Ophthalmic Migraine: consult a doctor by instant messaging

Ophthalmic migraine: consult online and get treatment

Ophthalmic migraine (also called retinal or ocular migraine) is generally defined as a temporary abnormality of the visual field or a disturbance of vision. It is also accompanied by headaches. Its cause is not certain, but it is thought to be linked to damage to the optic nerve, which causes spots on the retina and blind spots in the eye. Ophthalmic migraine also affects 20% of migraine sufferers, so it is not rare. Furthermore, the headache appears around 60 minutes after the visual symptoms begin. This condition mainly affects women under the age of 40. The visual symptoms of the migraine can last from 10 minutes to 1 hour.

The symptoms of ophthalmic migraine

People with ophthalmic migraines have numerous visual symptoms before the headache appears. These symptoms are known as the migraine prodrome, while the migraine aura refers to the signs that precede the prodrome. The first symptoms of ophthalmic migraine therefore begin with visual symptoms:
   • Shimmering;
   • Flickering lights;
   • Flashes;
   • Distorted vision;
   • White areas or black spots in the eyes.
In addition to these symptoms, psychomotor disturbances can accompany ophthalmic migraine. These symptoms can seem quite worrying the first time they are experienced:
   • Speech difficulties
   • Numbness in one arm;
   • Severe fatigue.
Indeed, these symptoms are sometimes reminiscent of those preceding a stroke, even though they are only the signs that precede the headache of an ophthalmic migraine. Even so, caution is warranted in the presence of these disturbances. Then the actual migraine attack begins, characterised by a headache that starts in one part of the head (half of the head, "mi-graine" in French), associated with pain and sometimes nausea or vomiting. Patients generally also describe an intolerance to light and noise during a migraine attack. Finally, visual symptoms are more common with ophthalmic migraine than with classic migraines. The pain can be very severe and throbbing, like "hammer blows to the head".

What causes ophthalmic migraine?

Doctors put forward several hypotheses, even though the exact cause of ophthalmic migraine is not clearly established. Classic migraines are thought to have a vascular cause. Indeed, doctors consider it to be a neurovascular condition. Migraine is thought to be caused by vasodilation of the blood vessels in the brain. This vasodilation particularly affects the meninges, creating a feeling of pressure above the head. In the case of ophthalmic migraine, the headache and visual symptoms are not thought to be caused by vasodilation but, on the contrary, by vasoconstriction of the veins and arteries in the brain. This is why people with ophthalmic migraines may feel, the first time, as though they are having a stroke. Some specialists also mention a possible depression spreading from a neuron to the retina. This depression is thought to be similar to a depression spreading through the cerebral cortex. It can notably be observed in the visual aura of a classic migraine. Finally, it appears that genetic predispositions are often behind ocular migraines. Patients often do indeed have a family history. Even so, no scientific study has been able to clearly demonstrate this hereditary transmission. Overall, ophthalmic migraines occur before the age of 40. Beyond the age of 40, an emergency consultation is necessary to rule out the risk of a stroke. The visual symptoms are indeed very similar to those of a stroke.

Treatments for ophthalmic migraine

Treatment depends on the severity of symptoms and how often they occur. First-line treatment focuses on lifestyle measures, when migraine attacks are infrequent (once a month). In addition, certain trigger factors can be avoided:
   • Stress;
   • Alcohol;
   • Caffeine;
   • High blood pressure;
   • Smoking.
Medication is generally needed to relieve migraine symptoms. Doctors therefore prescribe non-steroidal anti-inflammatory drugs (NSAIDs) such as aspirin or ibuprofen. NSAIDs relieve pain and reduce the intensity of symptoms. They take around 20 minutes to take effect. When migraines are severe and recurrent, other medications may help, such as triptans (via nasal spray, orally, or by injection at the doctor's or self-injection). Their use must always be prescribed by a doctor; certain contraindications may apply. Indeed, triptans can be useful in treating certain headaches, but they should be avoided as far as possible in cases of transient visual loss. They could increase the risk of worsening vasoconstriction and the possibility of long-term vision loss. This health risk must therefore be assessed by the doctor. Even so, studies show the real benefit of using anti-inflammatories and certain anti-epileptic medications in reducing migraine symptoms.

Consult a GP online to treat your migraine

If your migraines are frequent and the symptoms disruptive on a daily basis, it may be worth consulting a general practitioner. Online consultation offers the advantage of fast care, within minutes, from a doctor able to diagnose the nature of the migraine attacks. Even so, when treatments (NSAIDs, triptans) fail to relieve the pain, the doctor may refer the patient to a medical centre specialising in the care and treatment of neurological disorders, to carry out further tests there. Head to Feeli for a diagnosis of your headache.