Known by many names, including “visual or silent migraines,” “opthalmic migraines,” also spelled “ophthalmic” and referred to as “ocular” or “occular migraines” may be misdiagnosed because they are painless and symptoms may be similar to other conditions.
According to Drs. Steven Ofner, M.D., and Darrin P. Fleming, O.D., ophthalmic migraines are quite common, painless, and only last a few minutes, but they can also be terrifying to patients who have never experienced them before.
People who experience bright zig-zag lights in their central or peripheral vision usually do not require medical attention unless they experience them frequently or want to be reassured by a doctor or ophthalmologist who can eliminate other diagnoses with a simple eye exam.
Ophthalmic migraine symptoms should pass in a few minutes, but they can last up to one hour. Symptoms are caused by a temporary spasm in the blood vessels behind the eye. This is a vasospasm similar to Charlie-horse symptoms in a leg cramp.
Some people experience the commonly-recognized headache after the symptoms stop, which is called a “migraine headache with visual prodrome.
If symptoms occur frequently or become distracting — as when they affect someone while driving or doing dangerous, tedious work like surgery or soldering — they should be examined by a doctor. There are pills available that decrease the frequency and severity of attacks.
For people who experience painful migraine headaches, some changes may also take place in the brain, which produce the ophthalmic migraines. Marilyn Haddrill describes a visual migraine as a “small, enlarging blind spot (scotoma) in your central vision with bright, flickering lights or a shimmering zig-zag line (metamophopsia) inside the blind spot.” Haddrill includes a re-touched photo of what the eye sees during a typical ophthalmic migraine at www.allaboutvision.com/conditions/ocular-migraine.htm.
Causes:
Also referred to as “acephalgic migraine, eye migraine, visual migraine, painless migraine,” and “migraine aura without headache,” the causes can be the body’s reaction to triggers such as hormones, flashing lights (like strobes), and even chemicals in food or medications. The triggers often set off a headache, but for those who experience only the visual problems without the headache, the term “silent migraines” is helpful to understand the diagnosis.
Other symptoms that may strike before a migraine headache are slurred speech, numbness, pain in other parts of the body such as the face or skin, and ringing in the ears. One man who has had migraines for over 15 years has deeply researched this topic to find help for himself. Jim” discovered that people with silent migraines are often misdiagnosed with totally unrelated diseases because they don’t have the familiar headache pain. Some misdiagnoses included “hypoglycemia, meniere’s disease (an inner ear disorder), depression, fibromyalgia and myofascial pain.
On his well-researched site, Jim suggests telling your doctor about other symptoms that might be related such as “irritability, euphoria, yawning, stiff neck and difficulty finding the right word when you’re talking.” Of course, if you have a family history of migraines, your doctor might suspect the right diagnosis quicker. (www.relieve-migraine-headache.com).
Another site that offers several causes and risk factors of “ocular migraine” states that, although the biological causes are unknown, there are some identified risk factors like “stress, premenstrual changes, alcohol consumption, hunger, or the use of oral contraceptives” that may precipitate migraines. Some identified foods that trigger attacks include: “red wine, chocolate, aged cheese, milk, chicken livers, meats preserved in nitrates, or foods prepared with monosodium glutamate.” Some people recognize that sunlight triggers an attack for them. (healthscout.com)
You can also see a picture of the visual phenomenon of “ophthalmic migraine” showing the area of flashing, zig-zag lights, which occur over a 15- to 30-minute period. The pattern usually starts in the center of the visual field and extends outwards. A migraine headache may or may not follow this aura. See www.richmondeye.com/simulation.asp#migraine.
Treatments:
After ruling out other things like a stroke and seizure disorders, which might involve tests like a CT scan, an MRI, blood tests and eye exams, a doctor will narrow down the possibilities.
For people like Jim who have run the gamut of tests and have suffered from migraines for years, you can learn what kinds of migraine medications work and what don’t. Jim says “abortive drugs” like effervescent aspirin (the fizzy kind) can stop symptoms. Fast-acting drugs include a beta-agonist inhalant like isoproterenol and sub-lingual (under the tongue) drugs like nitroglycerin and meclofenamate (Meclomen is frequently used for arthritis). Another drug that works for some is naproxen sodium.
An anti-seizure drug like topiramate can also be used for other migraines besides silent migraines. Jim has also discovered that another abortive drug, triptan, does not work quickly enough, but might be useful if one suffers a painful migraine later.
Silent or not, migraine sufferers may find that resting in a darkened room is useful until the symptoms resolve.
Help your doctor help you by being prepared with a family history and mentioning other symptoms that might narrow down the diagnosis more quickly.
If you experience other, unusual visual symptoms like a shower of black spots or floaters, you may have a separate condition of posterior vitreous detachment or retinal tearing for which you will most certainly want to see a doctor.
Sources:
Steven Ofner, M.D. and Darrin P. Fleming, O.D. “Ophthalmic Migraine.” Http://www.eugeneeyecare.com/conditions/Ophthalmic_Migraine.html. Retrieved 6-6-10.
“Ocular Migraines (Ophthalmic or Eye Migraines)” by Marilyn Haddrill; contributions and review by Charles Slomin, M.D. Http://www.allaboutvision.com/conditions/ocular-migraine.htm. Page updated January 2009. Retrieved 6-6-10.
Simulation of ophthalmic migraine at www.richmondeye.com/simulation.asp#migraine. Retrieved 6-7-10.
“Silent Migraine.” “The problem of misdiagnosis.” “Getting the right diagnosis.” “Treatment of silent migraine.” Http://www.migraine-headache.com/silent-migraine.html. Website heavily researched by “James,” a migraine sufferer for 15 years, whose family picture and bio are given at www.relieve-migraine-headache.com/migrainewebsite.html. Retrieved 6-7-10.
Causes and Risk Factors of Ocular Migraine.” Health Encyclopedia – Diseases and Conditions. Http://www.healthscout.com/ency/68/226/main.html. Retrieved 6-7-10.
