From the Guidelines
Ocular migraines are characterized by temporary visual disturbances, typically affecting one eye, and are best managed by avoiding triggers, resting in a dark, quiet room, and using over-the-counter pain relievers like ibuprofen or acetaminophen for acute episodes, with referral to a specialist if symptoms persist or worsen. The signs and symptoms of ocular migraines include flashing lights, blind spots, zigzag patterns, or temporary vision loss lasting 5-30 minutes, and may be accompanied by headache, nausea, light sensitivity, or no headache at all 1. Initial testing should include a comprehensive eye exam to rule out other causes, blood pressure measurement, and a detailed medical history focusing on migraine triggers and patterns.
Outpatient treatment primarily involves avoiding triggers such as stress, certain foods, alcohol, and lack of sleep. For acute management, patients can try resting in a dark, quiet room, and over-the-counter pain relievers like ibuprofen (400-600mg) or acetaminophen (500-1000mg) can be used, as suggested by the American College of Physicians guideline on pharmacologic treatments of acute episodic migraine headache in outpatient settings 1. The guideline recommends considering treating mild episodic migraine headache with an NSAID, acetaminophen, or the combination of an NSAID and acetaminophen.
Some key points to consider in the management of ocular migraines include:
- Avoiding triggers and managing stress
- Using over-the-counter pain relievers for acute episodes
- Considering preventive medications for frequent episodes
- Referring patients to a specialist if symptoms persist or worsen
- Counseling patients on the potential complications of migraine treatment, such as medication overuse headache, as noted in the guideline 1.
Referral to a neurologist or ophthalmologist is recommended if patients experience visual symptoms lasting more than an hour, increasing frequency of attacks, new onset after age 40, accompanying neurological symptoms like weakness or speech changes, severe headaches unresponsive to treatment, or if there's uncertainty about the diagnosis. Ocular migraines result from temporary changes in blood flow to the visual cortex or retina, causing the characteristic visual disturbances, and while typically benign, proper evaluation is important to exclude more serious conditions.
From the Research
Signs and Symptoms of Ocular Migraine
- Visual disturbances such as blind spots, flashing lights, or zigzag patterns 2, 3
- Temporary loss of vision or blind spots in one eye 4
- Sensitivity to light and sound 2
- Headache with nausea and vomiting 5
- Eyelid myokymia, a condition characterized by twitching or spasms of the eyelid muscles 6
Initial Testing for Ocular Migraine
- Comprehensive eye examination to rule out other causes of vision loss 4
- Neurologic and medical evaluations to determine the underlying cause of the migraine 4
- Imaging tests such as computed tomography (CT) scans to rule out other conditions 4
- Optical coherence tomography (OCT) to measure the thickness of the retinal nerve fiber layer and assess retino-choroidal changes 5
Outpatient Treatment for Ocular Migraine
- Medications to relieve headache and other symptoms, such as triptans or ergots 3
- Preventive medications to reduce the frequency and severity of migraines, such as topiramate 6
- Lifestyle modifications, such as avoiding triggers, getting regular exercise, and practicing stress-reducing techniques 2
Referral Criteria for Ocular Migraine
- Patients with persistent or severe visual disturbances that do not respond to treatment 4
- Patients with a history of migraine with aura or other complex migraine syndromes 3
- Patients with underlying medical conditions that may be contributing to the migraine, such as hypertension or diabetes 2
- Patients who require further evaluation or treatment by a specialist, such as a neurologist or ophthalmologist 5