Ocular migraine concerns and questions

[benjamin916]

Hello,

I had my first ocular migraine about 7 months ago.  It consisted of around 40 minutes of flashing lights and loss of peripheral vision in my right eye.  There was no observable effect in the left eye, only the right.  The symptoms cleared up after 40 minutes, and I regained complete vision.  Needless to say, being my first experience of temporary vision loss, I saw an opthomologist and he said there was nothing wrong with the eye.

Since then, I've had two additional ocular migraines with similar symptoms at about 3 month intervals.  Today was the latest one I've had, and I thought I would throw the symptoms of these headaches and ask a few basic questions.  I'm still pretty new to this, so any help is greatly appreciated.

The symptoms of my ocular headaches are as follows:
  - I'm a 24 year old male, pretty healthy with no known illnesses or disease
  - All have occured in the early morning (between 8AM and 9AM)
  - All have occured while working on a computer
  - All have effected only my right eye
  - Symptoms have varied only slightly and include: flashing lights, zig-zagging lines, missing spots in vision, peripheral loss of vision, and flashing geometric shapes
  - Ocular migraine has been followed by general headache behing BOTH eyes on one occasion (1 out of 3), other two did not have general headache following ocular migraine
  - Right eye feels tired and "pressure" all day following ocular migraine
  - Right eye "pressure" has lingered for months following ocular migraine (not sure if this is related, could be sinusitis)
  - Right eye is now pretty consistently bloodshot, especially in the morning, with a few veins that are very noticeable and never really "clear up".  I don't remember this happening before the ocular migraines started.

After the second ocular headache about three months ago, I had this constant "pressure" or sensation on the inner corner of my eye.  This lasted months, and I eventually saw my regular doctor about it.  He gave me generic flonase and said it was probably sinusitis.  I think it helped clear up the pressure a bit, and instead of constant "pressure" it turned into only occasional pressure.  After today's ocular migraine, however, the "pressure" is once again back.  I have an appointment with an ENT doctor about this a few weeks from now (they were booked for a long time...), but I think it might be more worthwhile to see someone who specializes in these types of migraines.  My regular doctor is the one who referred me to the ENT doctor, but I'm not sure my regular doctor is that well versed on ocular migraines.

So, knowing all of this, my questions are as follows:
  1. Do ocular migraines sometimes result in lingering headaches behind the eye ("pressure") that lasts for months?  Is this normal?
  2. I've heard that these type of migraines are most common among young people under 30.  If this is the case, can I expect these events to go away as I age (I'm 24)?  Or should I still expect to be having these things at 50?
  3. The opthamologist I saw told me there was no retinal issues, and also told me (almost laughingly) that it definitely wasn't optic neuritis.  Is it worth seeing a specialist about this if it continues at this 3 months interval, or should that examination be sufficient to rule out more serious things?  The only other thing I've read about that could be checked is for stroke, but it seems I'd have other serious symptoms if that were the case.
  4. Are there any medications that are recommended that provide immediately relief for this stuff?  Is there anything I can do that will act as preventative?  I've tried to avoid "triggers", but the only "triggers" I can deduce are morning (which I can't avoid) and working on the computer (which I also can't avoid... it's a big part of my job).

Thanks so much for any input or help.
Ben

[marileew]

Hi there,

I am a migraine sufferer too. I usually get severe headaches with no aura, but I have had headaches with aura before and also aura without headaches before. So, I know exactly what you're describing in terms of what you're seeing... a lot of us here do!! Don't worry, you're not alone!! The first time it happened to me, I had recently seen the film "the ring" and what I saw in my vision looked exactly like "the ring" in the killer video!! I was soo afraid and I thought I was going insane!!! I also had the blind spots and everything too. It wasn't until looking up what others had drawn online of what their migraines "looked like" that I realized I was seeing what everyone else was seeing!! Anyway, to answer some of your questions...

  1. Do ocular migraines sometimes result in lingering headaches behind the eye ("pressure") that lasts for months?  Is this normal?

Migraine headaches are often described as "pressure behind the eye". Also, although migraine headaches usually resolve within hours, or at least days, it is possible for them to last for months or years. Now, if the pain, or "pressure" you are feeling is not severe, then it is possible you have what is called a "transformed migraine". That is when the severe migraine pain turns into milder chronic pain. So yes, it is normal. It is not common, but it is also not something that is rare. It is just unfortunate that it is happening to you.

