Migraines are headaches that cause intense pain, which can last up to three days. (Learn More)

There are many symptoms that precede a migraine, but there are distinctive visual symptoms: blurred vision, flashes of light, dark spots in the field of view, and zig-zagging or wavy lines. (Learn More) Different types of migraines share different forms of visual auras.

To manage the visual symptoms of migraines, people can learn what triggers their migraines, and then take steps to control their environment (usually by resting in a dark, quiet place for 30 minutes until the auras pass). Medications, Botox injections, (Learn More) and home remedies might also help. (Learn More) All these measures can help to calm the abnormal activity in the brain.

What Is a Migraine?

migraine aura

A migraine is a type of headache that causes sufferers extreme pain, which often feels like a steady throb from deep within their brains. People also experience nausea, possibly vomiting, and intense sensitivity to light and sound.

Migraines can last from a few hours to up to three or four days. Many people who suffer from migraines will feel symptoms, known as auras, that occur before the migraine itself actually sets in. Some of these auras are visual in nature.

The exact cause of migraines is not fully understood, but it is speculated that abnormal activity in the brain is behind them. This activity can change the way nerves communicate, as well as affect the functioning of blood vessels in the brain.

Additionally, genetic and hormonal changes can also make people more sensitive to migraines, and the triggers that cause them.

What Are the Symptoms of Migraines?

When people experience migraines, they usually happen in specific stages, although a person will not necessarily experience every stage.

Before the migraine actually starts, a patient might typically notice a brief episode of depression, anxiety, irritability, and moodiness.

The aura symptoms show up shortly before the migraine sets in or even as it actually sets in. They start slowly and build to a peak, lasting between 20 minutes and an hour.

When the aura symptoms are visual, they can look like flashing lights in the field of vision (not dissimilar to the flash of a camera bulb), zig-zagging and wavy lines, or even stars or dots. Some people also experience a temporary loss of vision when this happens. Whatever the symptoms, the specific point in the field of view that is affected is known as the scotoma.

Other symptoms that might manifest during an aura include the pins and needles sensation in an arm or a leg, accompanied by weakness or numbness on that side of the body.

Positive, Negative & Altered Symptoms

The American Migraine Foundation explains that visual symptoms related to migraines are usually experienced in both eyes, but they can occur on one side of the visual field. Covering one eye first, and then the other eye, will determine whether the symptoms emanate from the brain (in which case both eyes will be affected) or from the eye (which will only affect one eye).

The visual symptoms of migraines are grouped into three categories: positive symptoms, negative symptoms, and distorted (or altered) vision.

In this context, positive symptoms mean seeing something that isn’t actually there, like the shimmery zig-zag lines that people see in their auras. Another example of a positive visual symptom is a “flash bulb” effect (like the flash of a camera) from no discernible source. In most cases, people experiencing a positive symptom like this will “see” an aura that slowly gets bigger, to the point of obscuring other vision. It then gradually breaks up over half an hour.

Negative symptoms, on the other hand, means part of the vision is missing. These are like blind spots, tunnel vision, or a complete loss of vision, usually located on the left or the right side of the visual field. Brigham and Women’s Hospital refers to negative symptoms as “pure visual darkness.”

With altered or distorted visual symptoms, people might feel like they are looking through water or shimmering heat waves. Their vision might take on the appearance of cracked glass, resembling a mosaic or a kaleidoscope. These symptoms might also show up as blurred vision, loss of perception of color, and some objects appearing too large or too small. Unlike positive and negative symptoms, people will see things but not as they actually are.

The visual symptoms of migraines come in very wide varieties, so it is not easy to tell whether the symptoms are the result of a migraine or a deeper problem.

Ocular Migraines

When a migraine causes a visual disturbance, this is known as an ocular migraine. They can strike on their own, with or without the pain of a typical migraine.

Ocular migraines are also known as migraines with auras (with the typical symptoms of lights, stars, or wavy lines). Ocular migraines can also bring about blind spots. Around 20 percent of people who have migraines report having these kinds of auras.

People who suffer from ocular migraines will not be able to write, read, or drive (especially in poor visibility conditions). An ocular migraine is not a serious condition, and the symptoms usually abate after a short while, but it can still be disruptive and potentially dangerous.

Ocular migraines are usually the result of migraine triggers affecting the brain’s visual cortex.

Ocular migraines are sometimes confused with retinal migraines, which are much rarer and only affect one of the eyes. A retinal migraine can cause a loss of vision, and it is a serious medical issue that requires immediate attention.

To add to the confusion, migraines with auras are sometimes also referred to as ocular migraines, even if the migraine itself is not an ocular migraine. The term ocular migraines is also used when talking about migraines related to the eye that cause visual disturbances, which do not necessarily come with the classic headache. When this happens, these migraines are better known as ophthalmic migraines.

Managing the Symptoms

Even though migraines and their symptoms are not always an indication of a serious medical problem, they can nonetheless be incredibly disruptive and debilitating.

When a person experiences ocular migraines, it can take about 30 minutes for the symptoms to pass. The best remedy is resting in a dark and quiet room because this avoids anything that might trigger or worsen the migraine.

Manually massaging the scalp and temples, or using a device that can provide that kind of contact and stimulation, will also help. If nothing else, a simple damp towel or an ice pack pressed down on the forehead will reduce the discomfort.

When the visual disturbances are no longer experienced, that is a sign that the migraine has passed.

Patients can get over-the-counter and prescription medications that can treat recurring and severe migraines. Simple drugs like ibuprofen or Excedrin Migraine can help reduce the symptoms of a migraine once they are in effect.

