The Link Between Ocular Migraines and Strokes

An ocular migraine is a headache accompanied by a visual disturbance or loss that typically lasts less than an hour. These headaches usually stem from a reduction in blood flow or from blood vessel spasms in or behind the retina of the eye.

A stroke occurs when blood flow to the brain stops due to a clot or bleeding. There are two types of strokes: an ischemic stroke (caused by a clot) that prevents blood from circulating in the brain, or a hemorrhagic stroke (caused by a blood vessel bleed) that puts pressure on the surrounding brain tissue.

This article explains the connection between ocular migraines and strokes, the signs and symptoms of each, and how to minimize risk.

Ocular Migraine Symptoms

There are two types of ocular migraines: a retinal migraine and a migraine with aura.

One of the main differences is that retinal migraines usually only affect one eye, while migraines with aura affect both eyes. The eye disturbance and vision loss symptoms typically occur within an hour of headache onset or during the headache.

Symptoms of migraine with aura may include:

• Flashes of light
• Blind spots
• Tingling in the hand or face
• Foggy vision
• Straight lines appearing curved or zigzag
• A partial loss of vision, or scotoma
• Small bright dots or the appearance of looking through heat waves or water

Some people who experience migraine with aura may also experience motor skill issues, speech difficulties, or other sensory difficulties.

Symptoms of retinal migraine can be more intrusive and may include:

• Decreased vision loss or disturbance in one eye
• Seeing what look like twinkling lights
• Temporary blindness

It can be hard to distinguish the cause or type of ocular migraine, so it's essential to talk to your healthcare provider if you are experiencing symptoms. In some cases, retinal migraine can lead to irreversible vision loss.

Stroke Symptoms

Stroke symptoms can come on suddenly and may include:

• Numbness or weakness in the face or limbs (especially on one side)
• Confusion and difficulty speaking
• Trouble seeing in one or both eyes
• Difficulty walking, lack of coordination, or balance issues
• Sudden severe headache without a known cause

How Are They Linked?

Some ocular migraine symptoms, such as vision loss or disturbance in one or both eyes, can be the same or very similar to stroke symptoms. Also, some who suffer from migraine with aura symptoms may have stroke-like symptoms, such as motor skill issues, speech difficulties, or other sensory difficulties.

A migraine with aura can also resemble a transient ischemic attack (TIA), also known as a ministroke. A stroke headache can also be similar to a migraine headache.

It's difficult to determine the cause of many headache symptoms without diagnostic imaging. On diagnostic imaging, white matter changes have been found in some people with migraines that appear similar to stroke patients.

Migrainous Strokes

Migrainous strokes occur when a migraine with aura and an ischemic stroke occur at the same time. This type of stroke is rare, accounting for less than 1% of all strokes.

Increased Risk

Research shows a link between migraines with aura and an increased risk of ischemic stroke. The exact reason for the link is unknown, but some researchers theorize that contributing factors may include:

• Vascular, inflammatory, or endothelial structure of the brain
• Gender (migraines affect more women than men)
• Oral contraceptive pill use
• Smoking
• A genetic heart condition called a patent foramen ovale
• Vasoconstricting medications used to treat migraines
  

In 2016, the American Heart Association reported a 25-year ongoing study showing that migraine with aura patients are 2.4 times more likely to have an ischemic stroke than those who don't have migraines with aura. In addition, migraine with aura patients are 3 times more likely to have an ischemic stroke from a mass or clot that originates in the heart and travels to the brain.

Those who suffer from ocular migraines can control two factors that may lower their risk of stroke, which include quitting smoking and discontinuing oral contraceptive pill use.

If you smoke, talk to your healthcare provider about methods that can help you quit. If you take oral contraceptive pills and experience migraines, discuss alternative options with your healthcare provider.

Treatment

For occasional ocular migraines, treating with medications that target migraine symptoms is a common approach. These may include:

• Nonsteroidal anti-inflammatories (NSAIDs), such as aspirin or ibuprofen
• Antinausea medications

Preventative medication therapies are also helpful and may include:

• Calcium channel blockers
• Antiepileptic medication
• Tricyclic medications

Other non-medical therapies and preventative measures include:

• Resting the eyes
• Lying down in a dark room
• Reducing stress
• Staying away from harsh lighting
• Avoiding staring at a computer screen for long periods

Talk to your healthcare provider or an eye specialist about other ways you can avoid migraine triggers.

Summary

Ocular migraines include migraine with aura and retinal migraine, affecting both eyes or one eye, respectively. They can include eye disturbances and temporary vision loss. While there is a link between ocular migraines and stroke risk, research has shown that the risk is relatively small.

The risk is higher for smokers and those who take oral birth control pills. If you smoke or use oral contraception, talk to your healthcare provider about methods that can help you quit smoking and about other birth control options.

A Word From Verywell 

Migraines can be painful and debilitating, affecting a person's daily life. Fortunately, with symptom management and rest, most ocular migraines are temporary. If you experience ocular migraines and are concerned about your risk of having a stroke, see your healthcare provider to talk about strategies and healthy lifestyle changes that may decrease your overall risk.