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Ocular migraines can be quite distressing for sufferers.

Ocular migraine is a migraine type that causes visual symptoms, which can be with or without other symptoms such as a headache itself.

What is an Ocular Migraine?

An ocular migraine can be quite complex to diagnose as it crosses over with various other types of migraine. 25-30% of people will suffer from migraine with aura, but usually as a one off occurrence. Some doctors will diagnose this as migraine with visual aura, others will refer to them as ocular migraines. Those who suffer from ocular migraines without the pain or migraine headache itself will sometimes be referred to as silent migraines. For accurate treatment, it is important that patients receive a correct ocular migraine diagnosis, as this condition can be very disruptive and debilitating. Binocular or monocular visual symptoms may last between 10 to 30 minutes at a time, longer than this is uncommon.

Ocular Migraine Symptoms include:

  • Temporary flashes of stars, zig-zag lines, or other patterns in the field of vision
  • Transient vision loss
  • Bright/blind spot starting in the centre of vision, which may spread to cover up to half of the visual field
  • Slurred speech and impaired motor skills
  • Sensitivity to light and sound
  • Nausea/vomiting
  • Tingling or numbness, normally on one side of the body
  • intense pain (pulsating or throbbing) in one or both sides of the head, which worsens with activity

What causes Ocular Migraines?

Migraine Aura is said to develop due to abnormal electrical activity on the outer surface of the brain, which spreads to the visual cortex/lobe, resulting in varying effects on vision. Ocular migraines are also thought to occur when the blood vessels in a person’s eye narrow, restricting blood flow.

It is not known what causes some people to experience aura and others not, but the triggers remain similar to those who experience other types of migraine. These risk factors include:

  • Certain foods (dietary triggers)
  • Poor lighting
  • Looking at screens for extended periods
  • Caffeine
  • Dehydration 
  • High blood pressure
  • Hormones
  • Anxiety or stress

What are the options for Ocular Migraine Treatment?

Common options to treat migraines with aura or ocular migraines typically focus on relieving symptoms and preventing future attacks. Here are some commonly used approaches:

Pain Relief Medications:

Over-the-counter pain relievers such as ibuprofen, aspirin, or paracetamol may help alleviate the severe headaches associated with ocular migraines. For more severe migraine pain, prescription medications like triptans or ergotamines may be prescribed. 

Anti-Nausea Medications:

If nausea or vomiting accompanies the ocular migraine, medications such as metoclopramide or prochlorperazine may be prescribed to alleviate these symptoms.

Rest and Relaxation:

Resting in a quiet, dark room and applying cold compresses to the forehead or temples may help ease headache pain and discomfort.

Avoiding Triggers:

Identifying and avoiding triggers that may precipitate ocular migraines, such as certain foods, stress, lack of sleep, or specific environmental factors, can help reduce the frequency and severity of attacks.

Stress Management Techniques: 

Practising relaxation techniques such as deep breathing, meditation, yoga, or progressive muscle relaxation may help reduce stress levels and decrease the likelihood of experiencing ocular migraines.

Medications for Preventive Therapy:

In some cases, healthcare providers may prescribe medications for preventive therapy to reduce the frequency and severity of ocular migraines. These may include beta-blockers, calcium channel blockers, tricyclic antidepressants, anticonvulsants, or botulinum toxin injections.

Lifestyle Modifications:

Making lifestyle changes, such as maintaining a regular sleep schedule, staying hydrated, exercising regularly, and managing stress, can help reduce the frequency and intensity of ocular migraines.

Pillow and Sleeping Position:

Choosing the right pillow and sleeping position can significantly alleviate headaches. Opting for a supportive pillow that maintains proper neck alignment such as an adjustable contoured memory foam pillow can reduce unwanted strain on your neck and head. Sleeping in positions that promote spinal alignment will also help reduce tension and pressure on head and neck muscles. This leads to improved sleep quality and a reduction in headache frequency.

Associated risks:

A condition similar to ocular migraine is retinal migraine. Retinal migraine headaches can lead to severe, irreversible vision loss through conditions such as central retinal artery occlusion (CRAO), or branch retinal artery occlusion (BRAO). Accurate diagnosis really is critical in this population, as practitioners must be precise in distinguishing migraine with aura from a retinal migraine headache, as well as ruling out other conditions associated with visual disturbances such as transient ischemic attack (sometimes referred to as a “mini stroke”).

If any rapid/severe vision loss, temporary blinding or loss only in one eye occurs, a medical professional should be contacted immediately.

As per all migraines, if sufferers of ocular or retinal migraines do not seek treatment for their condition, they may experience chronic daily migraines. This can be largely disruptive to daily life.

Migraine with aura is thought to be associated with increased risk of suffering a stroke, particularly in women.

Treatment includes but is not limited to identifying and avoiding individual triggers and visiting a medical professional. The Brisbane Headache and Migraine Clinic treats people with ocular migraines using a medication free approach, with largely positive outcomes.

If you are or know someone who is suffering from ocular migraines, call us on 1800 HEADACHE orbook an appointment here for a careful assessment, diagnosis and treatment today!

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