The Eyes Have It!
Ocular Migraine, Migraine with Aura, and Retinal Migraine
The eye is the jewel of the body.
- Henry David Thoreau
Are they the same thing and how do I differentiate them? The terminology is confusing but in the past, the term Ocular Migraine was often used to refer to any migraine episode with visual symptoms. Today, many doctors prefer more specific terms and often refer to two different conditions: 1. Migraine with Aura; and 2. Retinal Migraine. (If doctors do use the term Ocular Migraine, they more commonly use it to describe Retinal Migraine…but not always, so be sure to ask what they mean!)
Migraine with Aura impairs vision in both eyes, with flashes of light, blurry spots, sparkling star shapes and/or zig zag lines and patterns. These symptoms remain visible even when the eyes close. Migraine with Aura often causes a headache, but it can occur with a headache or without one. It often lasts for a shorter period of time if there is no head pain. The visual symptoms typically last under one hour, and although the symptoms do not linger, they can be very frightening and interfere with daily activities, such as reading, writing, or driving. Migraines with Aura can also go beyond vision changes and include: difficulty speaking, dizziness, loss of balance, numbness/tingling in your arms, legs or face, or tinnitus (ringing in the ear). These symptoms can begin on one side of the body and spread.
Retinal Migraine refers to visual symptoms that occur only in one eye, most commonly either before or during a migraine attack. Along with the headache, Retinal Migraine visual symptoms tend to be more intrusive than Aura symptoms and include decreased vision, twinkling or bright flashing lights, and even temporary blindness. The visual distortion often begins with a small sparkling area that slowly expands outward and has jagged, zig-zag edges. These visual symptoms typically last about 20-30 minutes and then completely resolve. In addition to these visual symptoms the patient can also experience the symptoms of a headache or a migraine. About 75% of Retinal Migraines cause pain including:
Moderate to severe head pain including pounding, throbbing, pulsing, or dull pain
Sensitivity to light, noise and/or odors
Nausea/vomiting
Pale skin color
Loss of appetite
Either feeling warm and sweating or feeling cold with chills
The primary difference between a Migraine with Aura and a Retinal Migraine is the Migraine with Aura affects both eyes while the visual disruptions in one eye are typically more severe with a Retinal Migraine.
So, what causes these conditions? Migraines occur when abnormal electrical signals fire on the brain’s surface. “Your retina converts things you see into electrical signals and sends them to the brain,” says Dr. Kumar, an ophthalmologist at the Ford Health Medical Center. “If the electrical signals send abnormal messages, you may see lights and spots that aren’t actually there.” With a Retinal Migraine, these signals only affect the back of your eye (not the brain) and it is believed they may happen when the blood vessels in the retina become narrow and there is a reduction in blood flow to the retina. Although it is not perfectly clear, Migraine with Aura appears to be the result of abnormal electrical activity involving certain regions of the cortex in the brain.
With both the Migraine with Aura and Retinal Migraine, the triggers include: bright lights, eyestrain (from staring at a computer screen for long periods of time!), certain foods/drinks (such as chocolate, red wine, and caffeinated beverages), strong odors, loud noises, stress/anxiety, dehydration, high blood pressure, high cholesterol, hormone changes, and smoking. You are more likely to develop these conditions if you have a family history, are female, or between the ages of 30 and 40. Diagnosis typically involves: a comprehensive eye exam with dilation to check for visual changes and blood pressure in the eye, a review of your medical history, and perhaps a physical examination with a physician or neurologist to rule out other potential causes.
Remember, sudden vision changes in one eye can be caused by serious eye conditions that require immediate treatment. For example, a retinal detachment can have some similar symptoms to Migraine with Aura or Retinal Migraine. In this case, a layer of tissue in the retina at the back of the eye pulls away from the other tissues causing flashes of light, floaters, color changes, and black “curtains” These symptoms usually last much longer than 30 to 60 minutes. Although rare, retinal detachments are serious and treatment must begin quickly to resolve the problem.
As a general guide, it is best to see a healthcare professional right away if you have visual symptoms that have not been diagnosed before. These include:
Visual changes in only one eye
Visual changes that last less than five minutes or more than 60 minutes.
Visual changes without a headache
Weakness on one side of the body and/or speech changes
If you have not been diagnosed with Migraine with Aura and Retinal Migraine, but experience these symptoms, it is best to see your ophthalmologist right away or go to the Emergency Room.
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