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Q. My periodic headache is accompanied by visual disturbance nowadays. What is the reason?

Answered by
Dr. Aida Quka
and medically reviewed by Dr. Vinodhini. J
This is a premium question & answer published on Aug 11, 2020

Hello doctor,

I have had periodic headaches that I thought were tension headaches throughout my adult life. Sometimes they are every day for two weeks and sometimes I go a few weeks with nothing. I always seem to have some type of tension in my upper back, shoulders and neck which I felt was the cause of my headaches.

About four and a half years ago, I had my first ocular migraine, it seemed like the shadows of a ceiling fan blinking and it disrupted my vision. I did not have pain, which I thought was odd.

One or two years ago, I had my second ocular migraine, it was different like flashbulbs in my eyes and then zig-zags that spread across my field of vision. Again no pain.

Two days ago, I had my third episode followed by a headache (but I have had what I thought was a tension headache for almost two weeks so maybe they were unrelated?). The visual disturbance was more similar to the one I had a couple of years ago, flashbulbs and zig zags, except it was only the right field of vision.

I have been doing some research and found that women in my age group with migraine and aura have a higher stroke risk, which is scaring me. I am a 40-year-old woman, no smoking, no oral contraceptives, borderline high cholesterol since my 20s, with normal to low blood pressure.

I am honestly looking to ease my mind at this point if there is any good news, but I also need to know the truth about my risk. If my aura symptoms are infrequent, even if these headaches I am having are migraine instead of tension, am I still at high risk?

Dr. Aida Quka



Welcome to

I passed carefully through your question and would explain that you are not at an increased risk of stroke, considering the frequency of your migraines with aura. The tension headache, which is more frequent is not a risk factor for stroke. So, considering the fact that you have no other risk factors, there is no reason to panic.

Nevertheless, I would recommend performing a brain MRI, in order to examine your brain and calm your mind. You should know that frequent migraine headaches lead to some small white spots visible in the MRI.

If these spots increase in number after a couple of years (in the follow up MRI), I would recommend starting daily baby Aspirin (80 mg daily). Anyway, considering the COVID-19 pandemic and your young age, it can wait until performing a brain MRI.

I hope this helps.

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Thank you doctor,

Would you say visual aura with no pain at all is also associated with increased stroke risk? That was my first two experiences. Also, if the headaches are usually without aura, is that associated with increased stroke risk, or is any aura ever the risk? Is the frequency of either of the above associated with increased stroke risk?

Dr. Aida Quka



Welcome back to

Based on the scientific literature, there is no correlation between visual area and increased risk for stroke. Only in women with more than 12 aura per month, or those who take oral contraceptives, there is an increased risk for stroke. So, frequency of the aura is the most important issue to consider when judging about the risk for stroke.

To conclude, there is no reason to panic in your case. You are not at any increased risk for stroke. If the tension headache is frequent, I would recommend taking low doses of Amitriptyline (10 mg at bedtime) for three months, in order to help reduce the frequency and severity of headaches and thus improve your quality of life.

I hope this helps.

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