Many patients come in to see me with the same complaint: “I had this weird kaleidoscope/zig-zagging lines/Bart Simpson’s hair in my vision last week!” They all, almost without fault, say the weird visual phenomenon started, then got a little bigger, and then smaller and then went away, in total lasting 20-30 minutes. It can be pretty scary the first time you see it; even I was freaked out the first time I experienced it, and I knew what it was! When I tell patients they have had an ocular or visual migraine, usually they reply, “But I didn’t have a headache.” And that is true, a visual migraine is not followed by a headache. A visual migraine, by definition, is a visual aura without a headache afterward. Each person experiences it a little differently, but the photo below is a visualization of the most common descriptions.
Types of Migraines
Migraines are very complex and can be broken down into many categories. The “common” migraine is head pain accompanied by nausea, light and sound sensitivity without any visual symptoms such as the aura described above. A “classic” migraine is a headache with the accompanying symptoms mentioned above with a visual aura, and the visual aura without headache is known as an ocular or visual migraine. Unfortunately, we don’t really know what causes migraines and why some people experience visual symptoms and others don’t. According to the World Health Organization, migraines most likely have a genetic component, and some studies say up to 70 percent of people who suffer from migraines have a family history. It appears migraines are caused by changes deep within the brain that release inflammatory substances around the nerves and blood vessels in the head and brain. Unfortunately, the exact mechanism is unclear, but imaging studies have revealed that changes in blood flow to the brain occur during ocular migraines and visual auras. Each individual is also different with regard to what triggers migraines: for some it’s bright or flickering lights, with others it can be specific foods or strong odors.
When it’s Serious
The important thing to remember about ocular migraines is that they are benign and do not cause permanent vision loss or eye/brain damage. While they can be scary while occurring and you may need to pull off the road if you are driving, they usually do not last very long and will completely resolve. However, if the visual symptoms last longer than an hour or so or if you have complete loss of central or peripheral vision, go to see your eye doctor or go the ER right away. This is known as transient vision loss and can be a sign of a stroke or another serious condition. Also, if you notice flashes of light, like camera flashes or lightning bolts in your side vision, have your eyes checked right away as well. This can be suggestive of a retinal detachment and the sooner it is found and treated, the better.
How to Manage Them
Traditional migraines with headache can be managed with medications to lessen the severity and frequency of the headaches. Determining what triggers the headache (food, light, smell, etc.) is also important to lessen frequency by avoidance. A healthy diet, getting plenty of sleep and reducing stress are also beneficial to reducing the effects of migraine headaches. No treatment exists for ocular migraines, but avoiding triggers can help. Take home message: if something with your vision doesn’t seem right, see your optometrist right away. Even if the condition is non-sight threatening, better safe than sorry!