One December day, as I sat in front of my computer, a sparkling, glittery object took over my sight. A large crescent moon with shimmering silver sequins appeared in my eyes for about 20 minutes. I put my head down in my arms because I couldn’t continue to work. And then, worried it was a retinal tear or detachment, I called my ophthalmologist.
Turns out, it wasn’t a torn retina, and I didn’t have to worry. I had experienced an ocular migraine — also called a visual migraine or an ophthalmic migraine — which creates the aura associated with a migraine but without the telltale headache.
I was surprised. Who knew you could get a migraine without a headache? And who knew the aura would look like sequins on a starlet’s dress?
Ocular migraines affect women more than men. One study estimates they affect 3% of women and 1% of men. And good news: They’re usually not a cause for concern; instead, they’re just a short-term, blingy inconvenience.
Symptoms and causes of ocular migraine
“The most common thing people see is sort of an arc in their vision that looks like a rainbow that’s shimmering,” says Kimberly Blankshain, MD, a neuro-ophthalmology fellow at UI Health. Sometimes people see unusual shapes or colors, zigzags, a kaleidoscopic pattern, or wavy lines that look like heat waves coming off a grill.
Typically, the visual disturbance lasts from 15 to 30 minutes. “The classic thing is that it is in both eyes, lasts for a few minutes to an hour, and then just sort of goes away as quickly,” Blankshain says.
While nobody knows for certain what causes ocular migraines, researchers suspect they involve a contraction or spasm in blood vessels in the brain’s vision center, or occipital lobe. “The blood vessels can spasm a little bit. It temporarily alters blood flow to different parts of the brain and causes symptoms, but we don’t totally understand why or how it happens,” Blankshain says.
Potential triggers are the same as for migraine headaches: chocolate, red wine, aged cheese, caffeine, hormone changes, stress, dehydration, and irregular sleep, among others.
There’s no need for treatment, unless a migraine headache accompanies the visual symptoms. Just take a time-out, avoid triggers, and rest your eyes until the symptoms go away. For migraine headaches, some medications and lifestyle changes can help.
Ocular migraines can happen at any time, but anecdotally, they often happen after the holidays, when many people have changes in routine, says Michelle Andreoli, MD, an ophthalmologist at the Northwestern Medicine Department of Ophthalmology and spokesperson for the American Academy of Ophthalmology.
“Interestingly, the time that we hear this the most is in January,” Andreoli says. “In January, I probably see several people a day [with ocular migraine]. It’s often holiday-related; people have gotten a couple of bottles of red wine for the holiday, or people got some funny peppermint bark from an auntie that had too much dark chocolate in it.”
In addition to food and drink, sensory triggers can also set off an ocular migraine. A strong smell, loud noise, or bright light — like looking into a sunset — may trigger an ocular migraine in some people.
“They are much more common in people with a history of migraine headache themselves, a history of motion sickness especially as a child, and a family history of headache,” says Joseph Garber, MD, an ophthalmologist at Eye Physicians & Surgeons of Chicago and assistant professor at Rush University Medical Center. Migraines and motion sickness both involve abnormal activity in reflexes in the brainstem, which processes input from the senses.
“While [ocular migraines] can be unsettling and disturbing, usually they result in no significant issues. They go away, and your eyes are fine,” Garber says. “The good thing is it’s very rarely, if ever, associated with anything serious.”
When to call the ophthalmologist
If you experience a visual disturbance, call an ophthalmologist, who can rule out other more dangerous conditions, such as a torn retina or a transient ischemic attack, also called a ministroke. With those conditions, you’ll typically see flashing in only one eye, not both — for instance, when you close your left eye, symptoms persist, but when you close your right eye, the flashing goes away. Retinal tears may also be accompanied by an increase in floaters in your vision.
“With a retinal event, what you’ll see is a little lightning bolt off on the side of the vision, and then it’s gone. And then a minute later, you get another one, and then it’s gone. And a few minutes later, you’ll get a couple more, and then they’re gone. They are far more erratic,” says Andreoli, who recommends checking the American Academy of Ophthalmology’s eye health web page for more information on eye conditions.
If the visual disturbance lasts for only a few seconds and then disappears, or if disturbances persist for more than an hour, let your doctor know. Also, notify your doctor right away if you have a blockage of vision, a sudden increase in floaters in your eye, or any other abnormal symptoms.
If you’re driving when you get an aura, pull over and wait for it to pass, Andreoli says. You don’t want the image to block your vision while you’re driving.
“The event itself is harmless, and it will pass,” she says. “The time that you worry is if people are driving or if they have an abrupt change in pattern; for example, if somebody’s never had these before in their life, and then they get a bunch of them. Anything that seems new to a patient is cause for concern.”
If you are having symptoms, don’t hesitate to see an ophthalmologist, says Garber, who often runs a visual field test to screen for other problems.
“On the off chance that something strange is there, we can pick that up earlier rather than later. We would much rather see people with this and say, ‘You know what, your eyes look fine, there’s nothing to worry about,’” he says.
I’m glad I went to the ophthalmologist to have my eyes checked, even if I felt sheepish when he told me it was nothing to worry about. I haven’t experienced another ocular migraine, though chances are that I will sometime in the future.
But now I know that if I see a glittery crescent moon, sparkling like a diva, I can sit back and enjoy the show, knowing it will harmlessly fade away.