What are the other Names for this Condition? (Also known as/Synonyms)

• RM (Retinal Migraine)

What is Retinal Migraine? (Definition/Background Information)

• According to the International Classification of Headache Disorders, Retinal Migraine (RM) is described as repeated episodes of visual disturbances in one eye characterized by flashing lights (scintillations), areas of blind spots (scotoma), and temporary loss of vision, along-with migraine headaches
• Retinal Migraines are typically eye conditions that involve “only” a single eye. The condition is often confused for migraine headaches (especially migraine with typical aura) affecting the eye and vision; in which case, it has to be noted that both the eyes are generally involved
• A clear difference between the two conditions ‘migraine with typical aura’ and ‘Retinal Migraine’ has to be established, since it has a significant bearing on diagnosis, treatment, and prognostic factors
• This may be achieved by assessing if the visual symptoms are observed in both eyes (binocular) or, are confined to a single eye (monocular), by asking the affected individual to check their sight through each eye separately (keeping one eye closed each time)
• Retinal Migraines are known to develop when blood vessels of the eye get narrowed and supply insufficient quantity of blood to the eye, resulting in temporary vision abnormalities and vision loss. The same eye is affected during each attack of a Retinal Migraine
• Even though there are no specific treatment protocols for Retinal Migraines, the condition responds to symptomatic therapy. In most cases, the prognosis is good, since it is a transient eye condition and no permanent vision loss is usually noted

Who gets Retinal Migraine? (Age and Sex Distribution)

• Retinal Migraines are rare and may be seen in individuals of all ages; the condition is mostly observed in adults below the age of 40 years
• Women are more commonly affected than men
• The condition is seen worldwide and no preference for any race or ethnicity is seen

What are the Risk Factors for Retinal Migraine? (Predisposing Factors)

The risk factors associated with Retinal Migraine include:

• Young and middle-aged women
• Personal history of migraine headaches
• Family history of migraine headaches

Individuals with the following conditions have a higher risk for Retinal Migraine:

• Antiphospholipid syndrome (APS)
• Epilepsy
• Giant cell arteritis (GCA)
• Hardening of the arteries
• Sickle cell disease
• Systemic lupus erythematosus (SLE)

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases one’s chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Retinal Migraine? (Etiology)

Retinal Migraines are the result of reduced blood supply to the eye caused by constricted blood vessels. It is mostly a temporary condition; once the blood supply is restored, the condition resolves and vision return to normal.

There are certain factors that can trigger Retinal Migraines, and these include:

• Physical and mental stress; exercise exertion
• Use of birth-control pills
• Hypertension or high blood pressure
• Smoking tobacco
• High altitude
• Hypoglycemia or low blood sugar levels
• Very hot weather conditions
• Dehydration

What are the Signs and Symptoms of Retinal Migraine?

The signs and symptoms of a Retinal Migraine differ from one individual to another, but may include:

• Temporary vision loss involving one eye that may be partial or complete; it is characterized by:
  • Flashes in the eye (scintillation)
  • Dark or blind spots in the field of vision (scotoma) that increase in severity
• This may last for a period of 10-20 minutes or, even up to an hour before vision is restored
• The vision may also be blurry or dim
• Retinal Migraine episodes involve the same eye each time
• Headaches may precede or succeed the vision loss; it may also occur during the loss of sight

How is Retinal Migraine Diagnosed?

It is important to exclude conditions, such as a brain stroke, tumor in the brain, thrombosis, or other eye conditions causing temporary monocular blindness, prior to establishing a diagnosis of Retinal Migraine.

The diagnosis of Retinal Migraine may include the following tests and exams:

• Complete eye and physical examination including assessment of the presenting signs and symptoms; it is important to establish if only one eye, or both the eyes are involved
• Thorough analysis of personal and family medical history (including history of migraine headaches)
• Fundal examination by an eye specialist (retina specialist)
• Ocular coherence tomography (OCT) - an imaging technique that helps visualize the eye structure, if required
• Neurological examination by a qualified healthcare provider, if necessary
• Laboratory tests may be performed to rule out other causes of vision impairment
• Computerized tomography (CT) scan of the head
• Magnetic resonance imaging (MRI) scan of the brain
• Differential diagnosis to rule out conditions presenting similar signs and symptoms, such as hemianopia, amaurosis fugax, and scintillating scotoma, is very important

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Retinal Migraine?

Retinal Migraine may lead to complications such as:

• Emotional and mental stress
• Recurrent migraines affecting the same eye resulting (rarely) in permanent injury
• Poor performance at school or at work
• Risk for accidents while driving or operating machinery
• Complications from an underlying condition, if any
• Side effects of medication

How is Retinal Migraine Treated?

The following medications and measures may be used in the treatment of Retinal Migraine:

• Non-steroidal anti-inflammatory drugs (NSAIDs)
• Antiemetic medication
• Administration of blood pressure medication
• Pain medication for mild to moderate cases, such as acetaminophen, aspirin, etc.
• Use of antidepressants, anti-seizure drugs, beta blockers, calcium channel blockers, etc.
• Controlling the trigger factors

Certain home care treatments may include:

• Muscle relaxation exercises including meditation, yoga, listening to music, and gardening
• Getting adequate sleep; while sleeping, resting in a dark quiet room

How can Retinal Migraine be Prevented?

The prevention of Retinal Migraine largely depends on bringing about some lifestyle changes that may include:

• Avoidance of triggers
• Reducing the effects of estrogen (for some women); avoiding oral contraceptives for a period of time
• Having a stress-free routine with regular sleeping habits
• Regular exercise
• Stoppage of smoking
• Have plenty of fluids; avoid excessively hot conditions
• Taking adequate care of any eye abnormality or disease promptly is very important

What is the Prognosis of Retinal Migraine? (Outcomes/Resolutions)

The long-term outlook of Retinal Migraine varies from one individual to another. Nevertheless, the condition is transient and no irreversible damage to the eye is observed in a vast majority of cases.

Additional and Relevant Useful Information for Retinal Migraine:

The following DoveMed website link is a useful resource for additional information:

https://www.dovemed.com/health-topics/neurological-institute/