According to the American Migraine Foundation, around one in four people living with chronic migraine experiences visual aura. This disturbing but usually temporary symptom may or may not occur alongside severe headaches. Ocular migraine is another term for visual symptoms during a migraine.

Many MyMigraineTeam members have described their unique experiences with ocular migraine:

• “I have had three severe migraines in the last couple of weeks. Each one started with an aura of zigzag lines in my right eye.”
• “My visual auras affect a big portion of my vision, so doing day-to-day things is difficult (because I can’t see).”
• “The aura lasts maybe 20 to 30 minutes. I’m always afraid that it won’t stop!”
• “My aura starts from the outside corner of my right eye and travels across to my left eye from the inside corner to the outside corner. I cannot see through the pulsating waves.”

Ocular migraine can occur with other types of migraines, like cluster headaches and chronic migraine. An ocular migraine without head pain may be a warning that a migraine headache will follow.

Types of Ocular Migraine

The term ocular migraine is sometimes used to refer to any migraine with visual symptoms. However, there are different types of ocular migraine.

Migraine With Aura

A migraine aura is a visual or sensory disturbance that can affect hearing, sight, speech, or touch. An aura can occur before a headache, at the same time as a headache, or without a headache. In over 90 percent of cases, visual aura symptoms appear as flashes of light, zigzag lines, or blind spots. Visual aura occurs in 25 percent to 30 percent of people who experience migraine of different types.

“My visual auras affect a big portion of my vision, so doing day-to-day things is difficult (because I can’t see).”

— A MyMigraineTeam member

Migraine attacks with aura but no headache are sometimes called silent migraines or acephalgic migraines.

Retinal Migraine

Retinal migraine is characterized by visual symptoms in only one eye — either right or left, and not both at the same time. The condition causes aura and more intense visual symptoms like temporary blindness.

Retinal migraine usually occurs with a migraine headache or in people with a history of migraine. The condition is considered rare, but the medical community is still trying to determine exactly how rare.

Migraine With Brain Stem Aura

People who have migraine with brain stem aura (MBA) experience visual symptoms that are similar to migraine aura. However, symptoms can also occur in just one eye. The condition is characterized by headaches in the back of the head that span both sides of the head.

Symptoms of Ocular Migraines

Disturbances with vision and migraine aura can be disorienting. Visual symptoms in all types of ocular migraine tend to last between 10 and 60 minutes. In many cases, ocular migraine symptoms are an indication of an impending migraine headache attack. Although symptoms like impaired vision can be disturbing, they are temporary in most cases.

Symptoms may include:

• Sensitivity to light
• Flashing or sparkling lights, sometimes called scintillation
• Zigzag patterns or other geometric forms in your vision
• Blind spots, also called scotoma
• Temporary loss of vision

Other common migraine symptoms may coincide with visual symptoms, such as:

• Dizziness or vertigo
• Sensitivity to light
• Tingling or numbness
• Nausea or vomiting
• Headache

Ocular migraine symptoms can make activities difficult or hazardous. Balance and walking may become challenging and cause an increased risk of falls. Activities such as driving and operating equipment may be dangerous while experiencing visual symptoms and should be avoided.

Causes of Ocular Migraines

The exact causes of ocular migraines are not fully understood. They may be caused by environmental and genetic factors that affect the nervous system. Neurological symptoms from migraines can amplify sensitivity to light, sound, smell, and touch. However, there’s some variation in the specific causes of different ocular migraines.

Causes of Migraine Aura

Migraine attacks generally have four phases: prodrome, aura, headache attack, and postdrome. Not everyone with migraine experiences all four phases. The aura phase, which usually lasts an hour or less, is when visual disturbances are experienced. It can also occur at the same time as headache and other migraine symptoms.

Different types of brain activity have been measured during migraine with aura. They show changes in blood flow and metabolism in the occipital cortex, an area of the brain that affects vision. Cortical spreading depression (CSD) is a slowly spreading wave of changing brain activity. It has been associated with visual aura in migraines. The slow spread of brain disturbance is believed to correspond with the aura’s gradual start and duration.

Causes of Retinal Migraine

In retinal migraine, only one eye is affected at a time. This type of migraine is associated with a problem with blood vessels in the optic nerve or the eye itself, rather than the occipital cortex. A narrowing of blood flow in the central retinal artery may cause the condition. Some researchers also think that a spreading depression in neurons in the retina causes the condition. This phenomenon is similar to CSD but only affects the retina and not the entire brain.

Causes of Migraine With Brain Stem Aura

The causes of MBA are not well understood. Like other forms of migraine, a combination of genetic mutations (changes), environment, and changes in brain activity are factors. Abnormal blood flow and nerve function in the brain stem and occipital cortex may also cause the condition.

Risk Factors for Ocular Migraine

Ocular migraines have similar risk factors to migraine in general. Women are three times more likely than men to have migraine, including ocular migraine. Genetic and environmental factors may increase the chances of ocular migraine. These factors include:

• Family history of migraine
• Hormonal changes like puberty and menstruation
• Birth control pills or other hormonal contraceptives
• High blood pressure
• High altitude
• Change in weather

Women are three times more likely than men to have migraine, including ocular migraine.

Lifestyle factors can trigger ocular migraines, including:

• Stress or lack of sleep
• Dehydration
• Skipping meals
• Smoking
• Red wine
• Caffeine

Diagnosing Ocular Migraine

Neurologists (brain doctors), ophthalmologists (eye specialists), and optometrists (eye care professionals) diagnose ocular migraines based on symptoms, medical history, and exams. When symptoms are unusually severe or complex, a brain scan may be required to rule out other problems that could cause pain, such as a tumor or infection.

Treating Ocular Migraine

When visual disturbances with ocular migraine occur without head pain, symptoms usually resolve within an hour and do not require much treatment. People with migraine aura tend to benefit from basic remedies, such as:

• Rest
• Over-the-counter analgesics, such as ibuprofen (Advil) or acetaminophen (Tylenol)
• Caffeine
• Food
• Antinausea medication, if you’re experiencing nausea or vomiting

More acute ocular migraine with headache is generally treated the same as migraine without visual symptoms, with some notable exceptions. There are two types of drugs that are often used to treat acute migraine but are not recommended for retinal migraine:

• Triptans, such as sumatriptan (Imitrex) and rizatriptan (Maxalt)
• Dihydroergotamines, also called ergot alkaloids, such as dihydroergotamine (Migranal) and dihydroergotamine mesylate (D.H.E.45)

Preventive treatments that are typically used for other types of migraine may also be beneficial for preventing ocular migraine.

Talk With Others Who Understand

MyMigraineTeam is the social network for people with migraine and their loved ones. On MyMigraineTeam, more than 84,000 members come together to ask questions, give advice, and share their stories with others who understand life with migraine.

Do you have ocular migraine? What was your journey to diagnosis and how do you cope? Share your experience in the comments below, or start a conversation by posting on your Activities page.