(As appeared in Alamo Today, April 2011, pg. 28)
Several patients have come into the office lately complaining of ocular migraines. There are some different terms for this condition including aura, ocular migraine, ocular aura, and retinal migraines. Even though they have slightly different meanings, I will lump them into one for the purposes of this article. Initially, these can be very scary as patients are concerned that they are losing their vision and/or possibly having a stroke. Thankfully, neither will happen just from having an ocular migraine; however, depending on the exact symptoms, some eye and health conditions need to be ruled out.
An ocular migraine like a typical migraine, involves a blood vessel disturbance. This can be caused by many things such as diabetes, high blood pressure, and physical exertion. However, it is very common that these “just happen”. It usually occurs without any triggers and happens when people are in front of the computer, watching TV, or driving. The visual aura that people usually see is similar but can be variable and it can affect one or both eyes. Most patients report seeing bright or shimmering lights, zigzag lines, cloudy vision, and tunnel vision. Your central vision usually isn’t compromised, but it could be a little blurry. These visual disturbances last anywhere from a few minutes to about 30 minutes. If there is continued decreased vision, floaters, flashes of light, red eyes, etc., then an ocular migraine is not the diagnosis. The symptoms go away as quickly as they came with no prolonged visual changes and have no lasting visual or ocular consequences. These are commonly followed by an actual migraine about 1 hour after the aura starts. It is possible to not get the headache, but it is more likely that a migraine follows the aura. Initially these can be very scary and patients usually call the office to schedule a visit. This is advisable as there could be other causes and other conditions that need to be addressed depending on the symptoms, age, and medical history of the patient.
Unfortunately, there is no treatment for ocular migraines. However, I always recommend to patients to take their normal headache medications at the onset of the visual disturbances, since it is common to get an actual migraine about an hour after the onset of the visual aura. These headaches are usually severe and could last several hours. Taking Tylenol, Excedrin, etc. for the headache will not prevent it from coming, but it will blunt the severity. I would rather tell my patients to take the medication and not get the headache than to wait until the headache starts; at that point it is too late.
It is more common for normal migraine sufferers, women, and patients with diabetes, high blood pressure, and auto-immune diseases to get ocular migraines. There are no strong medical studies explaining the etiology of this condition. Even though there is no treatment, it is important to make sure that there is no medical reason for the ocular disturbances. The aura can easily be mistaken for symptoms of a retinal hole or detachment, stroke, or other neurological issues. Granted these conditions are pretty rare, but they do happen. An office visit to go over your personal medical history, exact symptoms, and an eye evaluation will help differentiate an ocular migraine from other potentially sight-threatening conditions.