Causes of Ophthalmic Migraines

Ophthalmic migraines are a little known form of migraine. Ophthalmic or ocular migraines are sometimes called silent migraines, because they can occur with or without a headache being present. They are characterized by a visual disturbance that occurs in one eye. Many ophthalmic migraineurs (persons who have migraines) describe the migraine as if they are peering through a cracked glass window. Other migraineurs describe their visual field as having an enlarging blind spot (scotoma), twinkling lights (scintillations) or distorted vision (metamorphopsia) with wavy or jagged lines. Unfortunately, physicians do not fully understand the causes of ophthalmic migraines.

Theoretical Causes

• Current hypotheses for causes of ophthalmic migraines include a vascular spasm or intermittent constriction in the blood vessels located behind the eyes, changes in blood flow to areas of the brain responsible for vision, problems within the nerve pathways or chemistry within the brain. According to Dr. Todd Troost, a recognized expert in the field of migraines, the family predisposition to this specific type of migraine is "similar to that expected in all patients with migraine preceded by visual aura." He believes that these types of migraines are more common in women than in men.

General Triggers

• Dr Jeff McDougall suggests ophthalmic migraines may be caused by the body's neurologic response to triggers such as "medications, hormonal changes, flashing lights or chemicals in foods." Most researchers agree with McDougall; evidence has linked the following environmental and hormonal factors to triggering ophthalmic migraines: loss of sleep or deviation from normal sleep schedules; premenstrual changes; oral contraceptives; weather or barometric pressure changes; strong perfumes or odors; strobe, flashing or bright lights

Food and Beverage Triggers

• Food and beverage triggers appear to be more individualized than the environmental and hormonal triggers among ophthalmic migraineurs. The triggers linked to this type of migraine are: alcohol use; artificial sweeteners (especially aspartame); caffeine; stress or tension; chemicals found in food (dyes or preservatives, such as MSG or nitrates); tyramine, an amino acid (found in red wine, aged cheese, smoked fish, chicken livers, figs and turkey); peanut butter; dairy; and certain other foods such as citrus fruits, chocolate, shellfish, nuts or fermented or pickled food.

Sodium

• It is thought that the sodium may affect the fluid levels and pressures within the brain. The current supposition is that removal of salt from the diet of an ophthalmic migraineur may reduce the number of ophthalmic migraines. In a well-publicized study by the New England Journal of Medicine, called the DASH-Sodium Trial, it was proven that those who reduce their overall consumption of sodium will reduce the number of headaches they experience. There has not been a follow-up study with only ophthalmic migraineurs being tested, because ophthalmic migraine is a relatively rare disease, thus making it difficult to study. However, physicians are cautioning patients with various types of migraines, including ophthalmic migraines, to cut back on sodium intake.

Stress

• Stress is an associated risk factor with ophthalmic migraines. The body's stress response causes a multitude of changes in the hormones within the body. These can alter sleep and menstrual cycles, interfere with the fluid balance and cause mood alterations. There is a link between ophthalmic migraines and depression. Through the use of relaxation techniques, adequate rest and meditation, stress-reduction can occur.

Prevention

• Avoidance of triggers is the best prevention against the onset of migraines, including ophthalmic migraines. In some individuals, triggers are hard to pinpoint. It is helpful to keep a migraine journal to record the onset of migraines, environmental factors, medications, hormonal changes and levels of stress that are experienced. Review this journal yourself and with a physician to help delineate triggers.

Considerations

• Ophthalmic migraines are unlike other types of migraines, in that they primarily affect the eyes. This special type of migraine usually lasts 15 minutes to several hours; however, on rare occasions the damage to the visual field may be permanent. As with other types of migraines, the person who experiences this type of migraine is often exhausted at the conclusion of the experience. During the ophthalmic migraine and immediately afterward, rest as been shown to provide some benefit to migraineurs. Ophthalmic migraines can be dangerous, because they impact your vision and thus make one prone to accidents. Notify your health care provider if this is a new symptom for you or if these types of migraines are occurring with increasing frequency.