Visual Changes With Migraines

migraine

Most of us have either heard of migraines, known someone who has had migraines, or better yet, has had the misfortune of being stricken by migraines ourselves. Migraines are a type of debilitating headache that doesn’t get much press. Everyone has heard of it, but no one actually knows much about it. Maybe this is because people who get migraines (aka migraineurs – yes there is a special word dedicated to sufferers!) tend to go hide in dark quiet rooms until the attack is over. And even then, they emerge as a very fatigued version of themselves so they won’t be in the mood to share much about their experience. So, what do we know about migraines?

A migraine attack can consist of several phases:

  • Premonitory – usually occurs hours/days before headache onset; depression, cognitive dysfunction, food cravings, autonomic features.
  • Aura – neurological symptoms that precede, accompany, or (rarely) follow an attack, usually develops over 5–20 min, lasts for less than 60 min, can be visual, sensory, or motor, headache usually follows within 60 min of the end of the aura.
  • Headache – throbbing, moderate to severe intensity, lasts 4-72 hours, light and sound sensitivity, nausea and/or vomiting.
  • Resolution – feels tired, washed out, irritable, or listless, and can have impaired concentration, scalp tenderness, or mood changes (Silberstein, 2004).

Auras. And not the glowing angelic vibe kind.

So, the headache that we associate with migraine is only one part of the fun. According to the American Migraine Foundation, approximately 25-30% of the lucky people who get migraines also get auras.

The cause of migraine auras is not clear, but research suggests that it is caused by extra waves of electrical activity in the largest part of the brain called the cerebral cortex. This electrical activity, called cortical spreading depression, starts in the back of the brain where the visual areas are located. This might be why visual auras are the most common.

Migraine auras often occur over a period of 5-20 minutes and typically last less than an hour. Auras exist in six main forms:

  • Visual disturbances – seeing sparkles/light/stars, blind spots (scotomas), tunnel vision, flashing lights, zigzagging lines, colored spots; symptoms usually begin at the center of the individual’s field of vision, then move outward; some individuals even experience temporary blindness when they have a migraine (Viana et al, 2019).
  • Tactile disturbances – physical sensations like numbness or tingling; might start in a small location and spread to other parts of the face or body on the same side
  • Language difficulty – tough time trying to communicate and speak to other people; may find it difficult to find the words they need to use to construct a sentence, though they can often understand without difficulty.
  • Weakness – temporary paralysis or weakness that occurs on one side of the body (hemiplegic migraines).
  • Brainstem aura – double vision, ringing in the ears, vertigo, and slurred speech.
  • Retinal migraine – affects the vision in a single eye; may result in the appearance of flickering lights or even temporary blindness in one eye.

Some extra lucky individuals will experience a combination of any of the above, often occurring back to back. (Hadjikhani et al, 2021).

Interestingly, visually impaired migraineurs have also reported getting auras and light sensitivity but we will save that discussion for another day. (Silva et al, 2014).

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Visual Field Changes

Of all the types of auras that people can experience, visual changes are the most common. The following are types of visual field changes that a migraine can cause:

  • Photopsia: see flashes of light, like a bright bulb flashing in your vision.
  • Fortification spectra/teichopsia: bright, jagged lines that shimmer; vaguely resemble battlements or fortifications (the pattern at the top of a castle).
  • Metamorphopsia/Alice in Wonderland syndrome: when images distort in shape, size, and/or color, producing an often bizarre visual effect some feel is reminiscent of Alice in Wonderland.
  • Scotoma/partial loss of vision: spots in the field of vision or a tunnel vision effect.
  • Amaurosis fugax: a loss of vision spreading from the top down like a shade being pulled (Rastogi et al, 2016).

For real? A peek at what visual auras look like…

Credit: denarend.com

What does this all mean?

Not everyone who gets migraines experiences auras along with them. And if you get auras with your migraines, we aren’t really sure yet what it actually means in terms of what’s going on inside your head. What we do know is that for those who do experience auras, they’re often the ‘warning sign’ that a migraine attack is imminent. Having this warning gives the migraineur an opportunity to take some medication and get some rest, in the hopes of preventing the headache phase. So, in a way, it’s not so bad.

