Medicines for Retinal migraine

What it is

Retinal migraine is an uncommon type of migraine that causes temporary changes to the vision in one eye, usually alongside or followed by a migraine headache. It is different from the more common visual "aura" of migraine (which affects the vision in both eyes and involves the brain’s processing of vision) — in retinal migraine, the visual symptoms affect just one eye. The visual symptoms of a retinal migraine are temporary and can include: partial or complete loss of vision in one eye; seeing flashing or flickering lights, patterns, or a blind spot in one eye; or dimming of the vision in one eye. These symptoms usually last a short time (often minutes, up to around an hour) and then fully resolve, and are typically followed by, or occur with, a headache, which may have the features of a migraine (such as being on one side, throbbing, with sensitivity to light or sound, or nausea). Between attacks, vision is normal. Retinal migraine is generally not dangerous in itself and the vision returns to normal. However — and this is very important — temporary loss of vision in one eye can also be caused by other, more serious conditions (such as a problem with the blood supply to the eye or a "mini-stroke"/TIA), so it is essential that new or unexplained episodes of vision loss in one eye are assessed by a doctor, rather than assumed to be retinal migraine, to rule out other causes. Once other causes have been excluded and the diagnosis is made, retinal migraine is managed similarly to other migraines — by identifying and avoiding triggers, and with treatments for migraine as needed. The key messages are that retinal migraine causes temporary, reversible vision changes in one eye with headache, that it is generally not dangerous itself, but that new episodes of vision loss in one eye must be checked to rule out more serious causes.

How it is treated

Retinal migraine is managed like other migraines once the diagnosis is confirmed, but the crucial first step is to have new or unexplained vision loss in one eye assessed to rule out other, more serious causes. Because temporary loss of vision in one eye can be a sign of serious conditions — such as a problem with the blood supply to the eye, or a transient ischaemic attack (TIA, or "mini-stroke") — anyone experiencing this for the first time, or with new or changing symptoms, should be assessed by a doctor (and sudden loss of vision, or symptoms suggesting a stroke or TIA, need urgent assessment); this ensures serious causes are not missed. Assessment may include an eye examination and, depending on the situation, checks of the general and vascular health. Once other causes have been excluded and retinal migraine is diagnosed, management follows the principles of migraine care: identifying and avoiding or managing triggers (which can include stress, tiredness, certain foods, dehydration, and others); general measures that support migraine management (such as regular sleep, meals, hydration, and managing stress); and, for the headaches, treatments as for migraine — pain relief taken early in an attack, and, for frequent or troublesome attacks, considering preventive treatment, guided by a doctor. Because retinal migraine involves the eye’s blood supply, and because of the small association of migraine (particularly with aura) with vascular risk, managing general cardiovascular health and risk factors is sensible, and advice may be given about certain medicines (such as some forms of hormonal contraception) and lifestyle factors; a doctor can advise on an individual basis. It is important to seek assessment for any change in the pattern of symptoms, or new or different symptoms, and urgent help for sudden persistent loss of vision or signs of a stroke. The reassuring messages are that retinal migraine causes temporary, fully reversible vision changes in one eye and is generally not dangerous in itself, but that — because vision loss in one eye can have serious causes — new episodes must always be checked, and that once diagnosed, it is managed like other migraines by addressing triggers and treating attacks.