Head pain is the most recognizable symptom of a migraine attack, but there are numerous sensory changes that can affect a patient’s vision or eyes. In this post, we explore several types of visual disturbances that can occur before, during and after a migraine attack.
Visual Migraine Aura
It is estimated that as many as one-third of individuals with migraine also experience an aura with all or some of their attacks. Aura has been classified by many as its own “stage” within the migraine process, often following a period of other warning symptoms or disturbances known as the prodrome. In addition, it also represents a specific subtype of migraine with its own diagnostic criteria according to the International Classification of Headache Disorders (ICHD). Regardless, the aura typically manifests up to an hour before an attack, during which time it may last several minutes or only a few seconds; this is generally considered a sign of an impending migraine attack or that one has already begun. Aura can also continue into the headache phase and, in rare cases, may not even be accompanied by head pain or headache.
Although the aura phase can include other sensory disturbances such as nausea or touch sensitivity, it is predominantly described as being visual in nature. In fact, more than 90% of people diagnosed with migraine with aura have visual symptoms for some of their attacks.(1) Dr. Deborah Friedman of the Headache and Facial Pain Program for the University of Texas Southwestern Medical Center notes that visual aura represents a neurological issue, especially when it affects both eyes and regardless if the disturbance only occurs on one side of the visual field. Furthermore, the aura falls under three distinct categories:
Positive symptoms, which occur when a patient observes something in their sight that is not really there. Many have stated that that they see light flashes, spots, or zig zag lines, among other observed disruptions in their vision before a migraine attack sets in.
Negative symptoms, which are present when there is any loss of vision or blind spots as part of the aura phase.
Distorted vision symptoms, which can be identified when the visual field appears distorted in any number of ways. Patients may experience the sensation that they have “fractured vision” (such as looking through cracked glass) or change in color perception. Alice in Wonderland Syndrome—which is characterized by perceptual distortion of the size or shape of an object and is commonly experienced by children—is another of these symptoms.
These are a just a few of the vast number of reported visual symptoms as part of migraine with aura, and they vary from person to person as well as between attacks. And, as discussed previously, the majority of people do not even experience aura—visual or otherwise. It is important to seek proper diagnosis of any visual disturbances with a medical professional to ensure that they are not indicative of a more serious problem. Headache specialists can also be a great resource for diagnosing and treating migraine with aura as well as other migraine subtypes.
A specific type of migraine with aura with a visual component is retinal migraine. Retinal migraine has similar symptoms to typical aura, but they only affect one eye. Positive aura symptoms (flashing lights, zig zag patterns, etc.) as well as negative symptoms (partial blindness, blind spots) are reported with this type of migraine. Oftentimes, the ensuing head pain of an attack is concentrated on the same side as the visual disturbance(s).
Note: Many people—including medical professionals—often use the term ophthalmic, optical or ocular migraine to describe these symptoms that affect one eye; however, retinal migraine is the only subtype of migraine that is officially recognized by the ICHD.
Vertigo and dizziness
The perception of spinning or tilting of a person’s environment is a typical marker of vertigo or dizziness. In addition to being a neurological dysfunction of aura (specifically migraine with brainstem aura), it also can occur outside of the aura phase. This dizziness can persist anywhere from a few seconds in duration to days or even weeks, but it differs from aura in that is usually lasts more than an hour. Nausea and auditory symptoms also have a tendency to present themselves as part of this process.
This has been previously labeled “vestibular migraine,” although the ICHD considers vertigo an episodic syndrome associated with migraine attacks instead of a primary headache disorder. These disturbances are also estimated to impact a very small percentage of people, but researchers believe it may be underreported among many patients as well.
