary a lot. These are the ones that show up on the lists.
The Usual Suspects
- Stress
- Smoking
- High blood pressure
- Some kinds of hormonal birth control
- Exercise
- Bending over
- High altitude
- Not drinking enough
- Low blood sugar
- Too much heat
- Alcohol and caffeine
What Is Going On in There
No one knows the exact cause. One idea is a problem in the blood vessels that feed the retina. That is the light-sensitive layer at the back of your eye. Blood flow drops, your sight goes patchy, and when the vessels relax it comes back. In migraine as a whole, the attack is thought to start in the brain, in nerve paths and chemicals, and it changes blood flow there.
Your Hormones
Migraine leans female. In general it affects about 18% of women and 6.5% of men. Hormone changes across your cycle can set one off. So can birth control pills. Some women get fewer migraines while pregnant, though not all of them do.
Sleep and Skipped Meals
Changes in your sleep are a listed trigger, and so is not getting enough of it. Skipping meals belongs on the list too, along with low blood sugar. Certain foods can also set one off. Do you often wake up with a headache? Read about waking up with headaches.
Your Family
It can run in families. Among people who get the one-eye kind, 50% have a family history of migraine. So ask your mother, or your sister, what they get.
Keep a Diary
A diary is the cheapest tool you have. Write down what you did, ate and drank before it started. Note how you slept, and how you felt. It takes a few rounds before the pattern shows itself.
What Can Be Mistaken for It
This is the part that scares women, so let’s be plain about it.
A Stroke
An ocular migraine is not a mini-stroke. They are two different things. But a stroke can cause vision problems that look much the same. So sudden changes in your sight need care, not a wait-and-see. You cannot sort this one out by feel. Neither can anyone else at your kitchen table.
Other signs of a stroke:
- Weakness or paralysis on one side
- Trouble speaking, or losing speech
- Slurred or garbled words
- Loss of muscle control on one side of the face
- Sudden loss of a sense: sight, hearing, smell, taste or touch
- Being clumsy, or unsteady on your feet
- Dizziness, or the room spinning
- Feeling sick, or being sick
- A stiff neck
Those need help right away.
An Eye Problem
Your doctor may send you to an eye specialist. The point is to rule out a problem in the eye itself. That one could be serious. A doctor with the right tool can sometimes see less blood flow to your eye during an attack. That would settle it. But attacks are short, so one rarely gets seen. Most often the answer comes from your story, your history and your family’s.
Frequent Auras
Frequent auras raise the risk of stroke a little. Migraine is a risk factor on its own. And the risk runs higher in women who smoke and get aura. So if they come often, be known to a doctor rather than to the internet. Smoking is the one on that list you can change this week.
Red Flags: When to Get Help Now
Most of this is harmless. A few things are not. Keep this short list where you can find it.
Call 911 Now If
- It is the worst headache of your life.
- You have trouble with speech, sight or movement, or you lose your balance. Above all if that is new for you.
- The headache starts all at once.
Why the Short List Matters
You are not being dramatic if you call. These signs overlap with problems that need fast care. And in rare cases, ocular migraine leads to blood flow problems in and around the eye, including an eye stroke. Rare, but real. If your sight is affected, do not drive yourself to the hospital. Call, or ask someone to take you.
See a Doctor Right Away If
These are visual symptoms nobody has looked at yet:
- Changes in one eye only
- Changes that last less than 5 minutes, or more than 60
- Changes with no headache
- New headaches, or new changes in your sight
- Headaches or sight changes that start after age 50
- New weakness on one side, or new trouble with speech
Book a Visit If
- Your headache pattern or your pain changes.
- What used to work has stopped working.
- Your medicine gives you side effects.
- You take birth control pills and get migraines.
- Your headaches are worse when you lie down.
- You know you get these, and now they are worse, more often, or new.
And the very first one you ever get: see your doctor, to rule out a more serious eye or brain problem. None of this is about panic. It is about being known to a doctor before you need one in a hurry.
What Helps
Ocular migraine can start as early as age 7. Most people start in their 20s. The peak age is 40. So this may be with you for a while. Here is what the lists say to do.
During an Attack
Lie down in a dark room. Sleep if sleep will come.
Between Attacks
- Drink enough water.
- Eat at regular times, and do not skip meals.
- Move your body often.
- Get plenty of sleep.
- Keep a weight that is healthy for you.
- Work on your stress.
- Cut back on the triggers you have spotted, like caffeine and alcohol.
Sleep sits on that list twice, and it is the one most women let go first. Curious how last night really went? Take our free Sleep Check. Six questions, about 30 seconds, and you see your sleep efficiency.
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What Your Doctor May Suggest
If attacks are rare, say once a month, doctors often suggest no treatment at all. If they come often, the goal is fewer of them. Painkillers may be offered, and so may something for the nausea. To prevent them, calcium channel blockers are the go-to. Aspirin and anti-seizure drugs may help too. Propranolol, topiramate and amitriptyline are used as well. Some doctors offer acupuncture. If none of it works, you may be sent to a brain specialist. What you take, and how much, is your doctor’s call and not ours.
The Outlook
Doctors call it benign. The attacks can hurt, and they can scare you. But the outlook is good. In rare cases the vision trouble stays. That is the whole reason the first one gets checked.
Common Questions
What can trigger ocular migraines?
The lists name stress, smoking and high blood pressure. Also some hormonal birth control, exercise and bending over. Also high altitude, low blood sugar, too much heat and not drinking enough. Alcohol and caffeine are on there. So are hormone changes across your cycle, and changes in your sleep. Triggers are personal, so your diary beats any list.
What can be mistaken for an ocular migraine?
A stroke can cause vision problems that look much the same. So sudden changes need care. A problem in the eye itself can look alike too. That is why your doctor may check your eyes. And changes in one eye alone are often not retinal migraine, but something else.
What are the red flags for ocular migraines?
Call 911 for the worst headache of your life, or one that starts all at once. Do the same for new trouble with speech, sight, movement or balance. See a doctor right away for changes in one eye. Also for changes shorter than 5 minutes, or longer than 60. Also for changes with no headache.
Is ocular migraine a mini stroke?
An ocular migraine and a stroke are two separate things. But a stroke can cause vision problems that look much the same. So sudden changes in your sight need to be checked. Frequent auras do raise the risk of stroke a little. That is a good reason to be known to a doctor.
Sources
- Ocular Migraine, Cleveland Clinic
- Ocular migraine: When to seek help, Mayo Clinic
- Retinal (ocular) migraine, NHS
- Migraine, MedlinePlus, National Library of Medicine
- Migraine Aura, Cleveland Clinic
