Are you ‘seeing stars’? You might be experiencing an aura, the first sign of a possible ocular migraine.

While many people live with migraine, some experience symptoms specific to vision impairment before or during a migraine episode. This is known as an ocular migraine.

The exact cause of ocular migraine — and migraine in general — remains unknown, but experts believe many factors could contribute to this form of headache.

Experts in the field of migraine research understand what happens during an ocular headache. But the underlying cause remains to be discovered.

There are two types of migraine that affect the eyes (ocular migraine):

  • Migraine with aura. Visual impairment occurs in both eyes, before, during, or after the onset of head pain.
  • Retinal migraine. Visual symptoms occur in one eye before or during a headache. The symptoms are often more impairing than aura symptoms. Retinal migraine is more serious and one potential complication is permanent vision loss.

The causes of an ocular migraine may vary depending on which subtype you’re experiencing:

Migraine with aura

During an ocular migraine with aura, changes in the electrical activity on the outer surface of the brain are thought to contribute to visual symptoms.

This altered electrical pattern spreads across the brain’s surface within a few minutes to an hour, contributing to the progression of visual symptoms.

Retinal migraine

Similar electrical changes, specifically at the back of the eye in the retina, are thought to explain vision symptoms of ocular retinal migraine.

In some cases, experts believe reduced blood flow or vessel spasms in the retina may be to blame.

Are there other types of aura?

Yes. Auras are sensory experiences that can affect your vision and your ability to speak clearly (known as aphasic aura). Auras can cause weakness, numbness, or tingling in parts of your body.

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Possible triggers

The factors behind electrical changes in your brain or blood flow reduction to the retina are complex and not widely understood in relation to migraine.

Possible triggers for ocular migraine could include:

  • eyestrain
  • stress
  • smoking
  • hormones
  • high blood pressure
  • physical exertion
  • high altitude
  • dehydration
  • bending over
  • low blood sugar
  • excessive heat exposure
  • genetics

Stages of migraine attacks

Most migraine attacks emerge through a timeline of at least three stages:

  • prodrome
  • headache
  • postdrome

Ocular migraine, however, tends to have four stages due to the experience of visual auras:

  • Prodrome. Known as the pre-headache phase, this can last for hours or days and can present in a number of ways, including changes in mood, fatigue, light and sound sensitivity, insomnia, stomach upset, and muscle tension.
  • Aura. Experienced by approximately 25%-30% of people with migraine, auras are sensory experiences that can cause functional impairment, sometimes lasting for up to an hour.
  • Headache. This is the presence of pain on one or both sides of the head that can last for hours or days. Head pain can be moderate to severe and can be accompanied by nausea, light and sound sensitivity, and sleep disturbance.
  • Postdrome. The end of the headache phase, postdrome occurs in approximately 80% of people with migraine. It’s characterized by the absence of head pain, but the persistence of physical symptoms like body aches, fatigue, dizziness, or sensitivity to light and sound.

During an ocular migraine, visual symptoms most commonly appear before the onset of your head pain. But it’s possible to experience these visual changes during and after the headache, as well.

You can have a migraine without experiencing all of the stages. In fact, you can have an ocular migraine without any head pain.

Visual symptoms in ocular migraine can include seeing:

  • flashes of light
  • star-shaped lights
  • blind spots
  • jagged lines
  • black or white dots
  • waves (like looking through heat or water)
  • crescent shapes
  • shifting lines or angles
  • visual snow
  • colored dots or lights
  • tunnel vision
  • temporary blindness or partial blindness
  • flickering lights

Any changes to your vision before a migraine attack may be a symptom. Though rare, some people can experience hallucination-like visual symptoms that change how things in the environment appear.

Ocular migraine is a type of migraine. This means it can come with other migraine symptoms, such as:

Moderate ocular migraine that is not debilitating can be managed with common nonsteroidal anti-inflammatory drugs (NSAIDs), like ibuprofen or naproxen.

If your head pain is severe, prescription medications that might ease your symptoms include tricyclics, antiepileptics, or calcium channel blockers.

Your healthcare team will likely recommend lifestyle changes, such as smoking cessation, and limiting exposure to potential causes of ocular migraine. Common triggers you may be able to avoid include:

  • flashing lights
  • dehydration
  • stress or anxiety
  • too much or too little caffeine
  • alcohol
  • sleep deprivation

You may also benefit from:

Keeping a journal

Keeping a migraine journal that includes details about the circumstances of a migraine can help you spot potential triggers, such as hormonal fluctuations. This can help you avoid migraine attacks in the future.

Reducing eyestrain

Limiting the amount of time you’re staring at screens, using blue light-blocking glasses, and making sure screen angles are optimal may lower the risk of eyestrain.

Staying hydrated

Dehydration is listed as a potential trigger for migraine. The recommended amount of daily water intake is between 2.7 and 3.7 liters.

Experts aren’t sure what causes ocular migraine, though lifestyle factors, stress, and eyestrain are among potential triggers.

Treatment and self-management can help diminish the severity of migraine and the physical symptoms accompanying them.

Because it can be challenging to differentiate between ocular migraine with aura and retinal migraine, speaking with your healthcare team can help limit the chances of permanent visual impairment.