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Visual Auras & Migraines: The Connection & What They Mean

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Migraines with visual auras are a common form of migraine headache, but auras are not just a symptom of migraines.

Visual auras are blurry areas, fuzzy lines, blind spots, or flashes of light that appear in your vision, typically preceding headache pain. They don’t occur in every migraine case. Visual migraines and ocular or retinal migraines are different, but they have many overlapping symptoms.

If you develop visual auras with or without migraines suddenly, especially later in life, you may have a different problem, like a stroke, seizure, retinal detachment, or another health risk that requires immediate help. Work with your doctor on a diagnosis.

With your doctor, you can develop a plan to manage migraines. This will include identifying potential triggers and taking medications as needed or prescribed.

Visual Auras: A Symptom of Migraines or Another Health Condition?

A migraine is a common, but serious and disruptive, type of headache. About 40 million Americans experience migraines, often with accompanying visual auras, pain, nausea, or other symptoms.

People who get migraines are typically between ages 18 and 44. There are many potential triggers for migraines, but 90 percent of people who develop this condition have other family members who struggle with chronic headaches or migraines.

Visual auras are disturbances in your vision that indicate an oncoming migraine. While some people experience visual auras like wavy or zigzagging lines, shimmers, stars, or flashes of light without developing pain later, this is rare. Typically, visual auras indicate an ocular migraine that can become another type of migraine in an hour or less.

Visual auras can also be a sign of a different serious condition, called a retinal migraine. These typically lead to visual disturbances or even temporary blindness in one eye, not both. Signs of a retinal migraine need to be examined by a doctor, as they could also indicate a stroke or another very serious condition.

If you suddenly develop migraines, visual auras, or both, work with a doctor on an appropriate diagnosis of any underlying causes. Then, develop a treatment plan to reduce the impact of migraines on your life.

What Are Visual Auras, and How Are They Related to Migraines?

Medically, an aura refers to localized neurological disturbances that occur just before or in association with a migraine. It can be sensory, motor or visual. But visual auras are the most common and usually disappear within 30 minutes of the onset of a migraine. Visual aura entails:

  • Tunnel vision
  • Blurred spots within the visual field
  • Shimmering stars and sparkles
  • Deeply colored spots in the vision area
  • Lines of zigzag patterns
  • Flashes of light
  • The appearance of psychedelic images in the field of vision
  • Blindness in one or both eyes for a few minutes

How Are Visual Auras Related to Migraines?

Auras are most often associated with migraines as they indicate the beginning of a cascade of reactions among neurons in your brain. This is called cortical spreading depression, a term for a wave of “electrical silence” in which neurons in your cerebral cortex temporarily stop firing. After these neurons stop communicating with each other or other parts of your brain, a migraine headache begins.

Among people who suffer regularly from migraines, only 20% to 30% experience auras. A number of factors contribute, including genetics, hormonal changes, psychological stressors, nutrition and weather fluctuations.

Potential causes of ocular migraines, associated with visual auras, include:

  • Genetics.
  • Hormonal fluctuations, especially in women.
  • Stress or anxiety.
  • Weather changes.
  • Alcoholic beverages, especially red wine.
  • Food containing nitrates, tyramine, artificial sweeteners, or monosodium glutamate.
  • Powerful odors, loud sounds, or bright lights.

Visual auras can make several daily tasks more difficult or dangerous. They can indicate that a painful migraine is about to begin. In rare cases, they may go away on their own after less than an hour. Auras can also indicate more serious problems that could harm your vision or your brain.

Migraines are the seventh leading cause of disability worldwide. While most people associate migraines with severe head pain and doctors sometimes refer to migraines as cluster headaches, many types of migraines exist and interfere with daily life. These include migraines involving visual auras or other visual disturbances.

Types of Migraines With Visual Auras

When you experience visual auras from migraines, you may have one of two types of migraines.

  1. Visual migraines: These are migraines that affect vision in both your eyes. They appear suddenly, and they are often described as though you are looking through a cracked mirror into the world. These move across your field of vision and usually go away in about 30 minutes.
  2. Ocular or retinal migraines: These occur in the nerves of the eye, near the retina, rather than near the visual part of your cerebral cortex. They affect only one of your eyes at a time, with the experience involving a temporary blind or blurry spot in your central vision. This clears up in an hour or less.

While these migraines involve different clusters of neurons and nerves, they have similar triggers to other types of migraines. Both involve visual auras as the primary symptom. They often lead to head pain and other common migraine symptoms, but not always.

