On the surface, a retinal migraine looks a lot like a migraine with aura. These two migraine types can cause similar symptoms, like flashing, shimmery “lights” in your vision. But these conditions aren’t the same, and knowing which one you have may determine what kind of treatment you need.
Henry Ford ophthalmologist Nitin Kumar, M.D., explains the difference between retinal migraine and migraine with aura and when to seek medical care.
Key Differences Between Retinal Migraine and Migraine With Aura
“All migraines, including retinal migraines, are neurological conditions, meaning they involve your brain and nervous system,” says Dr. Kumar. “Migraines can cause changes in your vision because your eyes are directly connected to your brain.”
The most obvious difference between a retinal migraine and a migraine with aura is whether it affects one or both eyes. “A migraine with aura affects both eyes, but a retinal migraine affects only one eye,” explains Dr. Kumar. “And the vision disruptions from retinal migraine are often more severe than an aura, but they usually go away within an hour."
The visual disturbances from a retinal migraine or a migraine with aura include:
- Floating shapes or patterns, like squares or zigzag lines
- Scotoma (blind spot or decreased vision in one area)
- Scintillations (twinkling lights)
Another important difference is that migraines with aura can go beyond vision changes. An aura can also include:
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- Difficulty speaking
- Dizziness or loss of balance
- Numbness or tingling in your arms, legs or face
- Tinnitus (ringing in your ears)
What causes a retinal migraine or an aura?
Migraines happen when abnormal electrical signals fire on the brain’s surface. But with a retinal migraine, these signals only affect the back of your eye. Usually, this happens when the blood vessels in your retina become narrowed.
“Your retina converts things you see into electrical signals and sends them to the brain,” says Dr. Kumar. “If the electrical signals send abnormal messages, you may see lights and spots that aren’t actually there.”
All types of migraines can have triggers, which vary from person to person. If you have regular migraines, your provider will work with you to identify and avoid your triggers. Things that can cause a retinal migraine include:
- Consuming caffeine or alcohol
- Dehydration
- High blood pressure
- Hormonal contraceptives (birth control pills)
- Hypoglycemia (low blood sugar)
- Menstruation and hormonal shifts
- Smoking
- Stress
The triggers for migraine with aura are similar to a retinal migraine, but may also include:
- Bright lights
- Certain foods
- Sleep changes
Do retinal migraines and auras always cause a headache?
Many people think “migraine” always means a pounding headache. But about 25% of retinal migraines don’t cause head pain.
“A retinal migraine usually causes a headache within an hour of the visual symptoms, but some people never get head pain,” says Dr. Kumar. “The visual disturbances can be stressful, though, and can interfere with your daily life.”
Auras, on the other hand, cause a headache in more than 95% of cases. “For most people, the aura is a warning sign that the headache is coming,” says Dr. Kumar.
Can a retinal migraine or migraine with aura harm your vision?
The vision changes with retinal migraines and auras are temporary. However, you should still contact your provider if you notice sudden changes in your vision.
“Migraines usually don’t cause permanent vision problems,” says Dr. Kumar. “But don’t ignore symptoms like floaters or flashes of light or try to self-diagnose the issue. These vision changes could be a sign of a severe condition like a stroke, retinal detachment or an eye infection.”
Treating Migraines
Whether you have a retinal migraine or a migraine with aura, your treatment starts with a correct diagnosis. “There’s no test to diagnose a retinal migraine, but your provider can perform tests to rule out other causes of visual disturbances,” says Dr. Kumar. “You may need to see an ophthalmologist and neurologist for a complete workup. Then, we can recommend a treatment plan based on your medical needs and symptoms.”
Mild retinal migraines may not require treatment. “Identifying possible triggers and avoiding them whenever possible can help prevent attacks,” says Dr. Kumar.
If the symptoms are interfering with your life, however, let your provider know. “Medications can help prevent migraine attacks or provide relief after the attack happens,” says Dr. Kumar. “Your provider can help you find the therapy that helps you feel your best.”
Reviewed by Nitin Kumar, M.D., an ophthalmologist who sees patients at Henry Ford Medical Center - Ford Road, Henry Ford OptimEyes Supervision Center - Troy and Henry Ford OptimEyes Supervision Center - Sterling Heights.
