For most people, the concept of “migraine” is associated with an excruciating headache. However, few people know that some forms of this disease can be accompanied by visual disturbances. This type of pathology is called ophthalmic migraine or ciliary scotoma. Neurologists do not distinguish it as a separate disease. This is only a form of ordinary migraine, which occurs not only with a headache, but also with visual impairment. Stains (scotomas) appear in front of the eyes, covering the field of view, bright flashes, and glowing figures. Next, we will consider in detail the causes and treatment of ophthalmic migraine.
The mechanism of the development of the disease
In the occipital part of the brain is a visual analyzer. He is responsible for the correct perception by the eye of the surrounding world. Under the influence of various adverse factors, a temporary circulatory disorder in the analyzer area can pass. This leads to a distortion of the visual picture. Such disorders cause an attack of ophthalmic migraine.
Most often, patients associate the appearance of spots in front of the eyes with vision problems. But in this the cause of the pathology lies solely in neurological problems. No ophthalmic pathologies are detected.
Provocative factors
What can cause circulatory disorders in the visual part of the brain? The following causes of ophthalmic migraine can be distinguished:
- bad sleep;
- overwork;
- oxygen deficiency;
- hormonal disorders;
- vascular pathologies of the brain;
- alcohol and smoking;
- excessive physical activity;
- stress
- frequent climate change;
- taking certain medications;
- abuse of coffee and chocolate;
- flickering lighting and strong odors in the room.
Among doctors, there is an opinion that this pathology occurs due to a hereditary predisposition. However, official science does not confirm this.
Risk group
The ophthalmic form of migraine occurs much more often in women than in men. Pathology is most often noted at a young age - from 20 to 40 years. Elderly people rarely suffer from this condition.
This form of migraine is often seen in teenage girls. This is due to the fact that during the puberty, hormonal changes occur in the body that can provoke neurological disorders.
Attacks of ocular migraine often occur in pregnant women. This is also associated with hormonal changes in the body.
Forms of the disease
Let us consider how an attack of ordinary classic migraine proceeds, proceeding mainly with a headache. In its development, several stages can be distinguished:
- Prodromal period. There is a special condition preceding the attack.
- Headache. This is the main stage of the attack, accompanied by a painful pain syndrome.
- Recovery period. The pain gradually disappears, and the person feels well.
In some patients, visual disturbances occur before a headache. Otherwise they are called auras. In this case, doctors talk about ophthalmic migraine.
The visual aura can proceed with various manifestations. In this regard, several forms of ocular migraine are distinguished:
- retinal;
- ophthalmoplegic;
- basilar.
Next, we will consider in detail the symptoms and treatment of ophthalmic migraine, depending on the form of the disease.
Symptomatology
An attack of ocular migraine develops in several stages. Each period has its own special manifestations.
During an attack of ophthalmic migraine with auras, the following symptoms are noted:
- Prodromal period. A person feels severe tiredness and drowsiness, often yawns. There is a thirst and need for sweet food. The tension in the muscles of the neck is felt. A person is annoyed by bright lights and sounds. This period lasts from 1 hour to a day.
- Visual aura. Flickering bright flashes and spots appear before the eyes. Separate sections fall out of sight, up to the development of temporary blindness. A person perceives objects in a distorted form. Visual disturbances always occur in two eyes. At the same time, a person's hands go numb and speech becomes slurred. The visual aura lasts from 5 minutes to 1 hour.
- Headache. This period can last up to 24 hours. A person experiences excruciating pain in one half of the head. Reception of analgesics does not stop discomfort. The pain intensifies from bright light, sounds, pungent odors, often accompanied by nausea and vomiting. There is severe fatigue and drowsiness, but the headache does not let you fall asleep.
- The final stage. Headache gradually subsides. The person feels exhausted and quickly falls asleep. There is relief. The recovery period can last from several hours to several days.
Consider the features of the visual aura in various forms of ocular migraine.
A symptom of ophthalmic migraine in retinal form is the appearance of a flickering spot (scotoma) in the field of vision. Sometimes in its center zigzag lines are noticeable. It can be color or colorless and have different shapes and sizes. Because of this, certain areas fall out of sight. The aura lasts about 15 to 20 minutes. In this case, there is a violation of the blood supply to the retina, which is reversible.
If the attack happened in the dark, then luminous points and figures appear in the field of view. They are called phosphenes. Headache occurs mainly in the forehead and orbits. After the attack, the vision and blood supply to the retina are fully restored.
The ophthalmoplegic form of ocular migraine is otherwise referred to as Moebius disease. During the aura, not only the appearance of spots in the field of vision is noted, but also the omission of the upper eyelid, double vision, squint. The pupils are very dilated, regardless of the illumination in the room. There is paralysis of the eye muscles. This form of the disease is more common in children.
The basilar form is noted mainly in adolescent girls. During the aura, flashes appear before the eyes and serious visual distortions. Large objects are perceived by patients as small. Short-term visual hallucinations are possible. It seems to patients that the surrounding objects change shape and color.
In pregnant
As already mentioned, pregnant women are very susceptible to attacks of ocular migraine. Atrial scotoma is usually observed in the first trimester. This is due to the fact that in the early stages of pregnancy there is a rapid restructuring of the body.