The best way to avoid transformed headaches is to make sure that you stop the original headache. This means properly treating the original headache with proper migraine medication. You should be treating your migraines with triptans the moment you feel them coming on, at the first sign of the aura (the visual symptoms). The triptans will interup the headache and stop it from continuing and stop the possibility of it from becoming a transformed headache.

Also, you might want to avoid treating your headaches with over-the-counter NSAIDS like advil... as this can also cause rebound headaches. BUT if you are going to do that, you MUST replace them with something, PREFERABLY PROPER migraine medication... and that's triptans. You will need a prescription from your doctor.

It is good you got your eyes tested. That would have been everyone's first suggestion. But you did it. Continue getting yearly eye tests. Make sure they test the pressure in your eyes (they do this by freezing your eyes slightly and then poking them with something). Make sure you go to an eye DOCTOR, that's an Ophthalmologist, don't ever go to an optometrist to get your eyes tested if you are worried that there is something wrong with them, please always go to an actual eye DOCTOR, and those are ophthalmologists.

Also, if you ever experience any NEW strange visual symptoms, sudden severe eye pain, what looks like a "veil" has been placed over your vision or any complete visual loss (as opposed to blind spots) or any undiagnosed lasting visual symptoms that do not resolve themselves on their own or with medication, please seek immediate medical attention, please do not mistake these as being normal just because you have suffered from migraines before. Such new symptoms could be signs of a stroke or serious eye problems and you will need emergency medical attention.

2. I've heard that these type of migraines are most common among young people under 30.  If this is the case, can I expect these events to go away as I age (I'm 24)?  Or should I still expect to be having these things at 50?

I haven't heard that any type of migraine is more common among young people except for "stomach migraines without headache" that are more common among very young children.BUT! No, you should not expect to still have them around 50. MOST people find that their migraines decrease in both severity and frequency the older that they get.

3. The opthamologist I saw told me there was no retinal issues, and also told me (almost laughingly) that it definitely wasn't optic neuritis.  Is it worth seeing a specialist about this if it continues at this 3 months interval, or should that examination be sufficient to rule out more serious things?  The only other thing I've read about that could be checked is for stroke, but it seems I'd have other serious symptoms if that were the case.

First... what you described sounded like a migraine. I know it feels scary and looks scary and seems like something huge. I thought I was going insane the first time it happened to me. I totally understand how freaky it is. But... really, you don't have to worry about scarier things. All the stuff you described are migraine symptoms. But, to answer your questions about the other stuff...

At this point, if you'd had a stoke... well, you'd have had a stroke. The point of identifying stroke symptoms early and early medical intervention is so that lasting brain damage does not occur and so that physical/speech/behaviour/etc therapy can begin taking place ASAP. If you had a stroke months ago... well, it was probably minor. Now, you've said it's happened three times. So, the next time it happens, if you are worried about a stroke, then go to the ER. They will be able to do a CT scan and an MRI to rule out a stroke and to do any corrective surgery that needs to be done on the very very off chance that it is a stroke. At this point, had they all been mini strokes, it's possible that it might show up on scans (quite possible) and it's possible that you could start medication and stuff to prevent further strokes... but, it's also possible it wouldn't show up at all and that not a lot could be done... and, anyway, from what you are describing, the likely hood of it being anything other than a migraine is so small... because, you are describing what so many of us see on a regular basis!! ;) I know it's scary!! But... it's really nothing to be afraid of!  

Hmm... sarcastic laughing doctors... trust me, we're all familiar with that on here as well too. Don't know why there are so many doctors out there with such terrible bed-side manners!! When something scary happens to us... we are scared.... and, we don't have medical degrees. We are going to ask questions. It's natural. And, we're not going to understand what's happening to us. It's up to the doctors to EXPLAIN what is happening to us and answer our questions so that we UNDERSTAND... because scary events are some-what traumatizing!! But, a lot of doctors skip the explaining part, just tell us we're fine, and shoo us out of their offices... leaving us feeling just as confused and afraid as when we first walked in.

