Retinal Migraine

The Basics of Retinal Migraines

Retinal Migraine is a form of migraine with repeated attacks of visual disturbances that occur in only one eye before the headache phase of the migraine attack. The term “retinal migraine” is often misused to mean any migraine that involves any visual symptoms or a migraine with visual symptoms but without the headache phase of the attack. Please refer to the International Classification of Headache Disorders 3rd edition (beta version) website for more information on the criteria used to diagnosis retinal migraine: https://www.ichd-3.org/1-migraine/1-2-migraine-with-aura/1-2-4-retinal-migraine/

A retinal migraine attack begins with monocular (in one eye) visual symptoms that can include:

  • Scintillations (seeing twinkling lights)
  • Scotoma (areas of decreased or lost vision)
  • Temporary blindness

How Long do Retinal Migraine Headaches Last?

The headache phase of a retinal migraine begins during or within 60 minutes of the visual symptoms.

People suspected of having retinal migraine should be carefully assessed by their doctor for an underlying cause. As well, they should be evaluated to make sure that they do not have a different primary headache disorder that can mimic retinal migraine. Other primary headache disorders that mimic retinal migraine include migraine with typical aura.

In retinal migraine the visual symptoms should only be present when looking through one eye. For example if you look through the right eye and close the left eye, you see twinkling lights but when you look through the left eye and close the right eye your vision is normal. In migraine with typical aura, when you alternate which eye you look through the visual disturbance will be seen with either eye but possibly more prominent with one eye or the other. This is because in retinal migraine the vision symptoms are coming from the eye (so are only seen with one eye), while in migraine with typical aura the vision symptoms are coming from the brain (so are seen with both eyes).   The distinction between retinal migraine and migraine with typical aura is important for treatment considerations and counselling regarding future outcomes. Irreversible visual loss may be a complication of retinal migraine but not migraine with typical aura. It is unclear how often permanent vision loss occurs with retinal migraine and there are no identified predictors for this currently.

Diagnosis of Retinal Migraine

There are no diagnostic tests to confirm retinal migraine. Diagnosis is accomplished by reviewing the patient’s personal and family medical history, studying their symptoms, and conducting an examination. Retinal migraine is then diagnosed by ruling out other causes for the symptoms. With retinal migraine, it is essential that other causes of transient blindness, such as stroke of the eye (amaurosis fugax), be fully investigated and ruled out. Seeing an eye doctor (ophthalmologist) for a full eye exam is generally required for a good look at the back of the eyes.

Treatment for Retinal Migraines

There are no clear guidelines for the management of patients with retinal migraine. For infrequent attacks, medications used for other forms of migraine are often employed to relieve the other symptoms. These medications can include NSAIDs and antinausea medications. Triptans and ergotamines are avoided in these patients. Preventive therapies used for other migraines types should be explored, such as the calcium channel blockers, antiepileptic or tricyclic medications. Daily aspirin is considered for these people as well. People should stop smoking and discontinuation of oral contraceptives may be advisable.

Summary of Retinal Migraines

Retinal migraines are a subtype of migraine associated with monocular vision symptoms. Patient’s suspected of having retinal migraine should be carefully assessed by their doctor for an underlying cause. To help distinguish retinal migraine from migraine with typical aura, it is important that people carefully assess whether there vision symptoms are perceived in one or both eyes by alternating looking through either eye. The distinction between retinal migraine and migraine with typical aura has ramifications for treatment choices as well as prognosis counselling.

Resources:

The International Headache Society. https://www.ichd-3.org/1-migraine/1-2-migraine-with-aura/1-2-4-retinal-migraine/

Grosberg BM, Solomon S, Friedman DI, Lipton RB. Retinal migraine reappraised. Cephalalgia 2006; 26:1275.

Grosberg BM, Solomon S, Lipton RB. Retinal Migraine. Current pain and Headache Reports 2005; 9: 268-271.