Ocular migraine: causes, symptoms, and treatment

Picture this: You’re out for a walk when suddenly zigzag lines or shimmering lights appear across your vision. They seem to come out of nowhere, and within an hour, they’re gone.

Visual changes like these can understandably be unsettling, especially if they are a new experience. But often, they’re caused by migraine with visual aura, which causes temporary changes in vision that fully resolve. “Ocular migraines can occur during everyday activities, although the stakes can feel higher when they happen during sports such as hiking, rock climbing, or skiing," says Ken McGee, PT, DPT, a physical therapist at Hinge Health.

“Ocular migraine” can be a confusing term because it’s commonly used to describe more than one type of migraine-related visual disturbance. Most often, people are referring to migraine with visual aura. Less commonly, the term may be used for retinal migraine, a rare condition that affects vision in one eye.

Ahead, learn what ocular migraine symptoms can look like, what may contribute to them, and what you can do when they occur, with tips from Hinge Health physical therapists who are trained in migraine care.

What is an ocular migraine?

Ocular migraine isn’t an official clinical diagnosis. It’s an everyday term that people, and sometimes healthcare providers, use to describe migraine episodes with visual symptoms. Most often, it refers to migraine with visual aura. Less commonly, it’s used to describe retinal migraine.

Knowing the difference is important. Visual aura originates in the brain and typically affects the visual field of both eyes, even though it may seem like the changes are happening on just one side. Retinal migraine affects one eye only and is much rarer.

But both can lead to temporary changes in vision and may occur with or without head pain.

Ocular migraine symptoms

Ocular migraine symptoms can vary. For example, visual changes associated with migraine often develop gradually and typically last anywhere from about five minutes to an hour. Some common signs of ocular migraine include:

• Shimmering or flashing lights

• Zigzag lines or geometric patterns

• Blind spots or areas of altered vision

• Light sensitivity

• Nausea

• Temporary changes in vision

Migraine with aura: the most common type

Most people who say they are experiencing ocular migraine are describing migraine with visual aura, which affects an estimated 25% of people with migraine. “It occurs when a wave of electrical activity moves across areas of the brain involved in processing vision,” says Dr. McGee. 

Those flashing or shimmering lights, zigzag patterns, or blind spots that gradually change or move across your visual field may seem like they’re coming from one eye, but visual symptoms generally affect both eyes.

Aura can also involve symptoms that go beyond vision, such as numbness or tingling or difficulty with speech. Symptoms often develop over the course of several minutes and usually resolve within about an hour. You may experience a headache afterward, but some people experience aura without that side effect.

Retinal migraine: the rare kind

Retinal migraine is much less common. “Unlike a typical visual aura, it affects one eye only and we think it may be due to temporarily reduced blood flow to the retina,” says Dr. McGee. It may start as a blind spot or even twinkling lights or shimmering. It usually lasts less than an hour. 

One-eye vision loss can also signal other serious eye or vascular problems, so if you develop new visual changes in just one of your eyes, be sure to contact your healthcare provider as soon as possible.

What causes ocular migraine

Ocular migraine causes aren’t super straightforward. It can be challenging to pinpoint why a particular migraine attack happens, because the onset of a migraine tends to involve a combination of triggers. 

Experts believe migraine with visual aura involves a temporary wave of electrical activity across the part of the brain that processes vision. Retinal migraine, on the other hand, may involve temporary changes in blood flow to the retina.

What triggers an ocular migraine

The triggers for ocular migraine are similar to those linked with other types of migraine. “They vary from person to person,” says Dr. McGee, who experiences ocular migraine himself. “My biggest trigger is bright light, so I can experience one if I’m at a climbing gym and look up at the light, or if I’m skiing in whiteout conditions.” Other triggers often include:

• Stress

• Smoking

• Changes in sleep

• Dehydration 

• Going long periods without eating (dips in blood sugar)

• Bright or flashing light

• Long periods of screen time

• Heat or weather changes

• Changes in caffeine or alcohol intake

• Hormonal shifts (such as those in perimenopause)

How to get rid of an ocular migraine

Again, visual aura doesn’t last all day. Usually, it subsides on its own within an hour of symptoms starting. “Once you have had a few, you begin to recognize early signs right away,” says Dr. McGee. Consider these tips to help manage your symptoms until it passes.  

• Pause what you’re doing to give your eyes rest. Power down screens and turn off bright lights if you’re able. Sit down and calm your mind until your vision returns. “It’s important to come up with a safety plan for when they happen while you’re driving or doing another vision-dependent activity,” says Dr. McGee. If your symptoms begin while you're driving, pull over safely as soon as you’re able.

