What is the treatment for ocular migraines?

From the Guidelines

Treatment for ocular migraines should prioritize non-steroidal anti-inflammatory drugs (NSAIDs) as first-line therapy, with ibuprofen and naproxen sodium being effective options, as evidenced by studies 1. When considering acute management, resting in a quiet, dark room and taking over-the-counter pain relievers like ibuprofen (400-600mg) may help alleviate symptoms. Some key points to consider in the treatment of ocular migraines include:

• The use of NSAIDs, such as ibuprofen and naproxen sodium, as first-line therapy for acute episodes 1
• The potential use of triptans, like sumatriptan, when headache accompanies visual symptoms, as recommended by studies 1
• The importance of preventive strategies, including lifestyle modifications, such as identifying and avoiding personal triggers, maintaining regular sleep patterns, and practicing stress management techniques like meditation
• The potential role of preventive medications, including beta-blockers, calcium channel blockers, or anticonvulsants, in frequent or severe cases, as outlined in guidelines 1 For prevention in frequent or severe cases, medications including beta-blockers (propranolol 40-160mg daily), calcium channel blockers (verapamil 120-360mg daily), or anticonvulsants (topiramate 25-100mg daily) may be prescribed, with the goal of reducing morbidity, mortality, and improving quality of life. It is essential to note that the most recent and highest quality study 1 provides the most relevant guidance on the treatment of ocular migraines, and its recommendations should be prioritized in clinical practice.

From the Research

Treatment Options for Ocular Migraines

• The primary objectives of migraine treatment are to abort the acute attacks, treat associated symptoms, and prevent future attacks 2.
• Non-specific anti-migraine drugs like non-steroidal anti-inflammatory drugs, anti-emetics, narcotics, and sympathomimetics are usually helpful in mild to moderate attacks 2.
• Specific drugs like triptans and ergots are useful for moderate to severe attacks 2, 3.
• Over-the-counter medications, such as acetaminophen, ibuprofen, naproxen, and aspirin, have shown strong efficacy when used as first-line treatments for mild-to-moderate migraine attacks 4.
• Triptans, such as sumatriptan, are effective for moderate to severe migraines, but may be expensive 5.
• Other medications, such as dihydroergotamine and antiemetics, are recommended for use as second- or third-line therapy for select patients or for those with refractory migraine 6, 5.

Approach to Treatment

• A step care approach can be used, where patients are started with the simplest options like simple analgesics first, followed by non-steroidal agents, then ergot preparations, and eventually triptans if they do not respond 2.
• A stratified care approach can also be used, where the attacks and the patients are stratified according to the severity and therapeutic response 2.
• Taking medication early in an attack and using a stratified treatment approach can help ensure that migraine treatment is cost-effective 5.

Considerations

• Narcotics should be reserved for use only in patients unresponsive to adequate trials of non-narcotic agents 3.
• Educating patients about self-help measures and avoidance of triggers is an important element in the effective management of migraine headaches 3.
• Rebound headache from overuse of analgesics and other headache medications can occur, and patients should be educated about this risk 3.