Your Complete Guide to Ocular Migraine

An ocular migraine (retinal migraine) is a migraine that causes temporary vision loss in one eye. The term ocular migraine can also be used to describe migraine with aura. A migraine aura causes visual disturbances like flashing lights and zig-zags.

Distorted image of a woman with migraine.

Ocular migraine is a term that refers to types of migraine that affect your vision. There are two subtypes that fall into this category: retinal migraine and migraine with aura.

Migraine with aura is more common, but both subtypes can significantly affect your quality of life and general well-being. Here’s what to know about ocular migraine, including the different causes, symptoms, and treatment options.

The two types of ocular migraine that make up this umbrella term are retinal migraine and migraine with aura. While you might hear the term “ocular migraine,” it’s important to know that this is not a modern medical term or diagnosis.

It’s estimated that between 25% and 30% of people with migraine experience aura.

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Although the exact statistics of a retinal migraine are unknown, it’s thought that 29% of people with this subtype also have a history of classic migraine.

Both types of ocular migraine can cause visual disturbances, but there are several key differences:

Retinal migraine

A retinal migraine refers to visual disturbances that affect one eye only. It develops as a result of blood flow disruptions within your retina, which is located at the back of your eye.

With this type of migraine, you may have vision loss in one eye for 10 to 20 minutes, or up to 1 hour at a time. This may occur during a migraine headache or before one develops.

Migraine with aura

Migraine with aura describes vision disturbances that may occur with or without a headache. Aura may also be a predictor of an impending headache, with visual changes occurring 10 to 60 minutes before a migraine attack.

During an episode of migraine with aura, visual disturbances may happen in one or both eyes. You may also experience speaking difficulties or muscle weakness when the aura occurs. While usually temporary, some people might experience migraine with aura for longer than 1 hour.

Migraine with aura is one of the most common types of migraine. Another common type is known as migraine without aura, which can cause sudden migraine headaches accompanied by blurry vision, fatigue, and sensitivities to sound and light.

The symptoms of retinal migraine and migraine with aura can be difficult to distinguish.

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One key difference with a retinal migraine is that it can cause temporary vision loss or twinkling lights that occur in one eye. Retinal migraine may also cause zig-zag lines or colored spots in your vision.

Rather than vision loss, symptoms of a migraine aura tend to encompass disturbances only, and they may affect both eyes. You might see:

  • blind spots
  • zig-zag lines
  • stars or patterns
  • flashes of light

What are the stages of a migraine attack?

There are four stages of a migraine attack:

  • Premonitory symptoms: These develop up to 24 hours before the actual migraine attack, and may include mood changes, food cravings, and fluid retention.
  • Aura: During this second stage, you might experience visual disturbances, speech loss, or muscle weakness.
  • Severe headache: While not present in all migraine attacks, you might develop a gradually worsening headache at this stage.
  • Postdrome: Lasting a day or more after the migraine attack, you might feel exhaustion or confusion during this stage.

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Retinal migraine is caused by reduced blood flow or blood vessel spasms in the area behind your eye.

Migraine with aura is thought to be caused by abnormal electrical activity in your brain. While the exact causes of this aren’t known, researchers believe neuronal dysfunction may contribute.

Ocular migraine is also more prevalent in the following groups:

  • those with a personal or family history of migraine
  • people assigned female at birth
  • adults ages 30 to 39 years old

Retinal migraine may also develop in people with atherosclerosis, sickle cell disease, and lupus.

An ocular migraine may be diagnosed by an eye doctor. Their diagnosis may involve a combination of the following:

  • a physical exam
  • an evaluation of your personal and family health history, particularly migraine
  • an eye exam with dilation
  • blood testing or imaging tests to rule out other causes of your symptoms, such as stroke

Is an ocular migraine an emergency?

An ocular migraine isn’t typically an emergency. But you should seek emergency care if you’re experiencing symptoms for the first time. An accurate diagnosis from a doctor is important, as they will need to rule out other more serious causes of your symptoms.

You should seek emergency medical attention if you develop sudden visual disturbances along with confusion, stiff neck, or weakness on one side of your body or face. This could indicate a stroke or another medical emergency.

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The way you manage your migraine episodes will depend on several factors, like which type it is, how often they occur, and how severe they are.

Many people with ocular migraine just allow the episodes to pass on their own and don’t treat them with any medication. If you have an ocular migraine attack, the best thing to do may be to just get some rest while it runs its course.

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Treating migraine with aura might involve the use of rescue medications, that help stop a migraine at its start. It may also involve the use of preventive medications that can help reduce the frequency of your migraine headaches.

To prevent ocular migraine and migraine with aura, it also helps to identify your migraine triggers. Keep track of your migraine episodes and jot down a few notes on potential triggers. This can help you identify patterns over time.

Migraine triggers

The triggers of migraine with aura and a retinal migraine are similar to those of other types of migraine, such as migraine without aura. To reduce your risk, try avoiding the following known triggers:

  • stress
  • too little or too much sleep
  • excessive heat
  • dehydration
  • skipped meals
  • low blood sugar
  • drinking alcohol
  • smoking
  • bright and/or flashing lights
  • loud noises
  • driving long distances
  • excessive screen time
  • strong odors or perfumes
  • oral contraceptives

Weather changes, high altitudes, and hormone fluctuations may also trigger a migraine episode in some people.

Medical management

Managing migraine medically involves a combination of rescue treatments and preventive medications.

Preventive treatments may include:

  • antidepressants
  • antiepileptics medications (anticonvulsants)
  • beta-blockers
  • CGRP monoclonal antibodies (Aimovig, Ajovy, Emgality)
  • calcium channel blockers
  • tricyclic medications

Additionally, you may consider having rescue treatments on hand in case of a sudden, or acute migraine attack. Also called “abortive” treatments, options may include:

  • triptans
  • CGRP antagonists (Ubrelvy, Nurtec ODT)
  • ditans
  • Dihydroergotamine (DHE)
  • ergot derivative drugs, which may help at early migraine stages
  • over-the-counter pain medications such as acetaminophen or ibuprofen
  • anti-nausea medications

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