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“Seeing” migraines

Written by: Roanne Weisman
Published: July 30, 2008
Reviewed by: Kevin Zacharoff, MD, February 2008

“Seeing” migraines

There is one relatively rare type of migraine — called an ocular (a "one-eye" or ophthalmoplegic) migraine — that you may never have heard of, but it is worth knowing about it in case you have these symptoms one day. You might ask, "Why is this migraine different from all other migraines? The answers are in this article, along with what to do if you get one.

What you will learn in this article

  • What is an ocular migraine?
  • How to manage your ocular migraine

What is an ocular migraine?

The most significant thing about an ocular migraine is its one-sidedness. It is usually preceded by an aura (visual disturbance), such as blurring, blind spots, shading of the one part of your visual field, shimmering lights, or zigzagging lines. (See the article, “Everything You Need to Know about Aura” for more details of the visual symptoms.)

However, there are several differences between ocular migraines and the classic migraine with aura. While the classic migraine aura causes visual disturbances in both eyes, the ocular migraine aura only affects one eye. Another difference is the headache that follows, which is usually felt behind the eyeball of the affected eye, rather than in other parts of the head. And, unlike classic migraine, in which the aura usually subsides before the headache begins, the ocular migraine aura may last for the duration of the headache. So, in addition to the pain, you may also have to contend with lingering visual disturbances.

Frequency of occurrence is also an important distinction between ocular and classic migraine. While classic migraine generally occurs on somewhat of a regular schedule — several times a month, for example, or before a menstrual period — ocular migraines tend to happen in discrete clusters. In one two-week period, for example, you may have several ocular migraines, and then not another one for months or years. Ocular migraines are not related to other types of migraines, so you can have both kinds.

The source of the migraine is another important difference between ocular and classic migraines with aura, although there is some disagreement about what actually causes ocular migraines. One expert, Cleveland Clinic neurologist Mary Ann Mays, M.D., says that while ocular migraine and migraine with aura are very similar experiences, one key difference is the source of the vision disturbances. In migraine with aura, the occipital cortex of the brain is the source of vision disturbances. In ocular migraine, it is the retinal blood vessels inside the eye, says Dr. Mays. The retina is the thin lining on the back, inner part of the eye that prepares images for processing by the brain. An individual experiencing the aura of ocular migraine could cover or close one of the eyes and stop the symptoms. Not so for an individual experiencing traditional "classic" aura, in which the symptoms affect both left- and right-sided vision, says Dr. Mays. The source of the problem in classic migraine aura is the brain, not the eyes.

Managing your ocular migraine

Like classic migraine with aura, the ocular aura can be useful as a warning sign that a headache is coming on in time to take steps that might prevent or diminish the pain.. Ocular migraines may serve another purpose as well. We know that half of those with migraines don't seek medical help that could treat the headache. But these one-sided visual disruptions can be so disturbing to people that they will immediately go to see an ophthalmologist. Even though the symptoms are not related directly to the eye, at least this gets people to a doctor's office, which will then open the door to a diagnosis of migraine and appropriate treatment.

The message with ocular migraine, as well as other kinds of migraine, is to seek medical help and not try to treat the symptoms on your own. This is particularly important because the symptoms of ocular migraine are similar to those of other, more serious medical problems that require immediate treatment.

"There is some thinking that ocular migraines are more likely to occur as the result of stress. So biofeedback and stress reduction techniques may help prevent attacks. Your health care professional may also recommend medication taken as soon as the aura begins that may ward off the impending headache. If the pain does begin, simple analgesics, such as aspirin, may help, as well as lying down in a dark, quiet room. Triptans, which are used for other types of migraines, may not be appropriate for ocular migraines, says Dr. Mays of the Cleveland Clinic: The constricting affect that triptans have on blood vessels could cause problems in the retinal vessels, resulting in vision loss. The best treatment for ocular migraine, says Dr. Mays, is prevention—avoiding triggers, minimizing stress, maintaining a consistent schedule, eating regularly and getting enough sleep.


References

Cleveland Clinic Center for Consumer Health Information. (n.d.). The Magical Mystery of Migraines, www.clevelandclinic.org/health