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An ocular or visual migraine can be alarming, especially if it’s happening for the first time. One moment your vision is normal, and the next there may be a shimmering arc, zigzag lines, flashing lights, a blind spot, or an area of distorted vision.
The term “ocular migraine” is commonly used by patients to describe these episodes, but it can refer to more than one phenomenon. Most often, the symptoms are actually caused by migraine with visual aura, which originates in the brain and typically affects the visual field of both eyes. Much more rarely, temporary visual symptoms can occur in only one eye, sometimes referred to as retinal migraine.
The distinction matters because new visual symptoms affecting only one eye can also be caused by conditions involving the retina or blood flow to the eye and should not automatically be assumed to be migraine.
This article explains what people mean by ocular and visual migraines, what the symptoms can look like, common triggers, and when a visual disturbance needs medical attention.
What Are Ocular and Visual Migraines?
“Ocular migraine” and “visual migraine” are informal terms commonly used to describe temporary vision changes associated with migraine. In many cases, what someone calls an ocular migraine is actually migraine with visual aura.
A typical visual aura develops gradually, lasts between 5 and 60 minutes, and resolves completely. It may occur before a migraine headache, during one, or without any headache. Migraine with visual aura generally affects the visual field of both eyes, although it may seem as though the disturbance is only on one side of your vision.
A simple way to check is to cover one eye, then the other, while the symptoms are occurring. If the same visual pattern remains visible regardless of which eye you cover, the disturbance affects both eyes and is more consistent with a visual aura. If a new visual disturbance or vision loss is truly present in one eye only, it should be evaluated promptly. Retinal migraine can cause temporary monocular symptoms, but it is rare, and other ocular or vascular causes of vision loss need to be ruled out.
What Are Ocular Migraine Symptoms?
Migraine visual aura can take many different forms. Patients commonly describe:
- Shimmering or flashing lights
- A blind spot that gradually spreads or moves across the visual field
- Wavy or zigzag lines
- A sensation of looking through cracked glass or heat haze
- Glittering or sparkling specks
- Areas of blurred, distorted, or dimmed vision
Some people also experience symptoms such as:
- Light sensitivity (photophobia)
- Nausea
- Tingling or numbness in the face or hand
- Difficulty finding words
Visual aura does not always come with a headache. Some people experience the visual symptoms without head pain, sometimes called a “silent migraine.” When a headache does occur, it may begin during or after the visual disturbance.If you're unsure whether a visual disturbance is affecting one eye or both, cover each eye separately while the symptoms are occurring. This simple test can provide useful information for your eye doctor.
What Triggers Ocular and Visual Migraines?
Migraine triggers vary considerably from person to person. Some people can identify very specific patterns, while others experience migraines without an obvious trigger.
Commonly reported triggers include:
1. Dehydration.
Dehydration is a commonly reported migraine trigger. Some people notice that migraine attacks are more likely when they have not had enough fluids, particularly during hot weather, exercise, illness, or travel. Staying adequately hydrated throughout the day may help.
2. Stress.
Stress is another frequently reported trigger. Regular sleep, exercise, relaxation techniques, and other strategies for managing stress may help reduce migraine frequency for some people.
3. Dietary factors.
Certain foods are often reported as migraine triggers, but food triggers are highly individualized and the evidence for specific foods is inconsistent. Rather than eliminating large categories of foods unnecessarily, consider keeping a migraine diary and looking for patterns between your symptoms and what you have eaten.
4. Changes in caffeine or alcohol intake.
For some people, excessive caffeine can contribute to migraine attacks. Abruptly reducing habitual caffeine intake can also trigger headaches, so consistency may be important. Alcohol is another commonly reported trigger, although sensitivity varies from person to person.
5. Changes in altitude, weather, or air pressure.
Flying, traveling to higher elevations, or changes in weather and barometric pressure may coincide with migraine attacks in susceptible individuals.
