Optical Migraines: The Temporary Prism-Like Vision Change
Optical migraines are a temporary change in the field of vision that, although painless, is concerning. During an optical migraine one might describe zig-zag lines and blurring in one or both eyes. I have also heard it described as similar to a kaleidoscope, or a sensation of seeing a ceiling fan in the peripheral vision. Some might describe shimmering lights in the visual field. These temporary changes are worrisome, but usually harmless, and go away within 30 minutes of onset.
Causes of optical migraines are not fully understood. It is found that 70 percent of people with optical migraines have a family history of classic migraines that including a severe throbbing headache that often includes sensitivity to lights, sounds, or smells accompanied by nausea. There are possible causes that lead to optical migraines, which include: a change in caffeine intake, certain foods (aged cheese, red wine, chocolate, and foods with MSG as an ingredient) or eye strain.
Treatments are generally not needed since this resolves within 30 minutes. If you are driving or doing something that requires keen vision, you may want to stop and allow this to pass. If the symptom is due to lack of your usual caffeine, you might treat this with a small amount of caffeine and take acetaminophen (Tylenol) or ibuprofen (Advil).
Those who suffer from classic migraines might have a visual disturbance just before having the throbbing and pain that comes with a migraine. In this case, we would refer to the visual change as the aura, known as a pattern or signal that the migraine is about to occur. While this is different from painless optical migraines, classic migraines that are frequent or progressing in severity should be evaluated by your primary care physician or nurse practitioner so that proper treatment and prevention measures can be started.
What about a loss of vision? If a visual loss or black spot occurs in the field of vision, or even temporary loss of vision occurs, it is highly advised that you seek an evaluation by an ophthalmologist. This is to evaluate for potential serious eye disease, including retinal damage, retinal detachment or changes. Time is of essence in this case due to the risk of permanent vision loss if this is not treated in a timely fashion. If there is a visual change that is accompanied by any weakness, difficulty speaking, feeling faint or seizure, one should seek emergent care in the ER (not urgent care) so that they can be evaluated for signs of a stroke or other abnormal neurological problems.