Retinal migraine

Definition
Retinal migraine, also called ocular migraine or monocular migraine, is a rare subtype of migraine characterized by repeated attacks of fully reversible visual disturbances affecting one eye (monocular), sometimes followed by headache. It is distinct from migraine with aura, which typically affects both eyes (binocular visual field).

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Causes & Pathophysiology

• Exact mechanism not fully understood

• Believed to involve transient vasospasm or reduced blood flow in the retinal or ophthalmic arteries

• Associated with cortical spreading depression in the visual pathway

• Often occurs in people with a history of migraine

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Risk Factors

• Personal or family history of migraine

• Women of childbearing age

• Stress, fatigue

• Hormonal changes (e.g., menstrual cycle)

• Certain foods (e.g., chocolate, aged cheese, red wine)

• Smoking and oral contraceptive use may increase risk

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Clinical Features

Visual Symptoms (Monocular, reversible)

• Flickering lights (photopsia)

• Scintillations (sparkling spots)

• Scotoma (partial visual loss)

• Complete monocular vision loss (rare, temporary)

• Duration: Usually 5–60 minutes

Headache

• May follow within 60 minutes of visual symptoms

• Typically migraine-like (throbbing, unilateral, worsens with activity)

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Diagnosis

• Based on clinical history and exclusion of other causes of transient monocular vision loss

• Key step: Differentiate from transient ischaemic attack (TIA), amaurosis fugax, retinal detachment, or optic neuritis

• Eye examination: Often normal between attacks

• Neuroimaging and vascular studies if atypical presentation or risk factors for vascular disease

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Treatment

Acute Attack

• Symptoms often resolve spontaneously; no specific acute treatment for vision loss

• Standard migraine pain relief if headache occurs:

  • NSAIDs: e.g., ibuprofen 400–600 mg orally

  • Triptans (if no cardiovascular contraindications): e.g., sumatriptan 50–100 mg orally at onset

Prevention (for frequent attacks)

• Lifestyle modification: Identify and avoid triggers, regular sleep, hydration, stress reduction

• Migraine prophylactic drugs (same as for other migraines):

  • Beta-blockers: propranolol 40–160 mg/day

  • Calcium channel blockers: verapamil 120–240 mg/day

  • Anticonvulsants: topiramate 50–100 mg/day

  • Tricyclic antidepressants: amitriptyline 10–50 mg at night

• Avoid vasoconstrictor drugs in those with significant vascular risk

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Complications

• Rarely, repeated attacks can lead to permanent visual field defects or retinal artery occlusion

• Misdiagnosis may delay treatment of serious conditions like TIA

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Quick-Reference Clinical Chart — Retinal Migraine

Feature	Details
Definition	Migraine with repeated, reversible monocular visual disturbances
Visual Symptoms	Flickering lights, scotoma, temporary vision loss in one eye
Duration	5–60 minutes
Headache	Migraine-like, may follow visual disturbance
Triggers	Stress, hormones, certain foods, smoking
Diagnosis	Clinical; exclude TIA, amaurosis fugax, retinal detachment
Acute Treatment	NSAIDs, triptans for headache
Prevention	Avoid triggers, beta-blockers, calcium channel blockers, anticonvulsants
Prognosis	Usually good; rare permanent vision loss