Ocular migraine (retinal migraine)

Ocular migraine is a type of migraine that causes visual disturbances. This article describes retinal migraine, or ophthalmic migraine, a rare type of migraine that causes temporary full or partial loss of vision in one eye, usually the same eye each time. The symptoms of retinal migraine are similar to those of other more serious conditions, so always get urgent medical advice if you experience any sudden vision loss.

Retinal migraine can also cause a dull ache behind the eye and a migraine headache. As with other types of migraine, there can be many different triggers. Over-the-counter painkillers can help when taken at the start of a migraine attack. You may also be able to prevent migraines by identifying your migraine triggers and trying to avoid them. The vision loss that happens with retinal migraines typically lasts less than an hour, and long-term vision loss is very rare.

What is an ocular migraine?

An ocular migraine causes vision changes that are often, but not always, accompanied by a migraine headache. Retinal migraine is a rare ocular migraine that causes short-term vision loss in one eye.

Retinal migraine differs from migraine with aura, a more common type of migraine that causes visual disturbances. Migraine aura affects both eyes and causes visual changes without the loss of vision involved in retinal migraine.

What causes ocular migraines?

Ocular migraines happen when the blood vessels in the eye suddenly narrow and blood flow to the retina at the back of the eye is reduced. The retina is a layer of light-sensitive cells that receives light signals and sends messages to the brain to form the images we see. Once the blood vessels relax and the blood flow comes back, your vision returns to normal.

Ocular migraines are more common in:

• Women
• People under 40
• Those with a family history of migraines
• People with underlying conditions such as lupus, epilepsy, giant cell arteritis, and hardening of the arteries.

If you get ocular migraines, you may find they are triggered by certain activities and environmental or lifestyle factors, for example:

• Stress and anxiety
• Tiredness and lack of sleep
• Hormone changes
• Smoking, caffeine, and alcohol (especially red wine)
• High blood pressure
• High altitude
• Dehydration
• Low blood sugar
• Excessive heat
• Bright or flashing lights
• Strong scents
• Foods that contain MSG (monosodium glutamate) and tyramine (aged cheese, salami, smoked fish, soy products)

Your GP or optician may refer you to an eye doctor (ophthalmologist) for further tests if you get symptoms of ocular migraine to rule out other eye conditions or health problems which could be the cause.

Ocular migraine symptoms

Ocular migraines involve distinctive visual symptoms that can be very worrying if you’ve never experienced them before. Fortunately, permanent loss of vision is rare, and vision tends to go back to normal within an hour of symptoms starting.

Ocular migraine symptoms include:

• Visual disturbances, including flashes of light and zigzag lines.
• Partial or total loss of vision in one eye, starting as blind spots (scotoma) in your central vision that get bigger.
• Reduced visual field (loss of peripheral vision).
• If you experience repeated ocular migraines, it is normally the same eye that is affected each time.
• Migraine headache either before, during or after the vision problems.

Ocular migraine treatment

Treatments for ocular migraine are best taken at the start of an attack. You can take over-the-counter painkillers such as paracetamol or ibuprofen for pain relief. Soluble painkillers such as aspirin can enter the bloodstream faster and may be a good choice if you’re nauseous. You can also get anti-sickness medication if you feel sick with migraines.

Ocular migraine prevention

Before trying medication to prevent migraines, you can keep a migraine diary to learn about your migraine triggers. If you identify your triggers, you can try making lifestyle changes to reduce the frequency of your migraines without needing prescription medication.

If managing your migraine triggers isn’t working for you, and the frequency or severity of your migraines is a concern, speak to your GP. They may be able to prescribe preventative medication for ocular migraines, such as:

• Blood pressure medicine - beta-blockers that relax the blood vessels
• Calcium channel blockers - that stop the blood vessels from narrowing
• Anti-seizure medication
• Tricyclic antidepressants

Some of these medications have side effects, which your doctor will discuss with you. Some are not suitable for people who are pregnant or breastfeeding.

Frequently asked questions