Dr Ben Wild
Overview |
Historically, it was thought that migraines, which are episodes of moderate to severe head pain, were due to fluctuations in blood flow to the brain. These were thought to occur due to blood vessel spasms. Current literature is now thinking that the spasms occur after the onset of the migraine.
There are many different types of migraines but 4 types that affect the eyes directly include ocular migraine, migraine with aura (classical migraine), retinal migraine and ophthalmoplegic migraine. Other migraines affect the eyes indirectly as light sensitivity, pressure sensations, etc.
Ocular migraines are very common and occur at least once in most people at some point in their lifetime. An ocular migraine is an aura that affects both eyes but sometimes seems like it only affects one. Example; it affects the right side of your vision in both eyes thereby appearing to only affect your right eye. These auras can appear as heat haze, pixelated vision, blind spots, tunnel vision, or scintillations that last between 5-30 minutes or many short episodes one after another. In this case, there is no headache or any other symptoms.
A picture of a mountain range in Banff showing 3 different types of auras. 1) the rainbow of colors, may look like a kaleidoscope or may look pixelated, or may look like shimmers, 2) blur spot that may actually represent a full temporary blind spot, 3) translucent white apparitions that can take on any shape or form.
Classical migraines often start with a visual aura that lasts 5-30. Unilateral auras are uncommon. About an hour after the aura a headache starts and nausea and light sensitivity may ensue. For diagnostic purposes, these symptoms must be reversible, the auras last over 4 minutes or a patient has many short auras, auras do not last over an hour, and a headache starts 1 hour after the aura.
Retinal migraines affect 1 eye only and are thought to be due to blood vessel spasms around the eye. This occurs usually in young women but is rare. It is often associated with Raynaud’s (a circulatory disease), retinal emboli (strokes in the eye) and recurrent episodes may actually lead to permanent vision loss.
Ophthalmoplegic migraines usually start around the age of 10 and are recurrent in nature. During an episode, the patient develops a 3rd nerve palsy and loses control of most of their eye muscles. This has been associated with demyelinating diseases like Multiple Sclerosis.
Causes and Risk Factors |
Causes
It used to be believed that migraines were blood vessel spasms but new research shows it is more complicated. Unknown.
Risk Factors
Sudden change in light (light to dim or vice versa), strong smells, loud noises, stress, caffeine, alcohol, chocolate, cheese, birth control, lack of sleep, fasting.
Prevention and Treatment |
Prevention
Eliminate exposure to risk factors. This is easiest done by journaling every episode and writing down what was eaten or what occurred before the migraine. You may consider low dose analgesics to reduce recurrence.
Treatments
· Analgesics like Tylenol/aspirin.
· Prescription strength analgesics.
Prognosis |
Migraines are a common and debilitating illness. There is no known physiological cause but there are many different risk factors and possible triggers. Apart from reducing exposure to these triggers, taking analgesics during an episode or to help decrease the recurrence rate of episodes, a patient usually suffers with migraines for the majority of their life. In some cases, migraines do disappear and in other cases they may go into remission only to return several years later. It’s important to talk to your family doctor about any moderate to severe headache.
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