Last week I experienced an ocular migraine for the first time.  I didn’t really know what was going on until about halfway through the ordeal, and I thought it would be interesting to share my story.  Part of being an eye doctor is listening to my patients and learning their medical history.  There are so many things you can learn from a patient’s welcome form, or by just having a conversation with them.

This simulation shows what Dr. Abert’s ocular migraine looked like to him.

If someone says they have blurred vision, for example, that really doesn’t mean much to me.  I would treat blurred near vision in a 40-year old differently than a patient that has uncontrolled diabetes and blurred vision associated with high sugar-intake.  Likewise, it is important to learn the details of a patient’s symptoms.  Lots of people say that get headaches.  Many people also get what is called an ophthalmic, ocular, or optic migraine.  These headaches often present with an “aura” or visual component.  The aura has been variously described to me as a “zig-zag” shape hovering in mid-visual field, blurred peripheral vision, blurred central vision, or perception of shapes or movement.  These symptoms typically last less than an hour or so and are frequently followed by particularly nasty headaches.  Some people get just the visual component (the aura), some people get the headache and aura, and some people just get the headaches.  I’ve had some intermittent headaches throughout my life, though nothing I would ever describe as a full-blown migraine.

My migrainous aura started like many patients’ descriptions to me.  I was working at my computer around 8:00 PM or so (ironically writing an article for our practice website!) when I noticed that my central vision was distorted.  The effect seemed exactly like when you stare at a bright light and then see central blur when you try to look at a detailed object immediately afterwards.  It was hard for me to read, though I figured I had just been staring at the screen for too long.  I took a break from the screen and took off my computer glasses.  The central defect in my visual field only seemed to grow.

I went downstairs, thinking that maybe my eyes just needed a break from using the computer.  I did some dishes and began to notice that someone had left the ceiling fan on in the kitchen.  Interesting thing is that there is no ceiling fan in my kitchen!  I perceived a sort of motion blur in the upper left corner of my field of vision, and when closed my eyes I perceived a jagged line of motion across my central vision.  At this point I recognized the cause of my little visual adventure.  The strange shapes, perceived motion, and central vision defect were visible in both my right and left eye individually.  Some symptoms of a retinal detachment or an acute retinal hole can cause strange visual perceptions, though the odds of my having a retinal problem at exactly the same time in both eyes was pretty much nonexistent.  My visual field began to constrict and I acquired tunnel vision.  After about 30 minutes, I was completely back to normal, though I went to bed that night with a dull headache.

An ocular migraine is a misleading name because while the process does result in a strange visual perception, the migraine doesn’t actually occur in the eyes at all.  The source of all this is the occipital lobe, specifically the visual cortex, the part of the brain that processes the images acquired by the eyes.  The perception of shapes, movement, and visual field constriction are all essentially hallucinations brought on by a disturbance to the normal functioning of the occipital lobe.  Migraines can be brought on by food allergies, hereditary disorders, dehydration, or too much or too little caffeine in the diet (as compared to the caffeine intake that the patient is typically used to).  I suspect that my migraine was brought on by dehydration as I hadn’t had enough water to drink that day.  If headaches occur frequently, with or without a visual aura, it may be worth visiting one’s primary care physician to look into migraine treatment.  An ocular migraine should also be investigated by an eye doctor to rule out any problems with the retinas.  Fortunately for me, my wife is an eye doctor and she looked my eyes over and gave me a clean bill of health.

I have heard stories of optometrists who suffer from ocular problems and it is interesting to learn how they react to it.  A posterior vitreous detachment, a situation where the vitreous gel in the back of the eye separates from the retina causing potential visual disturbance, was once described in detail by an optometrist who was clearly freaked out by its occurrence.  Even though we eye doctors spend our whole days investigating eye and vision problems and comforting patients about their symptoms, things change when the tables turn.  I think it is useful to be in patients’ shoes every now and then to experience what they describe.  I know I will never look at ocular migraines the same way again after having experienced one for myself.