For many centuries, people have been suffering from migraine, of which ocular migraine is a special form. This predominantly chronic disease represents a suffering that is extremely unpleasant and immensely reduces the quality of life of those affected.
What is ocular migraine?
Infographic on the causes and symptoms of migraines and headaches. Click image to enlarge. In medical terminology, the synonyms ophthalmic migraine or migraine ophtalmique hide ocular migraine. This disease, also called ophthalmic migraine, can occur in two different courses. Ophthalmic migraine is often so severe that patients have to withdraw from everyday activities. Ocular migraine, which is usually perceived as “threatening,” can also be very painful and is characterized by various accompanying symptoms. The distress of ocular migraine results from the temporary absence of vision. Unfortunately, ocular migraine does not only occur in adults. More and more children are already affected by ocular migraine, a neurological disorder.
Causes
In finding the causes, not all processes have been completely researched, which is still a limitation, especially in terms of prevention and treatment. The cause finding of ocular migraine has so far yielded findings related to fluctuations in hormonal balance, various stressors, strong glare, and increased intake of alcohol and nicotine. Various ingredients in food as well as changes in climate may also be responsible as triggers for ocular migraine. Some medications are also suspected of being able to trigger ocular migraine. In the context of hormonal irregularities, puberty, birth control pills, the period immediately preceding menstruation, and menopause may be crucial in this regard. These factors influence the nervous system and centralize on the visual cortex, where the posterior cerebral arteries are located. The developing conditions in these areas contribute to the visual disturbances and visual loss, as well as the persistent massive pain, that can occur in ocular migraine.
Symptoms, complaints, and signs
A typical sign of ocular migraine is the appearance of visual disturbances, but they are temporary in nature. They manifest in both eyes. Among the most common symptoms of ophthalmic migraine is flickering scotoma. This involves a flickering sensation in front of the eye, which may be accompanied by flashes of light. Flickering scotoma is associated with loss of visual field. Characteristically, the external visual field narrows from the outside to the inside or the loss occurs in the middle of the visual field. The severity of the visual field loss varies from patient to patient. Some patients perceive their surroundings as if they were wearing blinders. If a flickering scotoma occurs, a part of the visual field appears flickering or blurred. Similar to migraine aura, the scotomas sometimes change or move from one direction to the other. It is also not uncommon for flashes of light to occur. These resemble the bright spots of light that occur when looking into a lamp and do not disappear immediately. In some cases, the symptoms change after a few years and change to other forms of migraine. If the ocular migraine is severe, the visual disturbances sometimes even turn into optical hallucinations. These include, above all, the appearance of double images or the perception of objects that do not exist in reality. Furthermore, all symptoms of classic migraine can also occur in ocular migraine.
Diagnosis and course
In classic ocular migraine, there are manifestations in both eyes that affect the ability to see. In these cases, so-called visual disturbances occur, which are described as flicker scotomas. Typical in ocular migraine are bilateral failures of the visual field and the scotomas in the form of moving flashes of light. These symptoms occur either in combination or singly. The subsequent course in ocular migraine is characterized by massive throbbing headache, pain in the face and/or neck. Those affected by ocular migraine suffer from nausea and vomiting, sensitivity to light, and dizziness.Because changes in blood pressure can occur, patients usually feel extremely uncomfortable and may sweat profusely.
Complications
In many cases, ocular migraine can severely limit the patient’s daily life. Thus, everyday things and activities are no longer possible because the ocular migraine causes severe pain and dizziness. Often it is also no longer possible for the patient to go to his place of work. Usually, the visual acuity is also severely affected, so that the affected person has to wear a visual aid in order to be able to see objects sharply. Ocular migraine is not treated directly, but there are many remedies that can alleviate the symptom so that normal everyday life is possible again. These include, above all, painkillers. However, it is not advisable to take them in the long term, as they can affect the stomach. Ocular migraine can also occur due to intolerance of a certain medication. In this case, the particular medication must be discontinued and a positive course of the disease occurs. If the ocular migraine is treated, there are usually no further complications. Without treatment, ocular migraine can greatly reduce the quality of life and pull the patient out of everyday activities. This can also cause social problems and difficulties.
When should you see a doctor?
Ocular migraine does not necessarily require medical treatment. In most cases, the symptoms disappear again after a few hours or can be alleviated independently by simple measures. A visit to the doctor is recommended if the symptoms last longer than usual (maximum 24 hours) or if health complications occur. Visual disturbances such as a flickering scotoma or persistent flashes of light should be examined by a physician. A migraine with aura, or neurological deficits, requires immediate treatment. If the ocular migraine remains untreated, it can lead to a migrainous infarction and subsequently to a stroke. Patients suffering from chronic ocular migraine should generally consult a physician. In severe attacks, hospitalization should be sought for further treatment. Children complaining of eye pain and typical migraine symptoms should be taken to a family doctor or pediatrician. In case of prolonged attacks, dizzy spells and neurological deficits, an emergency doctor should be called. Chronic migraine attacks should be discussed with a specialist. Expert advice is especially recommended if the symptoms are associated with severe symptoms such as impaired speech or consciousness or double vision.
