Differentiating Retinal Migraine and Ocular Migraine : Essential Insights for Accurate Diagnosis

Migraine is a prevalent neurological condition, renowned for causing intense headaches accompanied by a range of distressing symptoms, such as visual disturbances, nausea, and sensitivity to light. The spectrum of migraines is made up of many different types, including those traditionally classified under the umbrella of ocular migraine. Ocular migraines refer to migraine episodes that trigger specific visual symptoms. Within this subset, there also exists a subtype known as retinal migraine, which is distinguished by visual manifestations experienced in just one eye.^(1,2,3,4)

Understanding these terms, “ocular migraine” and “retinal migraine,” is important as the various characteristics of ocular and retinal migraines come with a complex array of symptoms, extending beyond just your simple headache manifestation. These symptoms might even involve flickering lights, blind spots, zigzag lines, or temporary vision loss in one eye during an episode.^(5,6)

The causes behind these distinct forms of migraines are multifaceted, involving a combination of several factors like genetic predispositions, neurological factors, and potential triggers like stress, hormonal changes, or certain foods.

Read on to learn more about retinal migraine versus ocular migraine and understanding the distinctions between the two conditions.

Retinal migraine presents as a unique neurological phenomenon characterized by the onset of visual disturbances primarily affecting one eye. These episodes often manifest either concurrently with a migraine attack or within an hour of its initiation.

Retinal migraine is sometimes also known by the following terms:

• Ophthalmic migraine
• Monocular migraine
• Anterior visual pathway migraine

The hallmark symptoms of retinal migraines includes a range of visual anomalies, inducing patches of diminished vision or even temporary vision loss in the affected eye. People who experience these episodes may also experience a visual spectacle characterized by twinkling lights, scientifically referred to as scintillations.

As per the criteria set forth by the International Classification of Headache Disorders, diagnosing retinal migraines typically entails the presence of at least two of the following defining features:⁽⁷⁾

• Gradual Onset: Visual symptoms gradually develop over a span of approximately five minutes, culminating in their full manifestation.
• Duration: The duration of these visual disturbances persists within a timeframe ranging from 5 to 60 minutes, often before subsiding.
• Association with Headache: Notably, either a severe headache surfaces within 60 minutes following the onset of retinal symptoms or occurs simultaneously with the visual disturbances.

Vision loss typically persists for a duration spanning 10 to 20 minutes before gradually returning to normal. In the majority of cases, the same eye experiences the effects during each retinal migraine episode.⁽⁸⁾

Although the precise cause of retinal migraine remains elusive, experts now believe that retinal migraine episodes stem from a wave of nerve cell deactivation that traverses towards the retina.⁽⁹⁾ The underlying reasons for why this happens remains unclear, but many people tend to have specific triggers that could precipitate such occurrences.⁽¹⁰⁾

An ocular migraine was a term previously used to denote retinal migraines or any migraine that causes visual symptoms. However, the International Headache Society (IHS) no longer recognizes ocular migraine as being a distinct migraine type in an attempt to prevent confusion. Due to this, medical professionals also generally avoid using this term. Nevertheless, in certain instances, clinicians and researchers may still employ the term ocular migraine. For example, in a 2022 case study, researchers opted to use this term instead of retinal migraine.⁽¹¹⁾

Nevertheless, when it comes to common usage, ocular migraine may actually also refer to another migraine subtype known as “migraine with aura.” This type of migraine involves recurrent headaches usually accompanied by sensory symptoms. Approximately one in three individuals experiencing migraines also experience episodes with aura, with nearly 98 to 99 percent of them encountering visual symptoms.⁽¹²⁾

Visual symptoms associated with migraine with aura include flashing lights, blind spots, shimmering stars, zigzag patterns, and alterations in vision. Beyond visual disturbances, migraine with aura can also cause symptoms like muscle weakness, speech difficulties, and numbness or tingling sensations, typically starting in one arm before affecting the face, lips, and tongue.

The precise cause of migraine with aura, again, remains somewhat unclear, although experts hypothesize that it may involve abnormal electrical activity in the brain, potentially manifesting as a slow wave.⁽¹³⁾

During a migraine with aura episode, finding relief in a darkened room and closing one’s eyes proves beneficial for many individuals. Using a cold compress on the forehead and taking pain relievers may help alleviate headaches. In some cases, doctors recommend taking preventive medications like antidepressants, beta-blockers, calcium channel blockers, or anti-seizure drugs to manage these episodes effectively.

As mentioned above, migraine with aura represents another form of ocular migraine characterized by visual symptoms. These symptoms exhibit certain distinctions from those experienced during retinal migraine episodes, and recognizing these differences can help people identify the exact type of episode they are experiencing and also take suitable measures.

In some instances, episodes of migraines featuring visual symptoms might occur independently without the presence of a headache.