Do I need treatment?

Yes and no. If this is the first time that you’ve had a migraine with an aura, you should keep a headache journal (any random notebook or notes on your phone will work) tracking how often you get the symptoms, what the symptoms are, and if you notice any triggers (certain foods, poor sleep, stress) and you should tell your doctor about the headache, especially if you don’t get your first migraine until you’ve left your teenage years behind. Most likely, if you are diagnosed with a migraine, you will be advised to take either over-the-counter or prescription medications and to avoid triggers. Sometimes, your doctor will recommend getting a brain MRI to make sure that you are just getting a migraine and not something more serious like multiple sclerosis. The good news is that most migraine sufferers usually find effective ways to manage their migraines and many actually end up “outgrowing” them by age 40, with fewer/less intense headaches and fewer/less intense associated symptoms. (American Headache Society)

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References:

  • Shah DR, Dilwali S, Friedman DI. Migraine Aura Without Headache [corrected]. Curr Pain Headache Rep. 2018 Sep 17;22(11):77. doi: 10.1007/s11916-018-0725-1. Erratum in: Curr Pain Headache Rep. 2018 Oct 20;22(12):85. PMID: 30225597.
  • Hadjikhani N, Vincent M. Can you have a migraine aura without knowing it? Curr Opin Neurol. 2021 Jun 1;34(3):350-355. doi: 10.1097/WCO.0000000000000924. PMID: 33661163.
  • Viana M, Tronvik EA, Do TP, Zecca C, Hougaard A. Clinical features of visual migraine aura: a systematic review. J Headache Pain. 2019 May 30;20(1):64. doi: 10.1186/s10194-019-1008-x. PMID: 31146673; PMCID: PMC6734223.
  • Rastogi RG, VanderPluym J, Lewis KS. Migrainous Aura, Visual Snow, and “Alice in Wonderland” Syndrome in Childhood. Semin Pediatr Neurol. 2016 Feb;23(1):14-7. doi: 10.1016/j.spen.2016.01.006. Epub 2016 Jan 27. PMID: 27017016.
  • Bunner AE, Agarwal U, Gonzales JF, Valente F, Barnard ND. Nutrition intervention for migraine: a randomized crossover trial. J Headache Pain. 2014 Oct 23;15(1):69. doi: 10.1186/1129-2377-15-69. PMID: 25339342; PMCID: PMC4227630.
  • Gazerani P. A Bidirectional View of Migraine and Diet Relationship. Neuropsychiatr Dis Treat. 2021 Feb 11;17:435-451. doi: 10.2147/NDT.S282565. PMID: 33603381; PMCID: PMC7884951.
  • Silva GC, Góes CP, Vincent MB. Aura-like features and photophobia in sightless migraine patients. Arq Neuropsiquiatr. 2014 Dec;72(12):949-53. doi: 10.1590/0004-282X20140200. PMID: 25517643.
  • Sun-Edelstein C, Mauskop A. Foods and supplements in the management of migraine headaches. Clin J Pain. 2009 Jun;25(5):446-52. doi: 10.1097/AJP.0b013e31819a6f65. PMID: 19454881.
  • Silberstein SD. Migraine. Lancet. 2004 Jan 31;363(9406):381-91. doi: 10.1016/S0140-6736(04)15440-8. PMID: 15070571.
Posted: June 23, 2022
<a href="https://ostrowon.usc.edu/author/joancwang/" target="_self">Dr. Joan C. Wang</a>

Dr. Joan C. Wang

Joan Wang, DDS, focuses on treating patients with orofacial pain disorders in the Chicagoland area. She received her BS in Computer Science and DDS from the University of Michigan and completed an AEGD residency program at the University of Minnesota. She is a Diplomate of the American Board of Orofacial Pain and is currently working on her Masters in Orofacial Pain/Oral Medicine at the University of Southern California.

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