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Although retinal migraine is usually not a medical emergency, you should seek urgent help if you experience a partial or complete loss of vision in one eye.
Retinal migraine is usually not a medical emergency. In most people, the condition is harmless, and vision returns to normal after some time.
Irreversible visual loss is a possible complication of retinal migraine, but it is rare. There is still uncertainty about how often retinal migraine can cause permanent loss of eyesight, and currently, no studies can predict who will get affected and how.
If you experience a partial or complete loss of vision in one eye for the first time, it is important to seek urgent medical help. Your doctor will examine your eyes and conduct additional tests to check if it is due to retinal migraine or some more serious conditions that are usually known to cause permanent blindness such as a stroke.
How long do retinal migraine headaches last?
- You may lose your vision ranging from one minute to one hour before it becomes normal again.
- The headache may occur before, during, or after visual disturbances.
- The headache in retinal migraine begins during or within 60 minutes of visual symptoms.
Your doctor will carefully assess you first and try to rule out serious causes of loss of vision such as amaurosis fugax. Amaurosis fugax is a temporary loss of vision due to a lack of blood supply to the retina. It may increase your risk of stroke, and hence, its identification is very important. Moreover, your doctor may like to know if a different primary headache disorder can mimic retinal migraine such as a migraine with a typical aura.
- To diagnose if you have retinal migraine, visual symptoms should only be present when looking through one eye. In migraines with aura, they are present in both eyes.
- For this, you need to close one eye and check if you have problems with eyesight, black spots, or twinkling lights when you see only with the other eye.
- In the case of migraine with aura, you have visual disturbances in both eyes, but the intensity may be more in one eye.
What does retinal migraine feel like?
Retinal migraine feels like you’re becoming blind in one eye (monocular) that precedes the headache phase of the migraine attack.
There is a lack of consensus regarding the definition of retinal migraine. Some say it is different from visual or ocular migraine, which is accompanied by visual disturbances, including scintillations (seeing twinkling lights) and scotoma (areas of decreased or lost vision), whereas others say a retinal migraine can have these types of visual disturbances that are consistent with the International Classification of Headache Disorders.
Experts are divided on whether headaches should always follow visual disturbances or loss of vision in retinal migraine. The migraine with only visual symptoms but not headache has been termed acephalgic migraine.
How is retinal migraine diagnosed?
There are no diagnostic tests to confirm retinal migraine. Your doctor will diagnose the condition by ruling out other causes or conditions that cause similar symptoms. They will ask about your personal and family medical history, study your symptoms and conduct a physical examination of the eye.
Your doctor may refer you to an ophthalmologist for a complete eye checkup, including that of the back of your eye.
Your doctor or the ophthalmologist may order tests, including:
- Carotid duplex ultrasonography
- Transcranial Doppler ultrasonography
- Magnetic resonance angiography
- Computed tomography angiography of the brain
- Fluorescein or cerebral angiography
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How is retinal migraine treated?
The is no fixed treatment protocol for retinal migraine. For attacks that do not come often, your doctor may treat your retinal migraine as they treat other types of migraine.
Medications for retinal migraines include:
- Nonsteroidal anti-inflammatory medications such as ibuprofen and aspirin
- Anti-nausea medications such as metoclopramide
- Calcium channel blockers (used to treat hypertension) such as nifedipine and verapamil
- Antiepileptic medications (used to treat epilepsy or seizures)
- Tricyclic medications (used to treat depression) such as amitriptyline
Depending on your habits, lifestyle, and any underlying medical conditions, your doctor may also ask you to do the following:
- Manage your stress
- Quit smoking
- Take steps to keep blood pressure under check
- Discontinue hormonal contraceptive pills
- Avoid traveling to places located at high altitude
- Drink plenty of water to avoid dehydration
- Have frequent, small meals to avoid hypoglycemia
- Avoid exposure to excessive heat
