Introduction
A migraine is a neurological condition which may involve a throbbing or pulsating headache. The pain may be moderate or severe. An individual can feel pain on one part of the head or both. Also, the pain worsens with movement. There may be a warning that a migraine is about to occur. The symptoms can last for 30 minutes.
Ocular migraine describes a headache accompanied by changes in vision. Migraines affect two in every ten people. Migraines can occur at any age though it may begin during puberty and young adulthood. Severe attacks can be disabling where one is unable to engage in daily activities
Sub-Types
Ocular migraine occurs in two ways:
- Migraine aura (classic or variant migraine) - It is non-serious and happens when an individual experiences visual symptoms without a headache. Numbness may precede a migraine.
- Retinal aura - It is serious but rare, only occurring in an individual who has experienced other migraine symptoms. It affects only one eye. However, vision loss in one eye does not mean one has a migraine. It could be that another severe condition is causing the vision loss.
Other types may include:
- Migraine without aura (common migraine) - It includes a sudden headache experienced on one side of the head.
- Headache - It may or may not have visual or neurological changes. The pain may radiate from a specific point like the back of the ear. This pain is sometimes confused with eye pain.
- Migraine without headache - There are aura symptoms or visual problems but without a headache.
- Complicated migraine - It is accompanied by neurological changes like paralysis of the eye and loss of ability to read and write. It may or may not be accompanied by a headache. Acephalgic migraine is the most common form of complicated migraine with transient visual changes without a headache.
- Ophthalmoplegic migraine - It is a rare type of migraine with pain in the head accompanied by double vision, a large pupil and droopy eyelid.
- Basilar-type migraine - It mainly affects children and adolescents and is characterized by double vision, partial or total vision loss.
- Abdominal migraine - It mostly affects young children with little or no headache.
- Hemiplegic migraine - It is a rare but severe migraine that results in temporary paralysis.
- Menstrually-related migraine - It affects menstruating women.
Causes and Risk Factors
Causes of migraines remain unclear. Doctors, however, think it is associated with changes in some of the brain's chemicals or people with a sensitive nervous system. Certain things can trigger a migraine headache such as:
- Emotional problems, stress and anxiety
- Excessive stimulation of the senses such as strong odors
- Irregular sleep patterns where individuals have too little or too much sleep
- Environmental triggers like changes in the weather, certain lights or perfumes
- Food additives such as enhancers found in fast foods and artificial sweeteners
- Hormonal changes in women. Pregnancy, use of contraceptives, periods or menopause can cause these changes
- Foods like chocolate, fava beans, soy products, smoked fish, aged cheese, hard sausages, some nuts and red wine. Hunger can also trigger migraines
Migraines occur more in women than men. It can be hereditary and affects both adults and young children.
Signs & Symptoms
The symptoms for migraines involving the eye include:
- Sensitivity to light
- Seeing zigzag lines
- Nausea or vomiting
- Flashes on the peripheral vision
- Seeing colored or shimmering lights
- Sudden and complete blindness in both eyes
- Repeated bouts of diminished vision or blindness in the retinal aura
Diagnosis
Doctors base the diagnosis of migraine on the symptoms mentioned above.
The eye care professional will take a medical history to learn more about the cause of the migraine. He/she may refer individuals to neurologists or other professionals to enable further tests and examinations.
The professional will also do a dilated eye examination to disqualify retinal tear, retinal detachment or posterior vitreous detachment.
A computed tomography (CT) and magnetic resonance imaging of the head can be done if certain warning signs are present. The CT and MRI are also conducted if headaches have recently developed.
A lumbar puncture (spinal tap) can rule out tumors or intracranial bleeding.
Treatment
Treatment of migraines is aimed at stopping them in their initial stages. Treatment also reduces the number and severity of migraine attacks.
Medical Treatment
Prescription and non-prescription drugs both help to relieve pain from a migraine headache. They include over-the-counter medications such as aspirin and ibuprofen. Caffeine can sometimes help with pain relief.
Doctors can recommend prescription drugs that balance the chemical changes that cause migraines. They include Amerge®, Imitrex®, Zomig® and so on.
For those with a persistent, severe migraine, the doctor might recommend taking medications daily. Such medicines include beta blockers and drugs that help with seizures.
Alternative Treatment
Yoga is said to reduce the intensity and frequency of migraines. This is because it makes use of physical poses which strengthen and stretch one’s muscles. The poses are combined with meditation, deep breathing and relaxation.
Prognosis/Long-term outlook
Migraines may become chronic when it occurs about 15 days a month. It usually significantly reduces or resolves from age 50.
Overuse of analgesics, triptans or caffeine can lead to even more severe migraines. Failure to take a dose or taking it late can also trigger migraines.
Prevention/Follow Up
To prevent migraines one can identify and avoid things that are likely to trigger an attack. A journal is helpful to note down triggers since they can be difficult to detect. People can write down what they did just before the migraine began. What one ate, the quality of sleep and so on are some of the things to look out for. Patients should also note down their response to treatment.
One can also opt to take drugs daily to prevent migraine attacks. These medicines include beta blockers.