For more serious cases, a doctor can prescribe a variety of medications that will help manage the symptoms of a migraine. These include:

  • Beta blockers, to relax blood vessels.
  • Calcium channel blockers, to prevent blood vessels from constricting.
  • Antidepressants and antiepileptics, which have the off-label use of treating and preventing migraines.

While some medications can be taken on an as-needed basis (when the visual auras make themselves known, for example), patients with chronic or exceptionally painful migraines might have to take medications on a regular basis, even when there are no noticeable triggers or auras.

Ocular migraines don’t usually require treatment, but if they occur with regularity and cause disruptions to normal living, a patient should go to a doctor. Any kind of migraine that causes vision loss or otherwise affects vision requires immediate medical attention.

Silent Migraines

woman suffering from ocular migraine

One way to tell if there is another issue at play is if visual auras remain after the migraine has passed. Dark spots or floaters could possibly be the result of a retinal or vitreous detachment (when the vitreous, or gel, that fills back the back of the eye, is separated from the retina). They might also occur with flashes of light or even loss of vision.

These symptoms (or any symptoms that remain after a migraine has passed) require an ophthalmologist's evaluation and treatment. There is a risk of permanent changes to visual perception or outright loss of vision.

Other medical problems that might share the visual symptoms of a migraine (flashes, blurred vision, or loss of vision) include a stroke or a mini-stroke.

It is also possible to experience the visual symptoms of a migraine without the headache itself. This is known as an acephalgic migraine or a silent migraine. Even though there is no associated pain, it is indicative of a problem that needs medical evaluation. Acephalgic migraines can still disrupt activities that require vision, such as driving or controlling machinery, and they can be very frightening to patients.

Preventing the Visual Symptoms of Migraines

Can migraines with visual symptoms be prevented? This question is most frequently asked by patients who have regular, recurring migraines. Many people who have isolated visual migraines experience them so infrequently that specific preventative treatments are unnecessary.

Of course, if a patient knows what triggers their migraines, the best way to prevent migraines from developing is to avoid those triggers. When the migraines are frequent and painful, the best that any preventative strategy can do is to reduce their impact. There is no completely effective method of countering migraines. Simply reducing the number of episodes in a given month would be considered a success.

Vitamin B2 (riboflavin) is commonly used as a preventive treatment for migraines, primarily because it has no serious side effects (aside from turning urine a bright yellow). The European Journal of Neurology wrote that high-dose riboflavin is “a safe and well-tolerated” option for migraines.

Other medications will likely cause side effects, but starting with a low dose and gradually ramping up will help. Gabapentin, topiramate, and amitriptyline are examples of these medications. These are drugs that have other primary uses, but they have been approved for off-label use for migraine treatment.

Botox Injections

botox procedure

Some patients might opt to receive botulinum (Botox) injections into their foreheads and scalp to ease the pain and visual symptoms of migraines.

In 2010, this was FDA-approved for patients who have a history of chronic migraines and suffer from headaches, including migraines, for at least 15 days every month. This is not an option for patients who have headaches for 14 or fewer days every month, or who suffer from other types of headaches, such as cluster headaches.

Botox gained fame for its ability to relax muscles in the face by smoothing wrinkles. Patients who received this for cosmetic purposes also reported alleviation in their headaches, which led to studies on whether Botox could be used to treat migraines. Adults who suffer from chronic migraine headaches with visual symptoms experienced a reduction in the total number of days they experienced these headaches after getting Botox shots. They also reported more pain-free days every month, even having to take fewer days off work due to migraines.

Doctors suspect that Botox works to prevent the symptoms and development of migraines because it prevents neurotransmitters that carry pain signals through the brain from reaching the nerve endings in the head. Side effects of this treatment can include neck pain and milder headaches.

Home Remedies

If a patient does not want to use medication to treat their migraines, some of the most effective methods (possibly even more effective than drugs) include meditation, breathing, yoga, massage, acupuncture, lifestyle changes, and light exercise (although not during a migraine).

A neurologist talking to Everyday Health suggests that a regular exercise routine between migraines can help ward off stress and boost the hormones that can guard against migraine triggers.

Many patients end up using a combination of treatments and preventative measures to manage their migraines. Work with your physician to find the best approaches for your situation.

 

References

What Are Migraines? (August 2017). WebMD.

Everything You Need to Know About Migraines. (November 2017). Medical News Today.

Common Migraine Headache Symptoms. (August 2019). WebMD.

Visual Disturbances: Related to Migraine or Not? (February 2016). American Migraine Foundation.

Patient’s Guide to Visual Migraine. Brigham and Women’s Hospital.

Understanding Ocular Migraines. (October 2017). American Migraine Foundation.

Migraine. (April 2019). Office of Women’s Health.

Retinal Migraine. NHS.

Why Do Ice Packs Feel Good When You Have a Headache? Excedrin.

Migraine Headache. (November 2019). MedicineNet.

I Now Understand What Vitreous Detachment Is. What Is the Cure or Fix for the Disease if Any? Is There Any Treatment Available to Improve the Condition? (March 2014). American Academy of Ophthalmology.

What Is a Silent Migraine? (April 2019). eMedicine Health.

Why Do Vitamins Make Urine Bright Yellow? (September 2013). Gizmodo.

High-dose Riboflavin Treatment Is Efficacious In Migraine Prophylaxis: An Open Study In A Tertiary Care Centre. (July 2004). European Journal of Neurology.

Can Gabapentin Prevent Migraines? (December 2019). Verywell Health.

Botox Injections for Migraine Treatment. (July 2017). WebMD.

Non-Medicinal Techniques for Managing Migraines and Headaches. (November 26, 2014). University of Wisconsin-Madison.

8 Exercise Tips for People With Migraines. (April 1, 2019). Everyday Health.