Ocular Migraine

"Ocular migraine" is a commonly used term that can be confusing. Most people use it to describe migraine with visual aura—brief, shimmering or zigzag patterns that affect vision in both eyes. Less commonly, people use it to mean retinal (ocular) migraine, a rare condition that causes visual loss or flickering only in one eye. Knowing which one you have matters because the evaluation and treatment can be different. If your visual symptoms are new or only in one eye, you should be checked promptly to rule out other causes. These red flags—and when to seek help—are outlined by major medical centers.1 Retinal migraine has formal diagnostic criteria and is considered rare.2

Symptoms depend on whether you are experiencing a typical visual aura (usually both eyes) or a retinal migraine (one eye):

• Typical visual aura (most common): flashing or shimmering lights, zigzag lines, blind spots, or fortification patterns that spread over 5–60 minutes. These visual changes generally involve both eyes because they originate in the brain’s visual cortex rather than the eye itself.3
• Retinal (ocular) migraine (rare): transient vision loss, dimming, or a scotoma in one eye, sometimes followed by headache behind that eye. Episodes usually last 5–60 minutes, but because they are monocular they warrant medical evaluation to rule out other causes (like vascular problems).4

Call urgent care or emergency services if you have visual changes with new weakness, trouble speaking, or sudden severe headache, or if visual symptoms last longer than an hour.

Visual aura is thought to be caused by a wave of altered nerve activity traveling across the visual part of the brain, a phenomenon known as cortical spreading depression.5 In retinal migraine, temporary changes in blood flow to the retina may contribute to monocular symptoms, although retinal migraine is very uncommon.

Many people notice triggers such as stress, dehydration, bright or flickering light, lack of sleep, certain foods or alcohol, heat, high altitude, or low blood sugar. Hormonal changes can also play a role. Migraine in general is more common in people with a family history and in women.3

Your clinician will take a careful history to confirm whether symptoms are affecting one eye or both, how long they last, and whether neurological symptoms occur. A basic eye exam and, when appropriate, neuro-ophthalmic or neurologic testing may be recommended. Retinal migraine requires repeated attacks of monocular visual disturbance lasting 5–60 minutes and meeting specific criteria after other causes of transient monocular vision loss are excluded.2

Because visual aura is commonly bilateral, many patients who feel “one eye is affected” actually have binocular symptoms when each eye is tested separately. A thorough exam helps distinguish typical aura from retinal causes and from other conditions such as TIA, seizures, retinal detachment, or ocular inflammation.6

For infrequent episodes of visual aura, treatment often focuses on trigger avoidance, hydration, sleep, and using usual acute migraine medicines (like NSAIDs or triptans) when headache follows—if your clinician says they are safe for you.

If attacks are frequent or disruptive, preventive strategies may help. For suspected retinal (ocular) migraine, clinicians often consider calcium channel blockers (such as verapamil or nifedipine) to reduce attack frequency; aspirin or certain anti-seizure medicines may also be used in select cases.4 For typical migraine with aura, preventive options include beta blockers, anti-seizure medications, CGRP-targeting therapies, neuromodulation devices, and lifestyle approaches.7

Important: medicines and device choices should be individualized, especially if you are pregnant, have vascular risk factors, or have other health conditions.

Many people learn to manage ocular migraine by spotting patterns and reducing triggers. Practical steps include:

• Keep a brief headache and aura diary noting sleep, stress, foods, hydration, screen time, and lighting.
• Build a consistent routine: regular meals, hydration, and sleep.
• Use sunglasses or tinted lenses in bright or flickering light; take periodic screen breaks.
• Manage stress with exercise, breathing, or mindfulness.
• Discuss caffeine and alcohol limits with your clinician.

See a clinician urgently if visual symptoms last less than 5 minutes or more than 60 minutes, are only in one eye, or occur with weakness or trouble speaking.1 General migraine education and self-care resources can also help day to day.8

Scientists continue to study what triggers aura and how to prevent it. New work has provided direct intracranial recordings supporting cortical spreading depression as the mechanism behind visual aura in humans, adding to years of imaging and preclinical data.9 Laboratory and clinical research on spreading depression and related pathways is guiding new therapies.

Active and upcoming trials explore noninvasive neuromodulation, CGRP-pathway medicines, and digital tools to predict or prevent attacks.10

If you think you have ocular migraine:

1. If this is your first episode, symptoms are monocular (one eye), or you have red flags (lasting >60 minutes, new weakness or speech trouble), seek same-day care.
2. For recurring, typical visual aura, schedule an appointment with Neuro-Ophthalmology or Neurology. Many clinics require a referral; ask your primary care or eye doctor to send one with your notes and any imaging. Waitlists are common—ask to be placed on a cancellation list, and check nearby centers if travel is possible.
3. Bring a brief diary (dates, duration, triggers, treatments tried) and a list of medicines and health conditions.
4. If attacks are frequent or disabling, ask about preventive therapy and whether your symptoms fit typical aura versus retinal migraine, as this can change the plan.
5. You can also connect directly to the right specialist on Kerbside for a medical education consult (this is for education only and does not establish a patient–physician relationship).