Treatment and therapy
Possible therapy for ocular migraine has been sought for a long time. Ocular migraine patients use the offers, which are given nowadays in the context of current therapy possibilities. From the principle the treatment of the eye migraine refers primarily to high-quality medicines. In this context, patients rely on such medications as painkillers and substances such as caffeine, ergotamine and pharmaceutical substances prescribed as beta-blockers for heart diseases. In addition, drugs such as amitriptyline and riza- or sumatriptan are relevant in the therapy of ocular migraine. These interrupt the transmission of pain by influencing the responsible neurotransmitters and act very reliably. Sumatriptan and rizatriptan, however, do not show an effect in all patients. Various homeopathic active substances on a natural basis can also be helpful against the symptoms of ocular migraine. In the acute onset of ocular migraine, proven pharmaceutical products such as painkillers and anti-nausea medications are taken. However, the best “medicine” against an ocular migraine is the preventive measures that lead to its
Ocular migraine is a manifestation that, even without medical treatment, usually recedes quickly and does not develop complications. Nevertheless, follow-up care for a short period after the attack is a sensible course of action. This is because the ocular migraine attack is often an event for patients that is not only stressful because of the physical symptoms, but can also cause anxiety in some people. Therefore, it is good if the ocular migraine is still followed by a rest phase. In particular, this makes sense if the actual ocular migraine attack is followed by a headache phase.Contacts for treatment and follow-up of ocular migraine are primary care physician or neurologist.
Follow-up care
Aftercare means that the patient gives himself some time after the attack to process the visual disturbances physically and psychologically and not immediately return to the daily routine. Driving, sunlight, going to discos. Ocular migraine is a condition that usually resolves quickly without medical treatment and does not develop complications. Nevertheless, follow-up care for a short period after the attack is a sensible procedure. This is because the ocular migraine attack is often an event for patients that is not only stressful due to the physical symptoms, but can also cause anxiety in some people. Therefore, it is good if the ocular migraine is still followed by a rest phase. In particular, this makes sense if the actual ocular migraine attack is followed by a headache phase. The contact persons for the treatment and aftercare of ocular migraine are the family doctor or neurologist. Aftercare means that the patient gives himself some time after the attack to physically and psychologically process the visual disturbances and not to immediately resume everyday activities. Driving, sunlight, visits to discotheques, watching television or even reading are associated with strain on the eyes and should ideally be avoided for another hour or two. Wearing sunglasses in appropriate weather conditions is useful. Distraction from the flicker event, which is often also perceived as a psychological burden by those affected, is ideal during aftercare. Sufficient drinking can also be helpful with regard to a classic attack of migraine. In consultation with a neurologist or family doctor, a tablet can also be taken for prophylaxis.
Outlook and prognosis
Ocular migraine is a classic seizure disorder that often always presents with the same appearance. A negative prognosis in the sense of a worsening of physical findings is not to be expected, since there is usually no organic finding behind the ocular migraine. This applies both to patients who simply wait out the attack or who seek treatment from a physician or alternative practitioner because of subsequent headache attacks. The prognosis of the acute condition of ocular migraine is also very good. The flickering scotoma, which leads to a more or less severe visual disturbance in the affected person, disappears spontaneously. In many cases, the phenomenon is over again within a quarter of an hour to 20 minutes. It does not matter much whether the affected person lies down during this time or, as far as possible, goes about their normal daily routine. The only conceivable course, which could be somewhat less favorable, has less to do with the eye fibrillation itself than with the psychological condition of the affected person. Time and again there are patients who, despite the doctor making a harmless diagnosis, become very anxious every time they have an attack. The fear can prolong a seizure or a possibly following pain problem and in some cases also slightly increase the disposition for the next seizure. In these cases, reeducation or brief psychotherapeutic treatment may be helpful.
Prevention
All causes, which are causally related to the development of an ocular migraine, should be initially avoided as useful prophylaxis. A renunciation of special foods and alcohol this should not be too big a problem. It becomes somewhat more difficult with stress factors, which can lead to an eye migraine, but are not always excluded. Medical professionals therefore recommend regularly performing relaxation exercises and learning relaxation techniques to successfully counteract an ocular migraine. Prophylactically significant drugs against ocular migraine do not exist.
What you can do yourself
There is no separate form of therapy for ocular migraine; the guidelines for treatment are based on classic migraine. The eye symptomatology announces itself reliably, so that patients can already take countermeasures in advance with medication. Doctors prescribe triptans – these are painkillers that are specifically approved for the treatment of migraine. The products are now available over-the-counter in pharmacies. For patients, it means security to always have a dose of their medication at hand. If painkillers are not enough, the doctor can prescribe additional preparations against nausea and dizziness.If the eye migraine announces itself, patients should act directly. While a glass of water is often sufficient for a normal headache, the pain of a migraine attack does not go away untreated. Even small signs can be counteracted with the dose of medication. An additional anti-stress program can be helpful for many patients. Behavioral therapies, hypnosis sessions or yoga can lower the personal stress level and thus curb the frequency of ocular migraines. The most sensible approach is to treat the cause of the condition. Sometimes, ocular migraines can be triggered by stress, high blood pressure or hormonal fluctuations. Regular use of any antihypertensive medications and reduction of stress are therefore often part of the treatment regimen.
