Generality
Ophthalmic migraine is a form of headache characterized by the appearance of visual problems and / or neurological symptoms.
Dealing appropriately with ophthalmic migraine and avoiding its triggers helps reduce the frequency of attacks. For this reason, it is important not to confuse it with other forms of headache.
Ophthalmic migraine is mainly determined by a temporary reduction in local blood flow; this event is caused by the sudden narrowing of the blood vessels associated with the eyes.
Ophthalmic migraine can be favored by asthenopia (eye fatigue), visual defects (myopia, hyperopia or astigmatism) or ocular pathologies that make vision difficult (cataract). In some cases, it can originate from an inflammation of the trigeminal nerve.
An episode of ophthalmic migraine lasts from a few minutes to several hours.
What's this
Ophthalmic migraine is a particular form of headache, accompanied by changes in monocular vision .
Even the headache that can accompany this condition affects only one side of the skull ; pain appears within an hour of vision problems.
Ophthalmic migraine is usually throbbing and presents a severe-moderate intensity. The disorder can be aggravated by walking or climbing steps and may be associated with nausea, vomiting and increased sensitivity to light or sound.
Ophthalmic migraines are more common in young women (usually within the age of 40). Furthermore, the disorder occurs more commonly in subjects who have a personal or family predisposition to manifest a migraine with aura.
Warning! In some cases, the medical term "ophthalmic migraine" can lead to confusion. This can in fact be used interchangeably to refer to the migraine aura and retinal migraine. In reality, these terms are not synonymous, but indicate different pathological conditions compared to ophthalmic migraine.
Migraine aura
The ocular migraine is sometimes described as an aura. The latter is a set of manifestations that precede or accompany, in some cases, a migraine headache.
If present, visual symptoms are short-lived and affect both eyes, while ophthalmic migraine is unilateral.
The migraine aura may be associated with other manifestations, such as numbness, nausea, vomiting and increased sensitivity to light or sound. Visual symptoms also include flashes or sparkles, dark spots, flashes of light and blind spots. Sometimes, then, the aura can occur without a headache.
Retinal migraine
Retinal migraine is a rather rare disorder, which involves severe pain localized behind the eyeballs. Usually, these episodes are repeated and last several hours.
Retinal migraine is anticipated by visual disturbances (sparking flashes and dark punctate areas) always at the expense of the same eye and followed by a transient loss of vision, partial or complete.
This condition could signal something serious; in fact, the causes are attributable to a retinal vasospasm or an ocular form of migraine infarction.
Despite the similarities with the transient and completely reversible visual symptoms associated with headache with aurea, with which it can be confused, retinal migraine can induce serious consequences, such as a permanent monocular blindness (not in both eyes).
For this reason, you need to make sure you see a doctor immediately for timely treatment.
Causes
Ophthalmic migraine is a condition that can manifest itself for various reasons. Adult women with a family predisposition to the problem are most affected.
Although many scientific studies have been carried out, the exact causes of this type of migraine have not yet been identified. However, it is known that this is a neurological response to specific stimuli, favored by reasons of different kinds, common to almost all those affected.
Furthermore, genetic and vascular factors appear to be at the base of ophthalmic migraine:
- Genetic causes : specific hereditary anomalies have been identified in some subjects suffering from this form of migraine;
- Vascular causes : the disorder can result from a temporary reduction in blood flow (vasoconstriction), caused by the sudden narrowing of the vessels behind the eyeball.
In addition, ophthalmic migraine can be associated with specific visual pathologies, such as:
- Incorrect visual defects (myopia, hyperopia or astigmatism);
- Eye strain (asthenopia);
- Ocular diseases that make vision difficult (cataract).
Factors that can promote an episode of ophthalmic migraine include:
- Dehydration;
- Excessive heat:
- High altitudes;
- Smoke;
- Stressful lifestyles;
- Hypertension;
- Hypoglycemia;
- Taking the contraceptive pill;
- Hormonal changes;
- drugs;
- Excess sodium in the diet;
- Disturbed sleep.
In some cases, ophthalmic migraine may originate from inflammation of the trigeminal nerve.
Other factors that can predispose ophthalmic migraine are concomitant diseases of various nature, such as atherosclerosis, systemic lupus erythematosus or sickle cell anemia.