Migraine with aura typically induces the perception of shapes, zigzag patterns, and luminous phenomena in both eyes. Notably, the visual disturbances persist even when the eyes are closed. On the other hand, symptoms associated with retinal migraines exclusively affect one eye without affecting both eyes simultaneously.⁽¹⁴⁾

Distinguishing between retinal migraine and ocular migraine can be challenging due to the overlapping nature of their symptoms. However, understanding the characteristics specific to each type aids in their differentiation. Here’s a general comparison on how to diagnose the two:

• Visual Symptoms: Retinal migraines primarily manifest visual disturbances affecting one eye during an episode.
• Duration of Visual Disturbances: Vision changes typically persist for around 10 to 20 minutes before gradually returning to normal.
• Recurrent Pattern: In most cases, the same eye experiences visual symptoms during each retinal migraine episode.
• Diagnostic Criteria: Diagnosis involves the adherence to specific criteria, such as symptoms developing over a few minutes, lasting for 5 to 60 minutes, and the onset of a headache within an hour after or concurrently with the visual disturbances.
• Medical Examination: A thorough examination by a healthcare professional is crucial to rule out other potential causes of vision changes.

• Variety of Visual Symptoms: Ocular migraines encompass a broader range of visual symptoms, affecting one or both eyes, including flashes of light, blind spots, shimmering or twinkling lights, and partial or temporary vision loss.
• Association with Migraine Headache: These episodes may or may not be associated with a headache. Some people experience visual symptoms without a headache.
• Diagnostic Challenges: The diagnosis of ocular migraines can be more challenging due to the variability in visual symptoms and the absence of clear-cut diagnostic criteria.
• Medical Assessment: Diagnosis typically involves a comprehensive evaluation by a healthcare professional to exclude other potential eye or neurological conditions.

Distinguishing between the two types often involves ruling out other causes of visual disturbances, such as retinal or ocular conditions, through thorough medical examinations, including eye examinations and neurological assessments. Imaging studies or other tests may be necessary to exclude other underlying issues.⁽¹⁵⁾

Both retinal migraine and ocular migraine (migraine with aura) can present with distressing visual symptoms, but the treatment approaches for these conditions are quite similar. However, it is important to note that management strategies should be discussed and guided by a healthcare professional who specializes in neurology or ophthalmology. Here are some of the general approaches for treating retinal and ocular migraines:⁽¹⁶⁾

• Identify and Avoid Triggers: Recognize and avoid potential triggers that might precipitate migraine episodes, such as stress, certain foods, dehydration, or hormonal changes.
• Pain Relief for Headaches: Over-the-counter pain medications like acetaminophen, ibuprofen, or prescription medications may help alleviate migraine headaches if they occur.
• Prescription Medications: In cases where migraines are frequent or severe, your healthcare provider may prescribe preventive medications like beta-blockers, calcium channel blockers, anti-seizure medications, or antidepressants.
• Lifestyle Modifications: Implement lifestyle changes such as regular exercise, adequate sleep, stress management techniques, and a balanced diet to potentially reduce the frequency and severity of migraine episodes.
• Dark and Quiet Environment: Moving to a dark, quiet room and resting during an episode can help alleviate symptoms.
• Cold Compress: Applying a cold compress to the forehead may provide relief during a migraine episode.
• Regular Check-ups: Regular follow-ups with a healthcare professional to monitor symptoms, evaluate effectiveness of treatments, and make adjustments if necessary.

Retinal migraine is usually considered to be a benign condition by doctors, implying that it does not lead to any kind of lasting health effects, despite its ability to disrupt daily life and cause discomfort.

However, certain migraine medications, including beta-blockers and ergots, might increase the risk of permanent vision loss. Therefore, it is crucial to avoid these medications when addressing retinal migraine.⁽¹⁷⁾

Managing all types of ocular migraine involves a process of trial and error over time. It often necessitates permanent lifestyle adjustments to evade triggers and a continuous regimen of medication.

People with migraine should always discuss their headaches and other migraine symptoms with their healthcare provider to determine the most suitable lifestyle changes and medications tailored to their specific needs. This will help in formulating an effective management plan for the condition.

While retinal migraine and ocular migraine share some similarities in terms of causing visual disturbances, they differ in their specific characteristics and diagnostic criteria. Retinal migraine predominantly involves visual symptoms in one eye during an episode, typically lasting 10 to 20 minutes, whereas ocular migraines encompass a broader spectrum of visual symptoms affecting one or both eyes. Recognizing these differences is important for getting an accurate diagnosis and appropriate management. Consultation with a healthcare professional who specializes in neurology or ophthalmology is necessary for those who are experiencing these conditions in order to establish better treatment plans and also alleviate the impact of these episodic visual disturbances on their daily lives.

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