Retinal Migraine: Symptoms, Causes and Treatment

Retinal migraine is a rare type of migraine that can cause visual symptoms in one eye. Most attacks are short-lived. Learn more about the symptoms, causes and treatment options for this disease.

Do you get symptoms like twinkling lights, flashes or temporary vision loss in one eye only? You may have retinal migraine, a type of migraine with repeated attacks of visual disturbances that happen in one eye. We spoke with Deborah I. Friedman, MD, MPH, a neuro-ophthalmologist (neurologist specializing in visual problems) and Professor in the Departments of Neurology and Ophthalmology at UT Southwestern Medical Center, Dallas, for more information on identifying retinal migraine and understanding the differences with other types of headache.

What are the signs and symptoms?

People mistake retinal migraine for migraine visual aura, which arises from the brain. “People will sometimes say ‘eye migraine’ and what they really mean is visual aura and migraine, or migraine pain in one eye” says Dr. Friedman. Or they may call it ‘ocular migraine’ (of or connected to the eye) because the problem seems to be with the eyes. “In fact, there’s no such diagnosis as ocular migraine,” she says. The visual disturbances of migraine usually come from the brain, not the eyes.

A retinal migraine attack starts with monocular (one eye) visual symptoms. These symptoms include:

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

The visual symptoms of retinal migraine last between five and 60 minutes. Symptoms can also increase over time. A headache may go along with the visual disturbance or start within an hour afterward.

“In reality, we see a lot of these [visual symptoms] that are not accompanied by a headache,” says Dr. Friedman. “But usually they’re typical migraine visual aura. They’re not coming from one eye. They are classic migraine aura symptoms, such as zigzag lines that move across the visual field, C-shaped shimmering, loss of half of the visual field that splits right down the middle, tunnel vision or simultaneous visual loss from both eyes.

What causes retinal migraine?

There is not a known definite cause of retinal migraine. It is set off by many of the same things as migraine with aura, such as:

  • Stress
  • High blood pressure
  • Smoking
  • Birth control pills
  • Dehydration (not enough water in the system)
  • Low blood sugar

The Difference Between Retinal Migraine and Other Types of Headache

There are some essential differences between retinal migraine and migraine with aura. The disease has visual disturbances in one eye only. If you experience twinkling lights in your right eye, vision in your left eye will be normal. In migraine with aura, visual symptoms are present in both eyes.

“A typical migraine with aura is usually still present with the eyes closed,” says Dr. Friedman. “So that’s one way to think about it. Did you see those flashing lights when you closed your eyes? If it comes through the brain, you’ll see it with your eyes closed.”

There are other brain diseases, like stroke, that can cause vision problems. It is important to seek medical attention if you experience sudden changes in your vision.

Diagnosis

At this time, there isn’t a test for retinal migraine. Therefore, diagnosis consists of your doctor ruling out other possible primary headache disorders and causes for the visual disturbance, including eye diseases. During the assessment, your doctor will review symptoms and personal and family medical history. They’ll assess for other potential medical issues, for example, a stroke that affects blood flow to one eye if you have temporary blindness.

Age is also a factor in the diagnosis of retinal migraine. “If an attack of a visual disturbance lasting less than an hour is experienced under the age of 50, by somebody who has no risk factors for other vascular disease, such as high blood pressure, high cholesterol, sleep apnea, family history of stroke, heart disease,…then chances are overwhelming that it’s going to be retinal migraine,” Dr. Friedman says.

Visit the International Classification of Headache Disorders 3rd edition website for more information on the diagnosis of retinal migraine.

Treatment Options

There are no clear guidelines for the management of patients with retinal migraine. Once the visual disturbance starts, it needs to run its course. Some treatments, such as triptans, can prolong the visual loss. Preventive therapies used for other migraine types can be effective. These can include medications from the following families: calcium channel blockers (reduces blood pressure), anti-seizure or antidepressant medications. Daily low-dose aspirin can also be helpful. Calcitonin gene-related peptide (CGRP—a protein that is released around the brain) is found in the retina but we don’t know if medications targeting CGRP are useful for this type of migraine.

Triptans (sumatriptan) and ergotamines are not used for retinal migraine. You should stop smoking and taking birth control pills as well.

Bottom line: If you have symptoms of vision loss, you should visit your doctor. Dr. Friedman says, “Just having an attack of vision loss is worrisome…. Regardless of the person’s age, they should go see somebody and get it checked out.” Additionally, visiting an eye doctor (ophthalmologist) for a thorough eye exam can be helpful for assessment.

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. 2006. Retinal migraine reappraised. Cephalalgia 26:1275-1286.

Grosberg BM, Solomon S, Lipton RB. 2005. Retinal migraine. Current Pain and Headache Reports 9:268-271.

 

Reviewed for accuracy by the American Migraine Foundation’s subject matter experts, headache specialists and medical advisers with deep knowledge and training in headache medicine. Click here to read about our editorial board members.