Ask any person with migraines what it’s like to have this health condition, and you’ll likely hear a slew of words that drill down to one thing: excruciating pain. But you might also get a few responses that, surprisingly enough, have nothing to do with head pain at all. Not all migraines come with discomfort. Instead, you could have an ocular migraine that messes with your vision but may not involve excruciating head pain.
An ocular migraine is basically when you experience the aura that can come with migraines, but not necessarily the achiness most people envision when they think of migraines, neurologist Andrew Charles, M.D., director of the UCLA Goldberg Migraine Program, tells SELF. Apparently, migraines contain multitudes.
Ocular migraines can make you see things that aren’t there, and they can also cause a temporary loss of vision. Either way, they can make it difficult to live your life as usual.
So, let’s talk aura, those sensory changes that can accompany migraines (but don’t always). Aura most often manifests as visual disturbances like seeing flashes of light, zigzagging patterns, blind spots, or shimmering spots or stars, the Mayo Clinic says, and can last for up to an hour. It’s also possible to experience other kinds of aura, like hearing music or feeling like someone is touching you, but an ocular migraine only involves the eye effects and can make it hard to do things like read and drive.
Ocular migraines are a type of silent migraine, which is a catch-all description experts sometimes use for migraines that don’t necessarily cause pain. While an ocular migraine is one form of silent migraine, these terms aren’t interchangeable, Ilan Danan, M.D., M.Sc., a neurologist at the Center for Sports Neurology and Pain Medicine at Cedars-Sinai Kerlan-Jobe Institute in Los Angeles, California, tells SELF. (For example, if you have other sensory disturbances like hearing music but don’t have head pain, that counts as a silent migraine but not an ocular one.)
Even if you think you’ve never heard of ocular migraines before, you might have, because there are a few different ways to refer to this health condition. Doctors often call them migraine aura without headache, Dr. Charles says. You could also use the term acephalgic migraines (cephalgia means head pain, so acephalgic insinuates a lack of it).
As if migraine lingo isn’t confusing enough, sometimes people use the term ocular migraine to refer to what doctors call a retinal migraine. Retinal migraines happen when a person experiences short periods of reduced vision or blindness, often before or with head pain, according to the Mayo Clinic. However, a retinal migraine usually only affects one eye while ocular migraines typically impact both.
The mechanism behind ocular migraines isn’t 100 percent understood, but experts have their theories.
The cause of ocular migraines is “complicated and often debated,” Ann Morrison, O.D., a clinical instructor at The Ohio State University College of Optometry, tells SELF.
One potential factor is misfiring electrical activity in your brain. “An electrical impulse causes abnormal electrical activity that spreads over the surface of the brain, triggering the migraine,” Dr. Danan says. The thinking is that if that wave of abnormal activity travels across your visual cortex, the part of your brain that processes visual signals, you can wind up with an ocular migraine, according to the Mayo Clinic.
It’s still not clear why people with ocular migraines can have the good fortune of missing out on the head pain while still experiencing vision changes. Some people only have an ocular migraine and then are able to go about their lives. But for others, that aura can be a sign that pain is on its way, with the potential of lasting up to 72 extremely uncomfortable hours.
What experts do know is that the same triggers that cause “regular” migraines can prompt ocular migraines as well, Ahmara Ross, M.D., Ph.D., an assistant professor of ophthalmology at the University of Pennsylvania Scheie Eye Institute, tells SELF. That includes factors like stress, caffeine, sleep deprivation, hormonal changes, and certain foods, like aged cheeses, according to the Mayo Clinic.
If you think you’re dealing with ocular migraines, it’s important to check in with an eye doctor to make sure there’s nothing actually wrong with your eyes.
“We don’t see any changes [from an ocular migraine] during an eye exam,” Colleen Halfpenny, M.D., a cornea surgeon at Wills Eye Hospital, tells SELF. But, she says, she usually encourages people with symptoms to come into the office to make sure they don’t have any issues with like retinal detachment (when the thin, light-sensitive layer of tissue at the back of your eye becomes dislodged), since it can cause similar symptoms and damage your vision if left untreated.
If you do in fact have ocular migraines, you can ride them out, or you can ask your doctor what kind of treatment might be available. It really depends on how much the migraines impact your life. If you just have visual disturbances every so often, for example, you might decide to deal with them as they come, which can be easier said than done. If you’re at work or driving, you may have to take a timeout or pull over to the side of the road until the visual disturbances pass, Dr. Danan says.
If you have intense, prolonged ocular migraines—even without pain—that are really affecting you, your doctor may prescribe migraine treatments. These generally include drugs to cut back on pain and aura during the migraine, along with preventive ones to stop migraine symptoms from happening in the first place.
Beyond that, it’s smart to try to avoid your triggers if you know what they are, Dr. Ross says. If you don’t, she recommends keeping a diary of what you eat and drink, as well as things you do, to try to help pinpoint the cause of your migraines. Then see a primary care physician (who may refer you to a neurologist) for their insight so you can try to put ocular migraines firmly in your past.