Ocular Migraine: Causes, Symptoms & Treatment

When most people think of a migraine, they imagine a debilitating headache with sensitivity to light and sound.

But for some, migraine attacks can come with other symptoms, including vision impairment.

An ocular migraine, for example, causes vision loss—or even blindness—in one eye for a short period of time, either before or during a migraine.

It can be alarming to experience vision loss with a migraine.

If you suffer from ocular migraine, your healthcare provider can recommend the best treatment options, along with suggesting ways to prevent your migraines from occurring in the first place.

In this article, I’ll explain the causes and symptoms of ocular migraine.

Then, I’ll explore diagnosis and treatment of this condition, along with how to prevent ocular migraine.

Finally, I’ll cover when to see a doctor for an ocular migraine. 

Causes

Migraine attacks are commonly associated with neurological symptoms, including visual disturbances.

Migraine with aura, for example, can cause people to see flashes of light, zig-zag patterns, or even blind spots before or during a migraine episode. 

Aura usually affects both eyes. But an ocular migraine—sometimes called a retinal migraine—causes temporary visual disturbances, even total blindness, in just one eye before or during a migraine. 

While this vision loss is usually caused by a migraine, it’s not totally clear what causes the vision loss to occur.

Some experts think people with ocular migraines experience spasms in the blood vessels of their retina, or the lining in the back of the eye.

Others theorize ocular migraines happen because of changes in retina nerve cells during a migraine. 

Certain risk factors, or triggers, can increase the likelihood of an ocular migraine if you already get them.

Many ocular migraine triggers are the same as triggers for migraine with aura.

These include: 

• Stress 
• High blood pressure
• Dehydration 
• Smoking
• Low blood sugar
• Exercise
• High altitude

Visual triggers, such as the following, may also cause ocular migraines: 

• Staring at a computer screen or another electronic device for a long time
• Spending time in harsh lighting, such as fluorescent lighting 
• Driving long distances 

It’s also thought that there’s a genetic factor involved in ocular migraines, which means they may run in families. 

Symptoms

An ocular migraine involves visual symptoms that happen in just one eye, either before or during a migraine headache.

Usually, the ocular migraine lasts less than an hour.

Symptoms may include: 

• Decreased vision in one eye 
• A blind spot that starts small and becomes larger
• Seeing twinkling lights in one eye
• Temporary blindness 
• Trouble with peripheral (side) vision 

It’s also common for ocular migraines to involve a headache, either during or after the visual disturbances.

Migraine headache symptoms may include: 

• Throbbing or pulsating pain, often on one side of the head
• Worsening headache when you move around
• Nausea or vomiting
• Sensitivity to light and sound

Because both vision loss and severe headache can be a sign of more serious conditions, tell your doctor if you experience either.

Your healthcare provider can rule out other issues and recommend a treatment plan. 

Diagnosis 

If you think you’re experiencing ocular migraines, receiving a diagnosis can ensure you get the treatment you need.

Your healthcare provider will ask you about your medical history and symptoms, along with examining your eyes. 

Before diagnosing you with ocular migraine, your doctor may conduct a physical exam and lab tests to rule out conditions like: 

• A stroke or transient ischemic attack (TIA)
• Amaurosis fugax, or temporary blindness that occurs from disruptions in blood flow to the eye
• Giant cell arteritis, a condition that causes inflammation in your blood vessels 
• Autoimmune conditions, which can cause blood vessel problems that affect vision 
• Sickle cell disease or polycythemia, conditions affecting your red blood cells 
• Substance use disorder 

If your medical exam and testing don’t show signs of other conditions, you may be diagnosed with ocular migraine. 

Treatment

All migraines, including ocular migraines, can be debilitating.

If you’re diagnosed with ocular migraine, your doctor may recommend one of the following medications: 

• Epilepsy drugs, such as valproic acid (Depakote or Depakene) or topiramate (Qudexy XR, Topamax, or Trokendi XR)
• Blood pressure drugs, such as beta-blockers, including metoprolol (Lopressor) or propranolol (Inderal), and calcium-channel blockers including nicardipine (Cardene) and verapamil (Calan)
• Tricyclic antidepressants, such as venlafaxine (Effexor), nortriptyline (Pamelor), and amitriptyline (Elavil)
• Calcitonin gene-related peptide (CGRP) inhibitors, such as eptinezumab (Vyepti), galcanezumab (Emgality), fremanezumab (Ajovy), and erenumab (Aimovig)

Because ocular migraine may also occur with pain, your doctor might recommend you take pain relievers, such as: 

• Acetaminophen (Tylenol)
• Non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Advil), aspirin, or naproxen (Aleve)

Prevention 

Avoiding triggers is an important way to prevent migraine attacks, including ocular migraines.

If you aren’t sure what your triggers are, keep a migraine journal where you track migraine episodes and potential causes. 

Some people experience migraine as a result of certain foods and drinks (such as alcohol or drinks with artificial sweeteners).

Other common ocular migraine triggers include: 

• Stress 
• High blood pressure
• Dehydration 
• Smoking
• Low blood sugar
• Exercise
• High altitude
• Staring at a computer screen or another electronic device for a long time
• Spending time in harsh lighting, such as fluorescent lighting 
• Driving long distances 

If you continue to get ocular migraines even as you attempt to reduce your triggers, talk with your doctor.

People who get four or more migraines a month may benefit from preventative medicines, which can reduce both the severity and frequency of migraine attacks. 

When to See a Doctor 

If you experience a new visual disturbance or severe headache, check in with a doctor, who may want to rule out other more serious causes. 

Even if you’re already diagnosed with ocular migraines, talk to your healthcare provider if your symptoms get worse or if your medication isn’t helping.

Your doctor can recommend a treatment plan that, hopefully, reduces the severity and frequency of your migraines. 

Rarely, changes in vision can be a sign of stroke, which is a medical emergency. Call 9-1-1 or have someone take you to the emergency department if you experience the following symptoms: 

• Sudden numbness or weakness on one side of your body 
• Confusion
• Difficulty speaking or understanding someone else talking 
• Difficulty seeing in one or both eyes
• Trouble walking or a lack of balance
• Sudden, severe headache 

How K Health Can Help

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