Optical Migraine

So your doctor has diagnosed you with optical migraine. Or maybe a friend, hearing about the symptoms you have, has suggested that this may be your problem. Great - but what exactly is this strange kind of migraine? Where does it come from and how is it treated?

It's very difficult to give a general answer to these questions, simply because "optical migraine" isn't really a standard term. More and more, doctors are using terminology from the Headache Classification Subcommittee of the International Headache Society, entitled The International Classification of Headache Disorders. This document is an attempt to standardize the names that we use for various types of headache, migraine and cluster headache.

When a doctor uses terms that are not a part of this document, they may be using the term differently from the doctor down the road. In other words, two people may be diagnosed with the same type of migraine, but in reality have very different types with totally different symptoms!

The "typical" optical migraine

In my experience, there is a typical set of symptoms that are diagnosed as optical migraine.  The symptoms have to do with the eye - some kind of visual disturbance, such as seeing speckles or zig zags, blurred vision, partial (or total) loss of vision, often in only one eye.  However, unlike a "typical" migraine, no headache ever develops.

If this is similar to what you're experiencing, you may actually have what is called typical aura without headache, or migraine aura without headache.  A common (unofficial) name for this has been silent migraine.

Sometimes you'll get the diagnosis when you have any kind of migraine with other optical symptoms, such as pain centred around one eye.  This could be, for example, migraine without aura or migraine with aura.

So where should I go from here?

Though the treatment of these conditions is often similar, doctors have found that some medications and treatments work better with some types of migraine and not with others. You will probably get the best treatment if you can confirm with a little more precision what type of migraine you have. First, you can get some confirmation that you really do have migraine here. (I do encourage you to check with a doctor, and not just diagnose yourself - we can sometimes miss things that may indicate another medical problem!)

Then you'll probably want to get a second opinion. Discuss The International Classification of Headache Disorders with your doctor, and ask her what type of migraine she feels you have. Then you can both discuss options.

There is now a short version of the headache classifications here that you can print, and take along to the doctor's office.

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References: Can you explain what an optical migraine is? from Aetna InteliHealth; The International Classification of Headache Disorders, 2nd Ed.