• Hydrate and have a snack if you need to. Staying hydrated and eating regularly are key for migraine management. “Low blood sugar or dehydration are two common triggers for ocular migraine,” says Dr. McGee.

• Treat the headache if it follows. Consider taking an over-the-counter medication. Pain relievers such as ibuprofen (Advil, Motrin), naproxen (Aleve), acetaminophen (Tylenol), or Excedrin may help ease migraine pain. If you have a medical condition or take other medications, check with your healthcare provider about which option is right for you and how often to take it. Using over-the-counter headache medication too often — often 10 to 15 or more days a month, depending on the medication — can lead to medication-overuse (rebound) headaches.

Treatments and prevention for ocular migraine

While you may not be able to prevent every migraine episode, you can reduce the risk by avoiding certain triggers. Of course, that doesn’t mean you need to live in fear of triggers. Instead, try focusing on daily habits that can help decrease migraine frequency and intensity overall. 

• Track your patterns. Pay attention to what tends to happen around your episodes, including lack of sleep, skipping meals, stressful situations, intense physical activity, and/or environmental factors. 

• Keep your daily foundations steady. Consistent sleep, regular meals, hydration, stress management, and movement can all support migraine management. You don’t need to do these things perfectly. “Most people have a budget for how hard they can push themselves before triggering a migraine,” says McGee. “If you’re under a lot of stress, for example, make sure that you drink a lot of water and get enough sleep, so you don’t go over your budget of what your body can handle.”

• Take screen and movement breaks. Long screen sessions are linked to migraine, including ocular migraine. If you've been looking at a screen or staying in one position for a while, changing positions or moving away from a screen can give your eyes and body a break. “I make sure that I get up and take a movement snack around every 20 to 30 minutes,” says Dr. McGee.

• Stay active. Regular physical activity can support sleep, stress management, and general well-being, all of which can play a role in migraine management. Start with movement that feels comfortable and gradually build from there.

• Consider complementary treatments. Talk to your provider if you’re interested in trying alternative treatments for ocular migraine relief, such as massage or acupuncture.

• Talk to your healthcare provider about frequent episodes. If migraine is interfering with your daily life, your provider can discuss treatment options, such as beta blockers, that may help reduce the frequency or severity of attacks. Certain supplements, such as magnesium or B vitamins, may help prevent ocular migraines. Always be sure to clear it with your doctor before starting a new supplement.

When to see a doctor

New or unusual vision symptoms always deserve attention because certain eye and neurological conditions can mimic ocular migraines. 

Seek emergency care if you have:

• A sudden, severe “thunderclap” headache

• Visual symptoms with new weakness, numbness, difficulty speaking, confusion, or loss of consciousness

• A sudden, dramatic change in vision

These symptoms can be due to a number of medical conditions that require immediate treatment, such as bleeding in the brain (stroke) or dangerous changes in blood flow through the brain.

Contact your healthcare provider promptly if you have:

• Your first episode of unexplained visual changes

• New visual changes that affect only one eye

• Visual symptoms that last less than five minutes or longer than an hour

• Episodes that are becoming more frequent or changing from your usual pattern

• New visual symptoms that don't fully resolve

When in doubt, get it checked out. If you’re not sure whether a visual disturbance is migraine-related, getting evaluated can help rule out other causes and give you a clearer plan for what to do if it happens again.

PT tip: Take deep breaths

Vision changes, even if temporary, can be alarming – even if you’ve experienced them before. Dr. McGee recommends slowing down and taking a few deep belly breaths while you wait for symptoms to pass. “Practicing diaphragmatic breathing can help calm you down, since stress can worsen an episode,” he says.

Try breathing slowly in through your nose and allowing your exhale to be relaxed and equally slow. The goal isn’t to “stop” the migraine with breathing exercises, but to help you regulate your nervous system and feel more comfortable as your symptoms resolve.

How Hinge Health can help you

If migraine is affecting your quality of life, you can get the relief you’ve been looking for with access to migraine care, virtual physical therapy, and more with Hinge Health. 

We offer a comprehensive program that helps you manage symptoms and delivers rapid relief of migraine pain in minutes with Enso for Migraine, an FDA-cleared wearable pain relief device. You’ll also have access to therapeutic exercises that help relieve migraine pain and personalized support from our care team designed to help you feel more in control of your symptoms. 

The best part: You don’t have to leave your home because our program is digital. That means you can easily get the care you need through our app, when and where it works for you. See if you qualify for Hinge Health and confirm free coverage through your employer or benefit plan here.

This article and its contents are provided for educational and informational purposes only and do not constitute medical advice or professional services specific to you or your medical condition.

References

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