Kritika Gautam, B.Optom
Fellow Optometrist, Dr. Shroff’s Charity Eye Hospital, Delhi, India
Migraine headache is a common neurological disorder that disrupts vision more than any other sensory and motor function, experienced nowadays. (1) Migraine currently affects up to 15 percent of adults and about 20-30% of migraine sufferers have headaches following the visual aura symptoms. (2) The intensity of headaches may range from mild to severe.
Visual disturbances experienced in migraine are temporary but migraine-related visual defects usually become permanent if persistent for more than 7 days. (3) These reports demonstrate that visual recovery may still occur when a field defect is present for 10 days or more. These symptoms are usually seen in both eyes. Research has determined that all migraines are at higher risk of suffering a stroke and this risk factor is potentially doubled or tripled for individual who suffers from migraine with visual disturbances collectively called “aura.” (4) Ocular migraine or migraine with aura, involves visual disturbances that occur with or without migraine pain. These symptoms may occur before a migraine headache, or the two events can happen at the same time. (5)
Common Visual Symptoms During Migraine
Negative symptoms- blurred or absent areas in the visual field, scotoma, loss of vision of one side of the visual field, tunnel vision, or complete blindness.
Figure-1: Showing the central scotoma in migraine as described by the patient
(Photo Courtesy: http://viaaneyecentre.in/blogs/retinal-migraine-causes-symptoms-and-more/)
Figure 2: Showing Loss of field of one side in migraine as described by the patient
(Photo Courtesy: https://aica.com/what-is-an-ocular-migraine/)
Figure 3: Showing multiple scotoma spots in migraine as described by the patient
(Photo Courtesy: https://www.medscape.com/answers/1142556-170231/what-are-the-positive-vis)
Positive symptoms – In positive symptoms patient will experience zig-zag line which shimmer, the illusion of different colours of dots, stars, sparks of light these are the identifiable signs of migraine (fig 4).
Figure-4: showing zig-zag shimmering lines in migraine as described by the patient
(Photo Courtesy: https://www.oilsfurhealth.ca/chatterbox-corner-blog/anyone-have-ocular-migraines)
Positive symptoms of visual migraine also include distortion of vision along with affected colour vision.
An ocular migraine attack usually starts with a small spot that slowly expands. These symptoms usually last for 20 to 30 minutes after which vision returns to normal but the ability to perform tasks like reading, writing, or driving can be impaired. (3) Heterophoria and fixation disparity are more common in the migraine group. The migraine group had slightly reduced stereopsis. (6)
Migraine symptoms without headache are called acephalgic migraine. Except for the absence of headache, the visual symptoms in acephalgic migraine are identical to the episodes that accompany a classic migraine aura. (7)
Migraine with aura isn’t the same as retinal migraine which is more serious. Retinal migraine is a condition occurring in a person who has experienced other symptoms of migraine. Retinal migraine happens in only one eye and can cause temporary visual blindness or in some cases irreversible damage. (8)
The exact aetiology of ocular migraine is not known, but many contributing factors have been identified such as stress, family history, bright light, and hormonal changes
The visual symptoms experienced during migraine relates to a phenomenon called “Cortical Spreading Depression”. One theory is that a narrowing of arteries causes a temporary lack of blood flow to the eye and induces symptoms.
Treatment for Ocular Migraine
There is no such treatment for the visual migraine without the headache as the visual symptoms resolve with time. But experiencing such visual symptoms may sometimes cause a lot of anxiety, when one gets familiar with the symptoms it will no longer cause the same anxiety level.
The patients having visual symptoms along with headache requires treatment to get relieved from the headache before it gets severe.
It is difficult to determine whether the visual disturbances are due to migraine, or the symptoms are due to any other problem. To rule out the cause of vision loss whether it is due to migraine, or the symptom of any other worrisome problem appropriate workup must be carried out even if a migraine is suspected.
- Vincent, M. B. (2015). Vision and migraine. Headache: The Journal of Head and Face Pain, 55(4), 595-599.
- https://americanmigrainefoundation.org/resource-library/visual-disturbances-migraine/ [last accessed – 22-06-2022;21:00hrsAEST]
- Sullivan-Mee, M., & Bowman, B. (1997). Migraine-related visual-field loss with prolonged recovery. Journal of the American Optometric Association, 68(6), 377-388.
- https://www.saebo.com/blog/ocular-migraines-stroke/ [last accessed – 22-06-2022;21:10hrsAEST]
- https://www.emedicinehealth.com/migraine_headaches_vision_effects/article_em.html [last accessed – 22-06-2022;21:00hrsAEST]
- Harle, D. E., & Evans, B. J. (2006). Subtle binocular vision anomalies in migraine. Ophthalmic and Physiological Optics, 26(6), 587-596.
- https://www.brighamandwomens.org/neurology/neuro-ophthalmology/visual-migraine [last accessed – 22-06-2022;21:06hrsAEST]
- https://www.mayoclinic.org/diseases-conditions/migraine-headache/expert-answers/ocular-migraine/faq-20058113 [last accessed – 22-06-2022;21:02hrsAEST]