Brief blindness or loss of vision in both eyes is also commonly associated with the aura phase of migraine; however, in a small percentage of cases, it can be a symptom of migraine with no history of aura. A study of patients at the Geisinger Headache Center in Pennsylvania showed that this type of temporary blindness occurred instantaneously during the headache phase of a migraine attack. It also varied in frequency—some experienced it in over half of their attacks while others only dealt with it once. Duration also differed from patient to patient, showing that it could last for either a brief or prolonged period of time.(2)
Light Sensitivity and Photophobia
Those with migraine might develop a severe feeling of sensitivity to light before, during or after an attack, which is also referred to as photophobia. Conservative estimates suggest that 80 to 90% of migraine patients are affected by light sensitivity, making it among the most common symptoms of the headache disorder. It is also one of the distinguishing criteria for diagnosing migraine. In addition to the sensation of light-related pain, individual migraine attacks can be brought on by light exposure—either triggered due to brightness, exposure to certain types of light (e.g. fluorescent), or harsh patterns of light. Although symptoms of light sensitivity can appear similar to aura, the two phenomenons are distinct. For instance, light-specific visual aura may or may not manifest as pain or painful sensitivity. It also is frequently reported as an indicator of an oncoming attack; conversely, exposure to light can actually spark the migraine episode, and thus lead to an ensuing visual aura for those with that diagnosis. Furthermore, light sensitivity can impact people who have migraine without aura as well. We wrote up a more detailed explanation of migraine-related light sensitivity, which you can read here.
If you deal with light sensitivity and/or light-triggered migraine attacks, experts such as Dr. Kathleen Digre of John A. Moran Eye Center in Utah emphasize that you not avoid light. Retreating to a dark room during an attack is acceptable as a temporary option for relief, but you risk dark adapting your eyes if you shield them from all forms of light—such as by wearing sunglasses indoors—as a preventative measure. TheraSpecs precision-tinted glasses are one option to help alleviate painful photophobia without compounding this risk.
Often mistaken for migraine with aura or even some psychiatric disorders, visual snow (VS) is its own unique syndrome that shares similar pathophysiology to migraine aura and migraine-related photophobia. Although migraine is not the only trigger for episodes of VS, one study showed that nearly 90% of those who experience this phenomenon were also diagnosed with migraine (with or without aura)—suggesting a comorbidity with the headache disorder.(3)
Visual snow is frequently compared to the hissing black and white static you see on a television screen; however, numerous other vision-based symptoms may also appear, including after images, trailing floaters, disrupted night vision, and painful light sensitivity. And similar to migraine with aura, it will manifest in different ways for patients. There is still much to be learned on this subject, but additional anecdotal evidence has indicated that visual snow may even be aggravated by common migraine treatment medications such as triptans as well as non-medicinal prophylactics.
Though dry eyes are not necessarily a recognized symptom of migraine attacks, research has linked the two conditions. One study showed that people with migraine were three times more likely to present symptoms similar to dry eye, even though they were not clinically diagnosed with dry eye syndrome.(4) These symptoms might include stinging, burning, and general discomfort in the eyes, accompanied by redness and irritated eyelids. It may also result in blurry vision. Furthermore, dry eye has been shown to increase light sensitivity, which is tied to and can trigger migraine. Talk with your doctor or specialist if you believe your migraine may also be affected by dry eye symptoms as they might be able to recommend over-the-counter or prescription drops to help treat it.
What other visual symptoms exist with migraine? Answer in the comments below! And be sure to read more about options for treating light sensitivity by clicking the button below.
1 The International Classification of Headache Disorders. 1.2 Migraine with Aura. International Headache Society.
2 Rozen T. Migraine With Binocular Blindness. Headache. 2011;51(10):1529-1536.
3 Schankin CJ, Maniyar FH, Sprenger T, Chou DE, Eller M, Goadsby PJ.The relation between migraine, typical migraine aura and "visual snow". Headache. 2014 Jun;54(6):957-66. doi: 10.1111/head.12378. Epub 2014 May 9.
4 Kinard, K. I., Smith, A. G., Singleton, J. R., Lessard, M. K., Katz, B. J., Warner, J. E., Crum, A. V., Mifflin, M. D., Brennan, K. C. & Digre, K. B. (2015). Chronic Migraine Is Associated With Reduced Corneal Nerve Fiber Density and Symptoms of Dry Eye. Headache: The Journal of Head and Face Pain.
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