Understanding Ocular Migraine: Symptoms, Causes, and Management

What is an ocular migraine?

Ocular migraine also termed retinal or visual migraine is a type of migraine that disturb vision. It may or may not be followed by a headache within 60 minutes of visual disturbance. This is a temporary condition and vision usually comes back to normal within 60 minutes.

What are the typical symptoms of an ocular migraine?

Symptoms of an ocular migraine may include:

Visual Aura:

The most common symptom of ocular migraine is the formation of a visual aura. Visual aura occurs in the visual cortex of the brain and occurs due to the spreading of electrical or chemical wave that results in visual hallucinations which can be in the form of:

  • Zigzag lines
  • Flashing lines,
  • Blind spots,
  • Flickering light
  • Temporary loss of vision

Monocular vision changes:

Ocular migraine usually affects only one eye at a time.

Temporary blindness:

People suffering from ocular migraine may experience temporary blindness or partial loss of vision in one eye. Losing eyesight can be pretty distressing but vision becomes normal within a short period of time.

How does ocular migraine occur?

It was believed by the researchers that the visual loss in retinal migraine might be caused by spasms in the blood vessels which supply the retina or the eye. But now it is understood that this term may not accurately represent the events occurring during a migraine attack. Further advancement in migraine research suggested the involvement of complex processes in the brain which include:

  • Changes in blood flow in the blood vessels
  • Stimulation of some specific areas in the brain
  • The release of some specific neurotransmitters, o chemicals

All these processes occur mostly in the visual cortex, a region of the brain responsible for processing visual information.

Another theory proposed by the researchers to explain the cause of retinal migraine is ‚Äúcortical spreading depression”. According to this theory a wave of electrical activity that spreads slowly through the brain cause the alteration in the neuronal activity. The term retinal or ocular migraine can be confusing because the name suggests processes happening in the retina of the eyes. But actually, these processes are mainly occurring in the brain. The cause and the processes that lead to ocular migraine are less understood and further research is needed to fully understand this abnormality.

What are the triggers for ocular migraine?

The triggers for ocular migraine are similar to those of the migraine without aura or with aura.

Stress:

Stress is the biggest trigger for ocular migraine.  Migraines triggered by stress and anxiety are mainly due to biochemical and physiological alterations in the body. Cortisol hormone released under stressful conditions can affect blood flow by making blood vessels more sensitive to neurotransmitters. Cortisol release can lead to fluctuations in blood flow that can trigger visual disturbances. Serotonin and noradrenaline are two neurotransmitters that have a role in anxiety and depression, therefore, any disruptions in neurotransmitter balance can also contribute to retinal migraines. However, the relationship between stress, anxiety, and retinal migraines varies from one individual to another. In some people stress and anxiety shows a strong correlation with ocular migraine while in some it does not.

Hormonal Changes

Migraine has long been considered predominantly a female-related condition. There is a strong connection between female hormones and migraines according to research. After puberty, the likelihood of women suffering from migraine is more in comparison to men and this difference becomes more prominent with age. A sudden drop in the levels of estrogen during or after menstruation is mainly responsible for menstrual migraines. Although research has shown that estrogen plays a significant role in migraines, the exact mechanism is unknown.

Certain Foods and Beverages:

Some food items can act as a trigger for ocular migraines in some individuals. These triggers can differ from one person to another, and it is not necessary that all individuals suffering from ocular migraine will experience migraines from consuming these items. Below are some commonly reported food and beverage items that can trigger an ocular migraine:

  • Caffeine
  • Chocolate
  • Alcohol
  • Artificial sweeteners
  • Cured meat
  • Processed cheese
  • Food having monosodium glutamate
  • Salty processed food
  • Pickles
  • Fermented food
  • Frozen food

Magnesium and Vitamin D Deficiency:

Research has shown that people who have low levels of magnesium are more likely to suffer from migraines. Researchers think that magnesium blocks the signals responsible for visual aura or migraine with aura. For effective absorption of magnesium, the body requires Vitamin D. Therefore, a deficiency of vitamin D further increases the likelihood of migraine episodes.  

Environmental Factors:

In susceptible individuals, seasonal as well as environmental changes can trigger ocular migraine. Environmental factors that act as triggers for ocular migraine are:

  • Weather change, for example, rapid shifts in temperature, humidity, and pressure
  • Allergens/pollutants
  • Variation in light, for example, bright sunlight
  • Sleep disruption
  • stress

These triggers can vary from one individual to another, therefore, keeping a migraine diary can be helpful in identifying the triggers.

How is Ocular migraine diagnosed?

A comprehensive evaluation by a healthcare professional is important for the diagnosis of ocular migraine. For diagnosis medical history, symptoms, physical examination, and diagnostic tests are performed. All the tests are done to rule out other conditions related to the eyes and to confirm the diagnosis. Eye examinations, tests for the visual field, imaging studies, and blood tests play a crucial role in the diagnosis of the condition. For correct diagnosis correct description of symptoms, and accurate information is necessary. This is because there is no specific test for ocular migraine exists and diagnosis is made by excluding other causes.

What are the different treatment options for ocular migraine?

Medications:

A combination of lifestyle change and medications is important for the treatment of ocular migraine. Triptans and non-steroidal anti-inflammatory medications are usually prescribed to reduce inflammation and pain caused by migraine. Antidepressants, beta-blockers, calcium channel blockers, and anticonvulsants are often prescribed by the healthcare provider to reduce the severity as well as the frequency of ocular migraine episodes. Dosage and medication prescription depends upon the individual and their medical history. Therefore, consultation with a healthcare provider is essential before starting medication.

Lifestyle changes:

By adopting a healthy lifestyle frequency and severity of ocular migraine can be reduced. Some recommended lifestyle changes are:

  • Regulating the sleep cycle
  • By managing stress
  • Keep hydrated
  • Avoiding food and beverages that act as a trigger
  • Maintaining a healthy diet
  • Limiting regular exposure to bright lights and glare

Alternative therapies:

Alternative therapies that can help in reducing the occurrence of ocular migraine are:

  • Relaxation techniques like meditation, and deep breathing
  • Acupuncture
  • Herbal supplements
  • Yoga
  • Cognitive behaviour therapy

It is always good to take advise from a medical professional before starting any alternative therapy. These therapies should be taken only after knowing the potential benefits and risks associated.

When to seek medical help?

If you suffer from any of the following visual symptoms not assessed by a healthcare provider then it is time to seek medical help.

  • Visual changes that affect only one eye or both eyes
  • Change in the visual field that occurs for more than an hour
  • Change in vision without a headache
  • Dizziness
  • Weakness/numbness in any body part
  • Changes in speech
  • Trouble walking
  • Lack of coordination/balance

The above symptoms would suggest a more serious problem and need to be checked by a medical professional. You should visit a medical professional if experience a new symptom.

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