So, your ophthalmologist was probably right, it probably has nothing to do with optic neuritis. He should have explained why. But... if you are still concerned, it would not hurt for you too get a second opinion... not being you might have optic neuritis, but just so you can understand WHY that's not the case. Although, if you live in America where you have to pay for doctor's visits or some other country like that... then I'd suggest instead visiting a neurologist, as they will help you understand the migraines, and understanding the migraines will probably help you the most right now.

[marileew]

4. Are there any medications that are recommended that provide immediately relief for this stuff?  Is there anything I can do that will act as preventative?  I've tried to avoid "triggers", but the only "triggers" I can deduce are morning (which I can't avoid) and working on the computer (which I also can't avoid... it's a big part of my job).

Yes. Triptans. Triptans are migraine medication. You take a triptan as soon as you feel the migraine coming on... that means the first weird visual thing you see, or, if you happen to feel something else prior to each individual attack that you don't feel other times. The triptans will stop the headache and will likely also shorten or stop the visual symptoms as well.

There are things you can try to do with regards to your computer that might help... such as turning down the brightness... taking short breaks... looking around the room every few minutes.... closing your eyes every few minutes... etc. just gives your eyes a break every few minutes. That might help. Wearing sunglasses. Make sure your computer screen is at the right level so you are looking directly at it. Make sure the screen is not too close or too far away so that you are stressing your eyes at all. Try a few things and see if any of those help.

The mornings... bright lights are a common migraine trigger. I find that quickly opening the blinds in the morning triggers my migraines... or turning on my light in the morning. Instead, I let my eyes adjust to the "natural" light in the dark room first and then I get up and walk in the kitchen, where it is much brighter, but without turning the lights on, until my eyes adjust to that... and then, once my eyes have adjusted, then I slowly bring up the lights in the house.... and I ALWAYS wear sunglasses during the day, no matter what season it is.

Also... morning... make me think of caffiene withdrawal too. Do you drink coffee in the morning? Caffeine is a strong trigger for many people. Could be related to caffiene consumption. Either your morning cup of coffee is triggering your headache... or not getting your morning cup soon enough... both can trigger migraines (and migraine does not have to include "pain" remember... just the visual symptoms count!!!)

Also, what do you eat for breakfast that is different than during the day? Do you eat breakfast? Blood sugar levels are very connected to migraines. You might want to try drinking a cup of juice or something before going to bed (remember to brush your teeth after!!) so that your blood sugar levels aren't so low first thing in the morning. And always remember to eat breakfast. Even if it's just one of those breakfast bars or a smoothie or something.

Well... hope that helps!! :)

[benjamin916]

Hi Marileew,

Thank you for your reply.  It's good to know that these things don't seem strange to people.  The first time I experienced an ocular migraine, I actually thought I was going blind - so I rushed immediately to an Optometrist, who couldn't find anything wrong with the migraine eye, but found a retinal hole in the periphery of the other eye (I hadn't been to an eye doctor in probably 10 - 15 years at that point...).  The Optometrist referred me to an Opthamologist (retinal specialist) who then sutured the retinal hole, but didn't find anything wrong with the eye I came to the doctor about in the first place... c'est la vie.


It's interesting that you mention caffein being a trigger.  I drink two cups of coffee most days, and it just so happens that yesterday I delayed my cup of coffee to shoot off an e-mail in the early morning.  I wasn't sure if this could be a trigger, but I suppose delaying my "morning routine" could have an effect on these migraines - I will try to keep things consistant from here on out.


Thanks so much for your input.
Ben

[fivestudent]

I have read a million posts here but never anything that comes close to what I experience. It's frustrating. I've had migraines all my life and know all about triggers and have my own system down pretty well. I take imitrex and methocarmomol and zanaflex and sometimes tramadol. My migraines became transformed in 2004 and they've been daily ever since. Now I get three to five a day. The latest thing is I've developed white round scotoma in both eyes.  I also see halos and long streaming lights that come out of the tv. This is not an ocular migraine. This is permanent. I have an appt. to see a neuro-opthamologist at Stanford in April. The regular opthamologist said the eye itself was fine and that the problem was either vascular, neurologic, or toxic. I also have been diagnosed with fibromyalgia. I deal with a lot of pain. And I have interstitial cystitis. I thought maybe MS but the MRI and lumbar puncture were clean. I'm supposed to have an upper spine MRI and maybe that will tell us something. Having three migraines a day is so much. I wonder what the eye doctor will say. Also, my eyes have been blurry and I had a few days of vertigo.