Ocular migraine is a type of headache that usually affects only one side of the skull, with visual symptoms and pain located in the periocular area (sometimes to a greater extent).
Although it is not dangerous, depending on the frequency of the episodes, it can be frustrating and disabling. For this reason, if there are additional symptoms to those we are going to see, or whenever the recommended treatments have no effect, it is necessary to consult an ophthalmologist capable of making complex diagnoses, such as those at the Clínica Oftalmológica Nebro, and a neurologist.
What is ocular migraine and its symptoms?
Ocular migraine is a type of migraine with aura, i.e. a characteristic headache, caused by temporary inflammation of some nerves, usually occurring 15 to 20 minutes before the onset of pain, with visual symptoms.
Within the migraine group, ophthalmic migraine refers to migraines in which the painful area is limited to or includes the periocular area.
As ophthalmologists, we cannot fail to warn about the possible causes of eye pain. Sometimes it is not a migraine, although this is the most common. At the first episode, even if we think it is a migraine, we should see a doctor immediately so that he or she can assess us and tell us when to consult an emergency specialist.
The common symptoms of ophthalmic migraine are listed below. Note that they do not all have to occur in the same episode:
- Blurred or scintillating scotomas.
- Loss of vision, usually partial, affecting only one eye. This eye coincides with the side on which the pain will occur.
- Eye pain or sensation of pain just behind the eye(s) (in some cases, migraine may affect both sides of the skull at the same time).
- Photophobia and phonophobia. Exposure to intense light or noise can increase eye symptoms and pain, as well as cause nausea.
What are the causes of ophthalmic migraine and its prevention?
The physiological cause of ocular migraine is the inflammation of certain nerves, or their temporary compression by a change in the size of the blood vessels that run parallel to these nerves. But the triggers of ophthalmic migraines can be several, and these are also called causes:
- Sustained stress.
- Lack of sleep.
- Genetic predisposition.
- Reactions to certain drugs.
- Exposure to flashing lights, which may flicker so fast that we do not notice them.
- Hormonal changes.
- In some patients, the intake of certain foods such as cheese and chocolate.
Some diseases may have ocular migraine as an additional symptom:
- Depression.
- Epilepsy.
- Lupus.
- Sickle cell anaemia.
- Any other neurological disorder.
- There are ocular migraines that occur as a result of spasms in the blood vessels, following an anxiety crisis, for example.
- In a few cases, the trigger may be a site-specific tumour, benign or malignant.
How ocular migraine is treated
Rest
The most effective way to overcome an ocular migraine is to lie down in the dark in a quiet and, if possible, cool room.
When this is not possible, try to avoid exposure to intense light sources, including screens of digital devices, and avoid noisy environments. Apply these measures from the moment visual symptoms or migraine aura begin.
Lifestyle
We will try to control all possible factors, maintaining good sleep hygiene, treating anxiety or depression and eliminating suspect foods from the diet, at least for a few months (then we will try to reintroduce these foods one at a time).
Drugs
Episodes can last from one hour to two or three consecutive days. Occasionally, these episodes are chained, so that the patient suffers daily ocular migraines for a period of time.
To help improve the quality of life for severe migraine sufferers, and for people who have very frequent episodes, we can prescribe analgesic, pain-controlling or anti-migraine drugs.
With the latter, it is not possible to get it right the first time, and it is necessary to experiment for a while through trial and error. Some antimigraine drugs have significant contraindications, usually with prolonged treatment. For this reason, we often prefer to prescribe a mild anti-inflammatory or a commonly used analgesic, while the patient learns to anticipate and reduce the intensity of their attacks.
An ocular migraine is not dangerous, but it is annoying. Sometimes it is a symptom of other illnesses and, when it presents symptoms that are not the usual ones, it could be something more serious. When there are doubts about the cause of what looks like an ophthalmic migraine, we perform a series of neurological and ophthalmological tests on the patient. If these tests show that there is nothing unusual, we will assume that it is indeed an ocular migraine, albeit an atypical one.