Are jagged spots clouding your vision? What to know about ocular migraines

Eye Care

by Baylor Scott & White Health

Jul 18, 2021

We all think of a migraine as a piercing, just-want-go-back-to-bed pain that makes you miserable. While that is the case for many people who are living with migraines, there is a type of migraine that could be painless.

While a painless migraine may seem like a better option, an ophthalmic migraine (or ocular migraine) can be just as disruptive. This type of migraine is a disturbance in the visual part of the brain.

“Your brain has different sections that do different things,” said Sudhir Shenoy, MD, an ophthalmologist on the medical staff at Baylor Scott & White Medical Center – Round Rock. “There’s a part of the brain—the occipital cortex—that processes your vision. When you get a migraine in that part of the brain, then you experience visual symptoms.”

Symptoms of an ophthalmic or ocular migraine

The symptoms vary from person to person, but Dr. Shenoy said that typically you will see a flashing or flickering light in the center of your vision. The term for these symptoms is called a scintillating scotoma and it usually lasts from about 15 minutes to an hour or two, but anything longer warrants an evaluation by an eye doctor.

“It is generally a spot of light that appears and grows,” he said. “It flickers and shimmers and usually has zigzag edges. A lot of people describe it as a kaleidoscope.”

The light will be bright and often form in an arc or C-shaped pattern. Some have also described it as heat waves in front of their vision. You can see through it, but it blocks your vision enough that it may impair your ability to read something on a page.

“Over that 15-minute time period, the spot will move off to the side and disappear,” Dr. Shenoy said.

Are these migraines painful?

Ophthalmic migraines—sometimes called visual or ocular migraines—can be associated with some pain. But the pain is usually not the typical excruciating pain that is associated with a migraine.

And although this type of migraine is associated with your vision, they do not cause any pain in the eyes.

“We get patients who come in panicky because they think they’re going blind, or they think they’ve had a stroke,” Dr. Shenoy said. “It’s hard to explain that they’ve had a migraine because they haven’t had any pain. Everybody believes that migraines cause horrible headaches.”

What causes ophthalmic migraines?

While the causes of migraines are largely unknown, Dr. Shenoy said that migraines tend to be genetic.

“Most commonly when someone has migraines, I’ll ask, does your mom have migraines?” he said. “And their answer is usually yes.”

While genetics may play a big part in who will suffer from migraines, Dr. Shenoy said that environmental factors like stress, activity, exercise, bright lights, smells and certain foods can trigger the symptoms of a migraine.

Migraine treatment options

If migraine symptoms—ophthalmic or otherwise—are disrupting or hindering daily activities, like driving a car or being productive at work, then you should seek help from a doctor.

“There are medications that can help,” Dr. Shenoy said. “It’s what we call migraine prophylactics. The medication helps to prevent a migraine from occurring.”

People who haven’t had a lot of success with standard migraine treatments have opted for Botox injections in the scalp or taking vitamins like coenzyme Q10 or magnesium, though you should check with your doctor about these treatments first.

“You can also treat migraines with migraine abortive therapy, which is medication used to abort a migraine that’s already started,” he said.

Dr. Shenoy said some people whose ophthalmic migraines are triggered by bright lights have told him that FL-41 filters have reduced the frequency of their migraines.

“They look like Elton John glasses because they are pink, but some migraine sufferers say they help,” he said.

Are there ways to prevent an ophthalmic migraine?

Other than choosing your parents, the only way to prevent getting migraines is to identify and avoid the triggers that can cause the symptoms.

It’s also a good idea to see your primary care physician if your migraines are getting worse or are hindering your work performance. Your doctor can put you on a regimen of migraine prophylactics or refer you to a migraine specialist.

The good news is that ophthalmic migraines aren’t usually debilitating. And they aren’t that unusual, even.

“Ophthalmic migraines are more common than you think,” Dr. Shenoy said. “If you do experience scintillating scotomas or a transient change in your vision, get your eyes evaluated by your eye doctor.”

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