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Ocular Migraines – Not Just the Head

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The first word that comes to mind when hearing the word ‘migraine’ is headaches. Splitting, blinding, excruciating headaches. However, ocular migraines, despite their name, are visual disturbances characterized by blind spots, flashing lights or wavy lines in one’s field of vision, that may or may not be accompanied by headaches, and can also be referred to as ‘Ophthalmic’ or ‘Eye Migraines’.

The Types

Despite being used interchangeably, even by many specialists, migraines of the eye are classified into 3 distinct categories:

1- Painless Ocular Migraine

Attacks of this nature are usually characterised by widening blurry spots (scotoma) in one’s central vision, surrounded by flickering, or shimmering bright lights (scintillations); with problems related to the other senses, speech, and other motor (movement) skills occurring simultaneously in some cases. However, despite being alarming if happening for the first time, painless ocular migraines usually last between 2-3 minutes to nearly 30 minutes and do not require urgent medical attention.

2- Migraine With Aura

In addition to scotoma and scintillations, other ‘auras’, or visual disruptions include zigzagging lines, stars, and in some cases, psychedelic images that might also be accompanied by a migraine headache, usually between the early and peak pain phase. Moreover, some people might also experience premonitory symptoms such as numbness or tingling in the hands or face, disruption of other senses nearly 10-30 minutes prior to the actual migraine. However, since it’s difficult to tell whether the migraine is occurring in one or both eyes due to the aura affecting both eyes, covering each eye alternatively can help determine the migraine affected eye.

3- Retinal Migraine

Often confused with aura migraines, a retinal migraine is, in fact, a separate diagnosis that affects only one eye with sudden, recurring and temporary vision reduction or complete blindness that may precede or accompany a classic migraine and is believed to be caused by reduced blood flow due to a sudden constriction of blood vessels in the affected eye. While rare, the condition requires urgent medical attention, as, unlike the previous types, it may cause permanent vision loss.

In some rare cases, an ocular migraine and headache can either occur simultaneously, or an ocular migraine might also occur after a migraine headache.

Causes

While the exact cause is undetermined, changes in neural blood circulation, fluctuations in estrogen hormone levels in women, and a family history of classic and ocular migraines have been observed in a large majority of people with the condition.

Triggers

Like migraine headaches, ocular migraines are usually caused by certain triggers that vary from person to person, with the most common ones being:

  • Bright lights
  • Loud sounds
  • Powerful odors
  • Weather changes
  • Artificial sweeteners
  • Excess caffeine or caffeine withdrawal
  • Nitrate foods like hot dogs and luncheon meats
  • Stress, anxiety, or relaxation after a period of stress
  • Monosodium Glutamate (MSG) found in fast foods, seasonings, spices and broth
  • A ‘prodrome’, such as mood swings, a general feeing of tiredness, and specific food cravings a few days or weeks prior to the actual migraine.

Treatment

The maximum time for any bout of migraine is 30 minutes; and while they can be disruptive, the best method is to simply try and work through the vision changes, and, stopping something that requires complete visual concentration, such as driving or reading, and waiting for the effects to pass. Avoiding triggers can also be an effective strategy.

In addition to Over-The-Counter (OTC) drugs like ibuprofen, people with recurring migraines and disruptive symptoms may also opt for prescription medications such as Beta-blockers and Calcium Channel Blockers to relax and prevent constricted blood vessels, and anti-epileptics or antidepressants to treat or prevent painful ocular migraines with headaches for symptom control on a regular basis.

Moreover, people with extreme migraine pain can massage their scalp with extra pressure on their temples, lie down or sit in a dark, quiet room, or put a damp towel over their forehead until the effects subside.

Underlying Conditions

People with recurrent bouts of aura migraines with headaches should check with an ophthalmologist to rule out various other underlying conditions:

  • Seizures
  • Head Injury
  • Brain Tumor
  • A tear in a brain artery
  • Neural inflammation due to infections
  • Toxic substance withdrawal or exposure
  • Structural abnormalities of the head, neck, or spine
  • Abnormal tangling of veins and arteries in the brain
  • Excess fluid buildup in the brain or spinal fluid leakage
  • An aneurysm (widening or bulging of part of an artery) in the brain
  • Sickle cell disease and other conditions that prevent normal blood clotting
  • A Hemorrhagic (a burst artery), or Ischemic (blocked artery) stroke in the brain

If you experience ocular migraines, make sure to consult your doctor for an accurate diagnosis and treatment. You can also book an appointment with a top Ophthalmologist in Islamabad, Lahore and Karachi through oladoc.com, or call our helpline at 042-3890-0939 for assistance to find the RIGHT Doctor for your ocular issues.

Disclaimer: The contents of this article are intended to raise awareness about common health issues and should not be viewed as sound medical advice for your specific condition. You should always consult with a licensed medical practitioner prior to following any suggestions outlined in this article or adopting any treatment protocol based on the contents of this article.
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