Migraines and Vision

Migraines are more than just headaches—they're a neurological condition that frequently affects vision. Visual aura, sensitivity to light, and eye pain are common migraine symptoms. Understanding the visual aspects of migraines helps with diagnosis and management.

Visual Symptoms in Migraine

Migraine Aura

Visual aura is the most common type of migraine aura:

Classic visual aura features:

• Zigzag lines (fortification spectra)—look like the walls of a medieval fort
• Flashing or flickering lights (scintillations)
• Blind spots (scotomas) that may expand
• Shimmering or sparkling visual effects
• May start small and expand across visual field

Timing:

• Usually lasts 20-60 minutes
• Typically precedes headache by 5-60 minutes
• Headache may not follow (acephalgic migraine)
• Usually affects both eyes (same visual field area)

Photophobia (Light Sensitivity)

• One of the most characteristic migraine symptoms
• May occur before, during, and after headache
• Normal light feels painfully bright
• Patients seek dark rooms
• Can persist between migraines in some people

Other Visual Symptoms

• Blurred vision during attack
• Eye pain (though often not the eye itself)
• Visual snow or static
• Trails or afterimages
• Difficulty focusing

Types of Migraine with Visual Features

Migraine with Aura

• Visual symptoms precede or accompany headache
• Aura fully reversible
• Most common aura type is visual

Migraine without Aura

• No warning symptoms
• May still have photophobia during attack

Acephalgic Migraine (Migraine Aura without Headache)

• Visual aura without headache
• More common in older adults
• Can be confused with TIA—needs evaluation

Retinal Migraine

Vestibular Migraine

• Vertigo and dizziness as primary feature
• May have visual motion sensitivity
• Often without significant headache

Triggers

Common Migraine Triggers

Visual/Environmental:

• Bright or flickering lights
• Glare
• Screen time
• Fluorescent lighting
• Visual patterns (stripes, checkerboards)

Sleep:

• Too little sleep
• Too much sleep
• Irregular sleep schedule

Dietary:

• Skipping meals
• Dehydration
• Alcohol (especially red wine)
• Caffeine (too much or withdrawal)
• Certain foods (aged cheese, processed meats)

Hormonal:

• Menstruation
• Hormonal contraceptives
• Menopause changes

Other:

• Stress (or letdown after stress)
• Weather changes
• Strong odors
• Neck tension

When Visual Symptoms Require Urgent Evaluation

Diagnosis

Clinical History

Key features suggesting migraine:

• Episodic nature
• Typical aura characteristics
• Family history of migraine
• Response to migraine treatment
• Associated symptoms (nausea, photophobia)

When Testing Is Needed

• Atypical features
• First presentation
• Change in pattern
• Older age at onset
• Prolonged symptoms
• Neurological abnormalities

Tests may include:

• MRI brain
• Visual field testing
• Ophthalmologic examination

Treatment

Acute Treatment (During Attack)

Over-the-counter:

• NSAIDs (ibuprofen, naproxen)
• Acetaminophen
• Combination products (Excedrin)
• Best taken early in attack

Prescription acute treatments:

• Triptans (sumatriptan, rizatriptan)—migraine-specific
• Zavzpret (zavegepant)—nasal spray CGRP antagonist
• Nurtec (rimegepant)—oral CGRP antagonist
• Anti-nausea medications
• Ergotamines (less commonly used)

Non-medication:

• Dark, quiet room
• Cold compress
• Sleep
• Hydration

Preventive Treatment

For frequent migraines (4+ per month or significant disability):

Medications:

• Beta-blockers (propranolol)
• Antidepressants (amitriptyline, venlafaxine)
• Anti-seizure medications (topiramate, valproate)
• CGRP antibodies (erenumab, fremanezumab, galcanezumab)
• Botox (onabotulinumtoxinA) for chronic migraine

Lifestyle:

• Regular sleep schedule
• Regular meals
• Stress management
• Regular exercise
• Trigger avoidance

For Photophobia

• FL-41 tinted lenses (rose-colored tint)
• Sunglasses outdoors
• Adjusting screen brightness
• Avoiding fluorescent lighting
• Gradual light exposure (avoid dark adaptation)

Living with Migraines

Tracking

Keep a headache diary noting:

• Date and duration
• Visual symptoms
• Potential triggers
• Treatments tried and effectiveness
• Impact on function

Workplace Accommodations

• Adjustable lighting
• Screen filters
• Quiet space during attacks
• Flexible scheduling when needed

When to See a Specialist

• Migraines affecting quality of life
• Frequent attacks (more than 4 per month)
• Acute medications not working
• Using acute medications too often (risk of rebound)
• Unusual or changing symptoms

Frequently Asked Questions

Can migraine aura cause permanent vision damage?

No, migraine aura does not cause permanent vision damage. The visual disturbances are temporary and fully reversible. However, visual symptoms that don't fit typical aura patterns should be evaluated.

How is migraine aura different from eye floaters?

Migraine aura consists of flickering zigzag lines that typically expand and move across your visual field over 20-60 minutes, affecting both eyes in the same visual field area. Floaters are spots or strings that drift when you move your eyes, persist constantly, and are more noticeable against bright backgrounds.

Why does light hurt during a migraine?

Photophobia during migraine involves hypersensitivity of the visual pathways. The trigeminal nerve (pain nerve) and visual system interact during migraine, making normal light stimuli feel painful.

Can I have aura without headache?

Yes, this is called acephalgic migraine or migraine aura without headache. It becomes more common with age. First-time aura without headache, especially in older adults, should be evaluated to rule out other causes like TIA.

Are visual migraines dangerous?

Typical migraine aura is not dangerous and doesn't cause lasting harm. However, migraine with aura is associated with slightly increased stroke risk, particularly in women who smoke or use estrogen-containing contraceptives. Discuss risk factors with your doctor.

When should I worry about visual symptoms?

Worry if symptoms are sudden and different from your usual pattern, last more than 60 minutes, affect only one eye, or are accompanied by weakness, numbness, or speech problems. When in doubt, seek evaluation.

References