Symptoms and complications
Ophthalmic migraine manifests itself with repeated attacks, characterized by visual disturbances in a single eye, in association with migraine-type headache.
Possible visual symptoms associated with this condition include:
- Photophobia (increased sensitivity to light);
- Increased tearing;
- Vision of blind spots, dark or colored, fixed or sparkling in the visual field (scotomas);
- Perception of flashes of light or flash in the absence of light (phosphenes);
- Partial loss of vision or temporary blindness.
These visual disturbances are completely reversible and usually last from 5 to 20 minutes (they never last for more than an hour). The headache, on the other hand, has a long duration, which varies from 4 hours, up to cases of 2 or 3 days.
Even the headache that can accompany ophthalmic migraine affects only one side of the skull. The pain appears within an hour of sight problems and is usually pulsating and severe to moderate in intensity.
Ophthalmic migraine may worsen during daily activities (eg walking or climbing steps) and may be associated with:
- Nausea and vomiting (in particularly strong crises);
- He retched;
- Hypersensitivity to sounds;
- Dizziness;
- Muscle strength disorders;
- Sense of numbness;
- Difficulty in expressing verbally;
- Loss of sensitivity in the fingers and palate.
These symptoms may temporarily interfere with some activities, such as reading or driving, but the condition is not considered serious and the symptoms are completely reversible.
Diagnosis
In the case of ophthalmic migraine, a very thorough eye examination should be performed immediately.
The diagnosis of this type of headache is often considered "exclusionary"; other conditions can cause, in fact, similar visual problems.
The most important difference is that during an episode of ophthalmic migraine, these symptoms occur only in one eye.
A doctor can diagnose an ophthalmic migraine by examining personal and family history, collecting information related to the symptoms experienced by the patient and conducting an ophthalmological examination.
Before making the diagnosis of ophthalmic migraine, it is important to rule out other possible causes of transient monocular blindness (amaurosis fugax), such as serious eye problems, the consequences of a stroke or those of a head injury, carotid dissection or optic neuritis.
Therapy
Once the diagnosis is established, ophthalmic migraine can be treated with the most appropriate treatment, which acts on the symptoms with fast-acting drugs.
Depending on the case, the doctor may prescribe pain-relieving treatments based on non-steroidal anti-inflammatory drugs (NSAIDs, such as aspirin or ibuprofen), ergotamine or triptans (active vasoconstrictor ingredients), beta-blockers or calcium channel blockers (which relax instead, the blood vessels in the brain).
Some medications may be useful to prevent an episode of ophthalmic migraine. These medicines include tricyclic antidepressants (such as amitriptyline or nortriptyline) and anticonvulsants (eg divalproex sodium and topiramate).
The doctor will choose whether to prescribe them based on the frequency of ophthalmic migraine attacks and the patient's age; following his directions helps to face the problem in the best possible way.
A useful intervention in the treatment of this disorder is the use of glasses to correct any problems or in any case to avoid eye fatigue.
Another effective strategy to prevent ophthalmic migraine is to act on all those that may be environmental factors. In the case of ophthalmic migraine caused by stress, for example, it is possible to resort to natural remedies, such as the intake of infusions of valerian, chamomile and lemon balm with a calming action, as well as the practice of yoga.
Prognosis
Most people who suffer from ophthalmic migraine usually experience an attack every few months. The visual disturbance phase tends to last no more than an hour.
Individuals with ophthalmic migraine can benefit from the adoption of some dietary-behavioral measures:
- Avoid factors that can promote the onset of headaches, such as cigarette smoke, poorly ventilated areas, alcohol consumption, excessive heat and exposure to intense noise;
- Limit the consumption of foods that may contain molecules such as monosodium glutamate, nitrites and lactose implicated in the onset of migraine attacks: dairy products, mature cheeses, Chinese cuisine, eggs, chocolate, citrus fruits, tomatoes, etc.
- Periodic check-ups with a trusted ophthalmologist are fundamental, in order to avoid that the lack of awareness of a given disorder (eg myopia, astigmatism, hypermetropia, etc.) may cause an ophthalmic migraine or any other type of problem .
