Seeing flashing lights, zigzag patterns, shimmering areas or a temporary blind spot can be frightening. These symptoms are often described as a visual migraine, ocular migraine or occipital migraine, but not every episode of flashing or disturbed vision is caused by migraine.
A typical migraine visual aura is a temporary neurological disturbance involving the visual areas of the brain. However, retinal tears, retinal detachment, vascular problems and other eye or neurological conditions can sometimes produce similar symptoms.
For that reason, particularly when symptoms are new or have changed, it is important not to assume that they are “just migraine” without appropriate assessment.
What is a visual migraine?
The term visual migraine usually refers to migraine with visual aura.
Typical visual aura may include flashing or shimmering lights, zigzag or jagged lines, sparkling areas, an expanding blind spot or temporary disturbance of part of the visual field.
The symptoms usually develop gradually rather than appearing instantaneously and commonly last between five and 60 minutes. A headache may follow, occur at the same time, or may not occur at all.
Although patients often feel that the disturbance is coming from one eye, typical migraine aura usually involves the visual pathway in the brain and therefore affects the visual field of both eyes. The occipital cortex, at the back of the brain, is strongly implicated in the development of visual migraine aura.
Is an occipital migraine the same thing?
“Occipital migraine” is sometimes used to describe migraine associated with visual symptoms because the occipital lobes contain the brain’s main visual processing areas.
It is not generally the preferred modern diagnostic term. Migraine with visual aura is more precise.
For patients searching online, however, visual migraine, ocular migraine and occipital migraine are often used interchangeably, which is why understanding the difference is important.
What is a retinal migraine?
A true retinal migraine is different from a typical visual migraine aura.
Retinal migraine is uncommon and causes temporary visual disturbance or loss of vision in one eye. The NHS specifically distinguishes retinal migraine from migraine with aura, which usually affects both eyes.
Because temporary loss of vision in one eye can also have vascular, retinal or neurological causes, monocular visual symptoms should not simply be assumed to be migraine.
Why is a full eye examination important?
This is perhaps the most important message.
Flashing lights and visual disturbances can occur with migraine, but they may also occur with posterior vitreous detachment, retinal tears and retinal detachment. A retinal detachment can lead to permanent loss of sight if it is not diagnosed and treated promptly.
A comprehensive ophthalmic examination helps determine whether the symptoms are actually coming from the eye.
At Edgbaston Eye Clinic in Birmingham, assessment of unexplained visual disturbances can include detailed slit-lamp examination, dilated retinal examination, Optos Daytona ultra-widefield retinal imaging, OCT scanning and visual field assessment where clinically appropriate.
These investigations can help exclude retinal, macular and optic nerve disease. If the examination suggests that the symptoms may have a neurological or vascular cause, appropriate onward medical or neurological assessment can then be arranged.
Visual migraine or retinal problem: what is the difference?
Migraine aura often evolves gradually. A shimmering or zigzag area may start small and slowly spread across part of the visual field over several minutes.
Retinal flashes are often different. They may appear as very brief flashes, arcs or streaks of light, particularly in the peripheral vision, and may occur repeatedly. New flashes accompanied by a sudden increase in floaters or a curtain or shadow across the vision require urgent retinal assessment. Moorfields advises urgent examination for new flashes and floaters because a retinal tear or detachment needs to be excluded.
Symptoms alone are not always enough to distinguish the two reliably. This is why examination matters.
When should visual symptoms be assessed urgently?
A first episode of unexplained flashing or visual disturbance deserves medical attention, particularly when the diagnosis has never previously been established.
Urgent assessment is especially important when vision is suddenly lost, symptoms affect only one eye, there are new flashes and floaters, a curtain or shadow develops, symptoms are significantly different from previous episodes, or the visual disturbance does not resolve as expected.
Symptoms associated with sudden weakness, facial drooping, difficulty speaking, confusion or sudden severe headache require emergency medical assessment because these can be features of stroke or another neurological emergency.
Can visual migraine occur without headache?
Yes.
A visual aura can occur without a subsequent headache. This is sometimes referred to as migraine aura without headache or, informally, a silent migraine.
The absence of headache does not automatically make the visual symptoms more concerning, but a new or unusual episode should still be properly assessed before assuming migraine is the explanation. NICE recognises that typical aura symptoms can occur with or without headache.
What happens after the eyes have been checked?
If a comprehensive ophthalmic examination finds no retinal or other ocular explanation and the symptoms are consistent with migraine aura, further management may be through your GP or, where appropriate, a neurologist.
Keeping a record of when symptoms occur, how long they last, whether one or both eyes appear affected and whether headache or other neurological symptoms follow can also be helpful when establishing a diagnosis.
Visual Disturbance Assessment in Birmingham
If you experience unexplained flashing lights, zigzag vision, temporary blind spots or other new visual disturbances, it is worth establishing where the symptoms are coming from before assuming they are migraine.
At Edgbaston Eye Clinic, patients can undergo a comprehensive ophthalmic assessment using advanced retinal and optic nerve imaging to exclude important eye disease and determine whether further medical investigation is required. A full examination including consultation and all diagnostic tests such as scans is £425 payable by card on the day.
Edgbaston Eye Clinic
The Consulting Rooms
38 Harborne Road
Edgbaston
Birmingham
B15 3HE
Tel: 01217263199
info@edgbastoneyeclinic.com
Mr Don Williams Director & Clinical Lead
ACP (Ophthalmology)