Migraine Aura

Migraine aura is part of the total headache phase but occurs in only about 15% of people with migraines.

Auras are typically physical changes in the senses that herald a migraine.

Most people are familiar with visual auras. People will have changes to their vision that ranges from blurry vision and distorted vision all the way to full blindness. Sparkling lights, dancing dots and zig zags are common. Migraine aura also appears in a wide variety of colors.

Most visual auras last from 5-20 minutes and then the headache always follows. Now why did I say this?

Simple: A migraine aura that lasts over one hour or a span between the aura and a headache of 24 hrs or more may be an emergency headache.

Other types of auras exist. Many of my patients tell me of a buzzing sound in their ears just before a headache.

Auras are thought to be electrical events in the brain, not unlike similar phases seen in seizures. Now if you really want to get fancy, the official term is 'a wave of spreading cortical depression'.

Not the emotional depression, but a slowing or depression of nerve cells in the cortex or outer part of the brain. When this wave hits the back of the brain, or occiput, visual symptoms result.

Ocular Migraine

So what is the difference between an aura and ocular migraine?

As mentioned above, auras are electrical events. Ocular migraine is the result of narrowing of the artery behind the eye..the retinal artery.

Ocular migraine also occurs only in one eye and the headache may or may not follow. Confusing isn't it?

Well, if this is a new symptom for you, it is best if you contact your doctor to discuss this as other conditions, such as a clot in the artery can cause the same symptoms.

TREATMENT: As auras are part of a migraine phase, the migraine as a whole is treated with various medications. Ocular migraine, however, may respond to a low dose of a beta blocker such as Inderal(propranolol) or Norvasc (atenolol). Inderal cannot be taken if you have asthma, so the second medication might be a better option.

Unlike "regular" migraines, ocular migraine should NOT be treated with a triptan like Imitrex. This could cause more constriction of the retinal artery and generally create more problems that it is worth!

Ocular Migraine in History

Many people in history have suffered from migraines, but one of the most famous was Lewis Carroll, the author of Alice in Wonderland. The story was based on some of the stories his niece, Alice would tell him.

Apparently, Alice also had migraine and would describe things 'getting large and getting small'. This form of ocular migraine has been described in children.

As seen in the picture to the left, these 'visions' that young Alice was having would be consistent with visual distortions in ocular migraine.

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