In most cases, after the third month of pregnancy, manifestations of all the symptoms of ophthalmic migraine go away on their own. In rare cases, such manifestations persist at later dates. The complexity of the treatment lies in the fact that during this period, most medicines are contraindicated for women. If ocular migraine is easy and practically does not bother the patient, then treatment is not prescribed. In severe cases, the doctor selects the most sparing drugs.
Complications
How dangerous is eye migraine? In a neglected form, this disease can lead to unpleasant consequences:
- Attacks can become chronic and last for several weeks.
- The quality of peripheral vision may be significantly reduced.
- A long attack of ophthalmic migraine can cause loss of consciousness or epilepsy.
- Eyes may become overly sensitive to bright light.
- The most dangerous complications of the disease are stroke and vascular aneurysm. Such consequences occur with severe circulatory disorders in the brain.
We can conclude that this disease is far from harmless. If the seizures are repeated more than once, then you should seek medical help. Doctors diagnose this disease if a person has had at least five episodes of head migraine.
Help with an attack
How to help yourself during an attack of ophthalmic migraine? The following measures will help ease the condition:
- If the light is on in the room, then it must be turned off. Sound stimuli also need to be eliminated.
- You need to lie down, relax and stay alone for a while. If possible, then we must try to sleep.
- It is helpful to massage your head and collar area. However, such a procedure should only be trusted by a specialist. Inadequate massage can aggravate the condition.
- You can rub whiskey with peppermint oil or Zvezdochka balm.
- It is good to drink black tea with sugar.
In the first 2 hours of an attack, the following drugs can help:
- Validol or Nitroglycerin. You need to put one tablet under the tongue. This will help expand the blood vessels and normalize blood circulation.
- Amyl nitrite. 3-4 drops of the drug are applied to the cotton wool and sniffed for about 20 minutes. This tool also gives a vasodilating effect.
- Risatriptan or Relpax. These are special medications designed to relieve severe migraine attacks.
- Ibuprofen or Paracetamol. Painkillers help with mild migraine attacks. With severe pain, they are ineffective.
After the end of the attack, it is useful to take a bath with pine needles or essential oils.
Diagnostics
For the diagnosis of ophthalmic migraine, you need to contact a neurologist. An oculist consultation is also necessary to exclude the presence of ocular pathology.
Migraine must be differentiated from retinal diseases. For this purpose, the following examinations are prescribed:
- external examination of the eye;
- ophthalmoscopy;
- determination of visual fields;
- visual acuity research;
- fundus examination;
- assessment of the reaction of pupils to exposure to light.
If the patient does not have ophthalmic pathologies, then the neuropathologist prescribes an MRI or CT scan of the brain vessels. This helps to determine cerebrovascular disorders.
Treatment methods
Ophthalmic migraine treatment is aimed at preventing seizures. Therapy is prophylactic.
Prescribe drugs to improve cerebral circulation:
- Cavinton
- Stugeron.
- Nootropil.
- Phenibut
The nootropic drug "Phenibut" is especially indicated for migraines associated with stress. It not only normalizes cerebral circulation, but also has a mild sedative effect.
Other sedatives are recommended. With a mild form of the disease, phytopreparations based on valerian, motherwort, and hawthorn are prescribed. In more severe cases, antidepressants and antipsychotics are prescribed.
For vasodilatation, Papazol and Eufillin are prescribed. In case of eye fatigue, drops with vitamins are indicated for prophylactic purposes: Taurine, Riboflavin, Taufon.
Currently, physiotherapeutic methods for the treatment of ophthalmic migraine are widely used:
- Bernard currents on the neck and eyes;
- exposure to sinusoidal currents;
- electrophoresis with novocaine and papaverine;
- coniferous baths;
- mud applications on the collar zone.
Doctors recommend that patients reconsider their lifestyle. It is important to prevent sleep deprivation and overfatigue, to avoid excessive exertion, to stop smoking and alcohol.
Forecast
The prognosis of the disease is favorable. The disease is not dangerous for the life and work capacity of the patient. However, ocular migraine, which occurs with severe disorders of cerebral circulation, can lead to serious vascular complications. Therefore, patients should be regularly observed by a neurologist and ophthalmologist.
Prevention
To avoid attacks of ocular migraine, patients need to follow the following recommendations:
- Avoid overwork and get enough sleep.
- Lead an active lifestyle, more likely to be in the fresh air.
- Exclude wine, cheeses, tomatoes, chocolate, milk from the diet. These products contain the tyramine amino acid, which is contraindicated in migraines.
- Do not abuse drinks and caffeinated products.
- It is useful to keep a special diary where to record seizures and circumstances preceding their appearance. This will help to identify provoking factors and to avoid them in the future.
- It is recommended to periodically undergo physiotherapy: massage sessions, aromatherapy, balneotherapy.
- Avoid excessive emotional and physical stress.
Patients suffering from ocular migraine should be monitored by a neurologist and an ophthalmologist. It is also necessary to regularly undergo examination of cerebral vessels. This will help to avoid the progression of the disease and complications.