6. Hormonal changes.
Changes in estrogen levels associated with the menstrual cycle, pregnancy, perimenopause, and menopause can influence migraine patterns. Hormonal medications, including some forms of birth control, may also affect migraine frequency or severity in some individuals.
Other potential triggers include missed meals, changes in sleep, heat, strenuous exertion, glare, and changes in a person's normal routine.
Keeping track of your individual pattern is often more useful than trying to avoid every possible migraine trigger.
Ocular Migraine Treatment
A typical migraine visual aura usually resolves on its own within 5 to 60 minutes and does not require treatment directed at the eyes.
If your vision becomes disturbed while driving, pull over as soon as it is safe to do so and do not resume driving until your vision has completely returned to normal.
Once you are somewhere safe, resting in a quiet, comfortable environment may help. Staying hydrated and treating any associated headache according to your physician's recommendations may also make the episode more manageable.
Eye drops, a new glasses prescription, or a contact lens change will not eliminate a migraine visual aura because the visual disturbance associated with migraine aura originates in the brain rather than the eye itself.
If attacks are frequent, worsening, or significantly interfering with your daily life, speak with your primary care physician or neurologist about whether migraine-specific treatment or preventive therapy may be appropriate.
How to Prevent Ocular Migraines
No single strategy prevents every migraine. Prevention usually starts with identifying patterns and managing the triggers that apply to you.
Consider keeping a migraine diary that records:
- When symptoms begin
- How long they last
- Whether they affect one eye or both
- Foods and beverages consumed that day
- Caffeine and alcohol intake
- Hydration
- Sleep
- Stress
- Exercise
- Menstrual or hormonal changes, when applicable
- Any unusual changes in routine, travel, altitude, or weather
Maintaining regular sleep, eating consistent meals, staying adequately hydrated, exercising regularly, and managing stress may help reduce migraine frequency for some people.
If episodes become frequent, change in character, last longer than usual, or interfere with your daily activities, discuss them with your primary care physician, eye doctor, or neurologist.
When to Stop and Call an Eye Doctor
A familiar visual aura that develops gradually, affects the visual field of both eyes, resolves completely within an hour, and follows the same pattern as previous episodes is generally consistent with migraine.
However, not every flashing light, blind spot, or episode of vision loss is a migraine.
Some visual symptoms can be caused by a retinal tear or detachment, problems with blood flow to the eye, or neurologic conditions such as a stroke.
Seek prompt medical attention if you experience:
- New vision loss or a blind spot affecting one eye only, particularly if confirmed by covering each eye separately
- A shadow, veil, or curtain over part of your vision
- A sudden onset or significant increase in flashes or floaters
- Vision that does not return completely to normal
- A visual disturbance lasting longer than one hour, particularly if this is different from your usual pattern
- A first episode of unexplained visual disturbance, especially if the symptoms are atypical, sudden, or monocular
- New or significantly different symptoms compared with your previous migraine episodes
- Visual changes following a head or eye injury
If visual symptoms occur with facial drooping, weakness or numbness on one side of the body, difficulty speaking, confusion, or other symptoms concerning for stroke, call 911 immediately.
When you're unsure whether an episode is a migraine or an eye problem, it is safer to have the symptoms evaluated rather than assuming they are migraine-related.
Specialty Eye Care at Miami Contact Lens Institute
Most migraine visual auras resolve completely and do not damage the eyes. However, new or unusual visual symptoms deserve attention because several eye conditions can initially resemble migraine aura.
A comprehensive eye examination can help rule out retinal and other ocular causes of visual disturbances. If symptoms are new, changing, persistent, or affecting only one eye, an eye examination can help determine whether additional or urgent evaluation is needed.
At Miami Contact Lens Institute, we care for patients in Miami, Aventura, Weston, and throughout South Florida. We provide comprehensive eye examinations as well as evaluation of urgent visual symptoms and eye conditions.
Contact Miami Contact Lens Institute to schedule an appointment with Dr. Elise Kramer or a member of our eye care team.
