Introduction
A migraine is a severe headache that is accompanied or preceded by visual disturbances. The symptoms last somewhere between four hours and three days. In a few such individuals, the headache is preceded by a visual aura. Individuals with migraine may have other symptoms related to the eyes, such as prolonged auras, visual blurring, retinal migraine, photophobia, palinopsia, ophthalmoplegic migraine, and visual snow.
What Are the Symptoms of Visual Disturbances in Migraine Aura?
Typical Visual Migraine Aura:
The visual migraine aura starts before the migraine headache, wherein a small blind spot with a brightly colored, flickering light appears near the center of the visual field. This spot prevents vision and can extend into one or more flashes of light. This blind spot is known as a scintillating scotoma. According to the International Classification of Headache Disorders, these symptoms are reversible and should not be related to any other disorder. The aura starts with flashes of light expanding across the visual field.
In some individuals, the blind spot in the visual field is colorless, irrespective of the other migraine symptoms. On closing the eyes, the aura symptoms are visible. The individuals experience sensory symptoms, speech problems, and motor symptoms apart from the visual symptoms during migraine with aura. Such individuals with at least two migraine attack criteria are considered migraine with aura individuals. Whereas others with migraine without aura are considered to have migraine with aura.
One of the typical symptoms of a migraine aura is gradual expansion. The aura begins with visual symptoms, sensory symptoms, aphasia, and motor problems. At times, certain individuals experience complex visual phenomena such as distorted body parts or visual splitting during the aura. The complex processes of visual perception related to orientation and size can be changed during migraine attacks. Some individuals report blurred or foggy vision. A headache follows the aura in many individuals.
Atypical Visual Migraine Aura:
Atypical migraine auras should be identified because they can be confused with other diseases. Migraines with aura can be confused with strokes because of the related visual defects and other symptoms. It is usually hard to differentiate between a stroke and a migraine with an aura. When migraine occurs in elderly people, causes like cerebral amyloid angiopathy should be ruled out as amyloid spells often resemble migraine attacks. Occipital epilepsy can also have similar visual symptoms, leading to headaches without motor seizures. These symptoms can be described as colored phosphenes. These colored phosphenes also occur in individuals with migraine.
Retinal Migraine:
In a retinal aura, the individual notices flashing lights in front of one of the eyes. There could be a temporary decrease or complete vision loss in that eye. It is a rare occurrence, but seven-year-olds could also experience it. It could be a hereditary phenomenon and is likely to occur in people with migraine headaches.
Ophthalmoplegic Migraine
Kids with migraines may sometimes experience double vision during a migraine attack. The third cranial nerve is mostly affected. Ophthalmoplegia is preceded by a migraine headache a few days earlier. And could persist for as long as two weeks.
Photophobia:
Photophobia is a fear of light and an abnormal sensitivity to light. Patients with migraine headaches experience an increase in headaches that are aggravated by light. Some individuals have been found to experience photophobia before the headache starts. There is light hypersensitivity, and such individuals have a lower light discomfort threshold.
Palinopsia:
Palinopsia means the preservation of visual images. This means seeing an afterimage of an object or a series of images when the thing is in motion. Individuals with migraines are prone to palinopsia.
Visual Snow:
Visual snow is the presence of many small dots in the visual field. The severity of the snow can differ from person to person. The snow is referred to as a form of persistent migraine aura. These migraine auras usually begin unilaterally and expand; individuals with visual snow typically experience them in the entire visual field without expansion.
What Is the Duration of Visual Disturbance From Migraine?
The visual disturbances of migraine usually last less than an hour, sometimes only for a few seconds. These might not always be associated with headaches, and some experience visual symptoms without the headaches. The visual disturbances may start before the headache or may begin during the headache. The characteristics and visible changes of migraines may change throughout life. The migraine headaches may decrease with time or vanish completely with persistent episodes of visual aura. At 50 years of age or later, certain individuals may experience visual symptoms related to migraine even without the headache.
Can Visual Disturbances Occur in Both Eyes?
Migraine visual symptoms generally occur in both eyes. It is hard to determine if the symptoms occur only on one side of the visual field. One should cover one eye and see through the other to determine whether the symptoms come from the brain or the eyes. If the symptoms come from the eye, they can be seen in one eye only, and if they come from the brain, they are seen in both eyes. The visual symptoms of migraine are categorized as positive, negative, and altered or distorted vision.
What Are the Causes of Concern?
The presence of various visual symptoms in migraines makes it hard to differentiate whether the symptoms are related to migraines or are due to an underlying condition requiring medical attention.
Some of the symptoms are:
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New dark spots in one eye that do not go away could be due to retinal or vitreous detachment.
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New flashes of light in one eye that do not disappear in an hour.
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Transient vision loss in one eye could be a sign of stroke or inflammation of the blood vessels.
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Loss of vision on one side of the eyes leading to blindness without headaches could be due to stroke.
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A sudden drastic change in an otherwise stable pattern of visual migraine symptoms.
Conclusion
Around 25 to 30 percent of individuals with migraines have visual aura symptoms. It is quite difficult to differentiate whether the visual symptoms relate to migraines. The visual aura is the typical visual disturbance in migraines and other visual symptoms. In most individuals with migraine, the headache is preceded by a visual aura, but there are many other symptoms related to migraine.
