Ocular Migraines: The Headache No One Talks About
What is an ocular migraine?
There are many different types of migraines. But if you’re seeing flashes or spots along with your head pain, you may be having an ocular migraine. Although the term is popular, it’s not an actual diagnosis, says University of Arizona neurology professor John Wall, MD. However, it does describe a real phenomenon that some people with migraines experience. “It refers to either some blindness in one eye during a migraine or having a migraine with aura,” he says. A patient may also call something an “ocular migraine” if they have an aura without a headache at all, says John Rothrock, MD, a professor of neurology at the George Washington University School of Medicine and Health Sciences. (Be aware of the signs that your head pain is serious.)
Symptoms of an ocular migraine
If you have a migraine with aura, you’ll “see” the symptoms before feeling any head pain. This may be wavy, zigzag, or shimmering lines or a blind spot in one area of your vision for about 15 to 20 minutes. (They normally do not last beyond an hour.) About 20 to 30 minutes after the aura disappears, your headache may start, says Dr. Wall.
Why do they happen?
While 12 percent of the American population reports getting migraines, a smaller number experience auras. An aura is a visual disturbance that comes with migraines. Periods of brain excitement followed by a drop in activity is believed to be responsible for setting off an aura, explains Dr. Wall. (Find out the common causes of migraines.)
Who’s most likely to have them?
Women are more likely to have migraines in general. In fact, migraines are three times more prevalent in women than men, says Dr. Rothrock. “This is likely due to female sex hormones that trigger migraines or make women more sensitive to migraines,” he says. There’s also a strong genetic component.
What are the risks?
By themselves, auras do not put you at risk. However, you may be more prone to other conditions, the most significant being slightly higher odds of stroke if you have a migraine with aura (rather than a migraine alone), says Dr. Wall. “Women with a migraine with aura may have about twice as many strokes as those who don’t,” he says. While that sounds alarming, the actual statistical risk is really small, he adds. If you have a migraine, you may also be at risk for this surprising disorder.
They may make you feel like you’re having a stroke
A migraine with aura isn’t just visual. Dr. Rothrock says that some people have sensory auras, which means they get numbness or tingling in their face or hand. “This can be misdiagnosed as a stroke or partial seizure,” he says. A patient history (in this case, someone who has had migraines with auras) is one of the best ways to make the diagnosis. An MRI can rule out a stroke.
You can still take birth control
If you’re a woman who suffers from migraines with aura, you may have heard that there’s also an elevated risk of stroke if you take estrogen-based oral contraceptives. However, if you have no other risk factors (for instance, you’re a female under age 35 who doesn’t smoke), a migraine specialist may feel comfortable prescribing these to you. “It may also stabilize your estrogen levels to make your migraines better,” says Dr. Wall. (Find out how to predict migraines.)
How to treat one
“The reality is that nothing to shorten or stop a typical aura has ever been shown to be effective,” says Dr. Rothrock. However, most patients who get started on preventive medication for too-frequent migraines, in general, will experience a decrease in migraines with aura as well.
Warning signs of a migraine
Many people who have migraines with auras have what are called “prodromal symptoms,” hitting up to 72 hours in advance. You may notice a predictive pattern of irritability, euphoria, thirst, hunger, or simply feeling “off,” explains Dr. Wall. In that case, he doesn’t suggest taking medication that far in advance, but make sure you’re ready for one by carrying your medications with you and responding quickly, he says. (Check out more migraine warning signs.)
Taking away the pain
If your ocular migraine (or a migraine with aura) precedes head pain, there are things you can do to treat it effectively. You can take an OTC migraine medication, like Excedrin, when you feel an aura coming on, says Dr. Wall. If OTCs don’t work, your doctor may prescribe triptans, an abortive medication to stop the pain. You’re a good candidate for these if you have about four to six migraines a month, he says.