Ocular migraine and migraine with aura are two migraine types that often get mistaken for one another. Both can cause unsettling visual disturbances, but they differ in where they occur, how they affect your vision, and their potential risks. Understanding these differences is important for accurate diagnosis and effective management, as well as ruling out other serious eye and brain conditions.
What is an Ocular Migraine?
An ocular migraine is a rare migraine subtype that causes temporary visual problems in one eye only. The term “ocular migraine” is often used in everyday language, but in formal medical classification (ICHD-3), this presentation is called retinal migraine.
Retinal migraine is defined as fully reversible monocular visual disturbances (visual disturbances in one eye) that are accompanied by, or followed within 60 minutes by, headache. These episodes are believed to be linked to temporary changes in blood flow or spasms in the retinal blood vessels.
Visual symptoms may include blind spots, flashing lights, twinkling or flickering lights, blurred vision, bright spots, or complete vision loss in the affected eye. While symptoms are usually temporary, they can be alarming and may occasionally indicate a more serious condition, such as retinal detachment or a transient ischemic attack. Because other serious conditions can mimic these symptoms, it’s important to seek prompt medical attention if you notice sudden changes in one eye.
Ocular migraine is thought to result from a temporary disruption to the blood supply in the retina or optic nerve, in contrast to other migraine types that originate in the brain. Possible triggers include hormonal changes, high blood pressure, certain medications (including birth control pills), stress, low blood sugar, bright lights, and family history.
What is a Migraine with Aura?
A migraine with aura is a more common migraine type defined by the International Headache Society as a migraine that involves temporary neurological symptoms before or during the headache phase. Most often, the aura is visual and affects both eyes, as it originates in the brain’s visual cortex rather than the retina. This phenomenon is believed to be caused by cortical spreading depression, which is a slow-moving wave of electrical and chemical changes in the brain. It temporarily alters nerve signalling and blood flow in specific areas.
Visual aura can include zigzag lines, flashing lights, bright spots, blurred vision, or other visual disturbances. Aura symptoms may also extend beyond vision, such as tingling sensations (sensory aura), difficulty speaking, or changes in smell and hearing. Migraine aura typically spreads over five minutes or more, with each symptom lasting 5–60 minutes, and can occur with or without subsequent migraine pain.
Common triggers for migraine with aura include bright lights, certain foods, hormonal fluctuations, high stress, and changes in sleep patterns.
Ocular Migraine vs Migraine with Aura – Key Differences
While both involve visual disturbances, an ocular migraine affects one eye only and is caused by changes in the retinal blood vessels. Migraine with aura affects both eyes and originates in the brain. Ocular migraine is rare but has been linked to permanent monocular vision loss in isolated reports, whereas migraine with aura does not typically cause permanent eye damage.
A simple check during an episode is to cover one eye; if the disturbance remains with either eye covered, it’s likely binocular and more consistent with migraine with aura. If it’s present in only one eye, an urgent eye assessment is advised.
Both conditions can be misdiagnosed and are sometimes mistaken for eye emergencies or neurological events, underscoring the need for professional assessment.
When to Seek Medical Care
Seek urgent medical help if you notice sudden monocular vision loss, visual symptoms lasting more than 60 minutes, or new-onset aura after age 50 (earlier if you have vascular risk factors). These could be signs of stroke, retinal artery occlusion, or retinal detachment.
Treatment Options and Prevention Strategies
Short-term relief may include resting in a dark room, staying hydrated, and avoiding bright lights until symptoms pass. To help prevent migraine attacks, identifying and managing possible triggers is key. This can include stress reduction, healthy blood pressure management, and avoiding known dietary triggers.
Prevention strategies can also include regular eye exams, maintaining a consistent sleep routine, managing screen time, and tracking symptoms in a migraine diary to identify patterns. Some people may be prescribed medications such as calcium channel blockers or other preventive treatments, depending on their risk factors and migraine type.
At Sydney Headache and Migraine Clinic™, our Watson Headache Approach is medication-free and non-invasive. We focus on identifying and treating potential underlying causes, such as brainstem hypersensitivity and cervical spine dysfunction, which can contribute to both ocular migraine and migraine with aura.
How Sydney Headache & Migraine Clinic Can Help
Our experienced clinicians conduct a comprehensive assessment, including evaluation of the upper cervical spine and brainstem, to determine whether dysfunction in these areas is contributing to your symptoms. Where appropriate, we apply targeted manual therapy to reduce sensitivity, improve function, and prevent migraine recurrence.
We frequently link symptoms to conditions such as Migraine Headache, Vestibular Migraine, and Hormonal Headache, ensuring patients get a tailored treatment plan based on their specific presentation.
Many of our patients experience significant improvement within just a few sessions, with a reduced frequency and severity of migraine attacks. By treating the root cause rather than only managing symptoms, our goal is to help you achieve long-term relief and protect your vision.
If you experience visual symptoms and suspect you may be dealing with ocular migraine or migraine with aura, booking now for an assessment is your first step towards an accurate diagnosis and effective treatment.
Understanding the Broader Picture
Ocular migraine and migraine with aura are both forms of migraine headaches, but they can present in different ways. You might notice a visual migraine aura before pain begins, or in some cases, no pain at all. A typical migraine, on the other hand, may cause head pain without visual changes.
Certain risk factors, like hormonal changes, high blood pressure, or a family history of migraines, can make these episodes more likely. Migraines happen when a combination of triggers and changes in the nervous system disrupt how the brain processes pain and sensory signals.
In some ocular migraine cases, a temporary reduction in blood flow to the retina can cause sudden visual loss. While this is often short-lived, it’s important to seek prompt medical attention if it occurs.
Working Together Towards Clearer Days
If you’ve experienced flashing lights, blind spots, or visual changes with or without headache pain, it’s worth getting checked. At Sydney Headache & Migraine Clinic™, we’ll work with you to understand what’s causing your symptoms and help you find a way forward. Our gentle, medication-free approach is designed to ease symptoms, reduce migraine episodes, and help you get back to doing the things you enjoy.
Book your initial appointment today and take the first step towards relief.
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Disclaimer: This blog is for informational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your healthcare provider with any questions you may have regarding a medical condition or treatment. Never disregard professional advice or delay seeking it based on information you have read here.
References
International Headache Society. The International Classification of Headache Disorders, 3rd edition (ICHD-3).
Grosberg, B. M., Solomon, S., & Lipton, R. B. (2006). Retinal migraine. Current Pain and Headache Reports, 10(3), 210–214. https://doi.org/10.1007/s11916-006-0040-3
Russell, M. B., & Olesen, J. (1996). A nosographic analysis of the migraine aura in a general population. Brain, 119(2), 355–361. https://doi.org/10.1093/brain/119.2.355
Queiroz, L. P., Friedman, D. I., Rapoport, A. M., & Purdy, R. A. (2018). Characteristics of migraine visual aura: A systematic review. Headache: The Journal of Head and Face Pain, 58(5), 629–640. https://doi.org/10.1111/head.13294
Gelfand, A. A. (2013). Pediatric and adolescent migraine. Neurologic Clinics, 31(2), 321–342. https://doi.org/10.1016/j.ncl.2013.01.006