Visual Auras Can Be Symptoms of Other, Serious Health Complications

While visual auras and migraines are closely linked, there are instances when you need help from a neurologist to ensure there is not a more harmful underlying condition. For example, if you are over the age of 40 and develop visual auras (with or without migraines) for the first time, this could indicate that you have had a stroke or suffered a seizure.

Visual auras with or without migraines can indicate several underlying health problems, like:

  • Head injuries.
  • Brain tumors.
  • Retinal detachment.
  • Blocked arteries in the brain.
  • Burst arteries in the brain.
  • Aneurysms.
  • An abnormal tangle of veins and arteries in the brain.
  • Inflammation in blood vessels in the brain.
  • Excessive buildup of cerebrospinal fluid in the brain.
  • Neuralgia.
  • Seizures.
  • Structural abnormalities in your head, neck, or spine.
  • Exposure to environmental toxins or intoxicating substances.

A study published in 2018 found that migraines with auras could indicate a stroke. Of 11,939 participants:

  • 426 had a migraine with an aura.
  • 1,090 had migraines without auras.
  • 1,018 had headaches that were not migraines.
  • 9,405 had no headache.

The group did not have a history of prior stroke or arterial fibrillation, but those who developed migraines with visual auras had a higher risk of arterial fibrillation or stroke compared to those who did not have migraines or headaches.

Treating Migraines Reduces Visual Aura Experiences

Working with a neurologist, physician, and/or an optometrist can help you understand your migraines, especially if they involve visual auras as a sign that a migraine will begin. One way to understand your migraine triggers is to keep a diary of when they occur, along with any information about what occurred before the visual aura started.

Ocular migraines typically go away on their own within 30 minutes, but pain and sensitivity to lights or sounds during that time can feel debilitating. Resting and avoiding triggers as much as possible will help the migraine go away faster. Recommendations include:

  • Lie down in a dark, quiet room.
  • Massage your scalp or temples with consistent, firm pressure.
  • Place a cool, damp towel on your forehead.
  • Place a cool, damp towel on your forehead.

Some over-the-counter medications can ease your migraine, like nonsteroidal anti-inflammatory drugs (NSAIDs), especially ibuprofen. Your doctor may also prescribe a medication to help manage your migraine, like:

  • Beta blockers that relax blood vessels.
  • Calcium channel blockers, which can prevent blood vessels from constricting.
  • Antidepressants.
  • Anti-seizure medications.

Treatment depends on how often you experience migraines and how severe they are. You may not need to take regular medication if you have occasional migraine headaches. Instead, managing these by laying down in a dark room and taking an NSAID can be the best procedure. Regular migraines that limit your ability to go to work or school can be treated with prescription medications.

When you experience a visual aura for the first time, whether it is accompanied by headache pain or not, work with your doctor on a diagnosis. It is possible that you have another underlying cause of visual auras that is not a migraine.

Advances in Migraine Treatment

The traditional treatment of migraines is to lower the levels of pain through NSAIDs and other pain relievers and through avoidance of potential migraine triggers to minimize future episodes. Other drugs used for migraine management are Beta-blockers, antidepressants, calcium channel blockers and anticonvulsants.

Newer drugs such as CGRP antagonists and Lasmiditan may have better outcomes in reducing migraine symptoms). Medicines such as NMDA receptor antagonists are likely to prevent or minimize the frequency and intensity of future episodes.

References

  1. Migraine Headaches. (August 2018). Cleveland Clinic.
  2. Aura. National Headache Foundation.
  3. Understanding Ocular Migraine. (October 2017). American Migraine Foundation.
  4. Typical Aura Without Headache. (2019). International Headache Society (IHS).
  5. Stanford Headache Specialist Demystifies Migraine Auras. (July 2017). Scope Blog, Stanford Medicine.
  6. What Are Ocular Migraines and How Are They Different From Regular Migraines? (November 2019). Shape.
  7. Migraine With Visual Aura Is a Risk Factor for Incident Arterial Fibrillation. (December 2018). American Academy of Neurology.
  8. Understanding Migraine with Aura. (July 6, 2017). American Migraine Foundation.
  9. Clinical features of visual migraine aura: a systematic review. (May 30, 2019). The Journal of Headache and Pain.
  10. Migraine with aura. (August 2021). The Migraine Trust.
  11. Migraine. (July 2, 2021). Mayo Clinic.
  12. Recent advances in migraine therapy. (May 17, 2016). National Library of Medicine.
  13. Visual Migraine. (August 2021). Brigham and Women’s Hospital.
  14. Resource Library. (August 2021). American Migraine Foundation.

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