Patient guide
Ocular migraine: the shimmering zigzag that fades within the hour
These are not a migraine until proven otherwise. Painless loss of vision in one eye, even if it comes back: go to a hospital emergency room, because it can be a sign of stroke. Vision change with weakness, numbness or trouble speaking: call 911. A shadow or curtain across your vision, or a shower of new floaters or flashes: call (609) 246-0236 the same day.
A zigzag figure appears near the point you are looking at. Over the next minutes it spreads to the right or the left, with a shimmering edge and a blind patch behind it, and then it goes. A headache may follow, or nothing at all. It is alarming the first time, and it is usually a migraine aura.
"Ocular migraine" is what most people call it. This page describes what a typical one looks like, and the details that separate it from the problems that cannot wait.
What it looks like
- It builds gradually. It spreads over five minutes or more. It does not arrive all at once.
- It shimmers. A zigzag figure with a flickering edge, leaving a blind or blurred patch.
- It moves. It starts near the point you are looking at and spreads to the right or the left.
- It ends. Each episode lasts between five minutes and an hour, and vision returns completely.
- A headache may follow within the hour. It may also not: aura without headache becomes more frequent with age.
About one adult in nine has migraine, and between a fifth and a third of them have aura. In more than nine in ten of those, the aura is visual.
Is it the eye or the brain?
A typical aura affects the same side of the view in both eyes, not one eye, so it is there whichever eye you look with.
You can check this during an episode. Cover one eye, then the other.
- There with either eye
- This is the pattern of the ordinary migraine aura.
- Only in one eye
- A one-eyed migraine, called retinal migraine, is recognized, but it is only diagnosed after the other causes have been ruled out. Treat a one-eyed loss of vision as urgent.
People are often mistaken afterwards about which it was, reporting one eye when it was one side of both. If you did not check, say so at your visit.
Telling it apart from something serious
- Migraine aura
- Builds over minutes, shimmers and spreads, is there with either eye, and is gone within the hour.
- Retinal tear or detachment
- Flashes caused by the gel inside the eye tugging on the retina, a shower of new floaters, or a shadow or curtain across your vision. Flashes and floaters explains why this needs a same-day exam.
- Blocked blood flow to the eye
- Painless loss of vision in one eye. Even when it passes, it is treated like a mini-stroke, and the place to go is an emergency room, not an eye office.
- Stroke
- Vision change with weakness, numbness or trouble speaking. Call 911.
- Giant cell arteritis
- Over 50, with a new headache, a tender scalp or jaw pain when chewing, and brief blackouts of vision. Giant cell arteritis is an emergency of its own.
When to be seen
- Your first episode. A visual aura or blind spot should not simply be assumed to be migraine. Have an eye exam, and bring a description of what you saw and how long it lasted.
- A first episode later in life. Aura can appear for the first time after 40, but at that age it is diagnosed only once other causes have been excluded.
- An episode that does not fit. Shorter than five minutes, longer than an hour, arriving all at once, or leaving any vision missing afterwards.
- Anything in one eye only.
Dilated examination, retinal scans and visual field testing are done in this office. If the eyes are healthy and the episodes are frequent or disabling, your primary care doctor or a neurologist can treat the migraine itself.
What to do during an episode
- Stop driving. Pull over as soon as it is safe, and wait until your vision is fully back.
- Cover each eye in turn and note whether it is there with both.
- Note the time it started and ended, and what it looked like.
The aura passes on its own and is completely reversible. Everyone's triggers differ; stress, bright or flashing lights and hormonal changes are among the common ones. A note of what came before each episode will show whether you have a pattern.
Migraine aura and stroke
In a pooled analysis of studies, people who have migraine with aura had about twice the risk of ischemic stroke. The risk was higher still in people with migraine who smoke and use birth control that contains estrogen.
The CDC's 2024 guidance rates combined hormonal contraceptives, the kind that contain estrogen, as a method not to be used by people who have migraine with aura. If you use one and have aura, tell the doctor who prescribes it. Progestin-only methods carry no such restriction.
Common questions
Can I have an ocular migraine without getting a headache?
Yes. Aura without headache is recognized, and it becomes more frequent with age. Because it can look like a mini-stroke, a first episode later in life should still be checked.
Is it damaging my eyes?
A typical aura affects the view of both eyes, not one eye, and it is completely reversible. An eye exam after a first episode is to make sure it was an aura and not something else.
How is this different from the flashes that come with floaters?
Those flashes come from the gel inside the eye tugging on the retina. An aura is a shimmering shape that builds over minutes and is there with either eye. If you are not sure which you had, treat it as flashes and call the same day.
They are happening more often. What can be done?
Preventive medication is recommended for people with disabling migraine on four or more days a month. That is managed by your primary care doctor or a neurologist.
Does this go through my vision plan or my medical insurance?
Vision plans cover routine exams and eyewear; medical insurance covers conditions, symptoms and monitoring. Vision plan or medical insurance explains how the reason for your visit decides which applies.
Call the office
For a first episode, or one that did not fit the usual pattern, call rather than book online. For loss of vision in one eye, or any weakness or trouble speaking, do not call us first: go to an emergency room or call 911.
Khoury Eye Care, Hamilton Mall, 4403 Black Horse Pike, Mays Landing.
Sources
The figures and recommendations on this page come from the following. Ask at your visit if you would like a copy of any of them.
- Headache Classification Committee of the International Headache Society. The International Classification of Headache Disorders, 3rd edition. Cephalalgia. 2018.
- Fisher CM. Late-life migraine accompaniments as a cause of unexplained transient ischemic attacks. Canadian Journal of Neurological Sciences. 1980;7(1):9-17.
- Mac Grory B, Schrag M, Biousse V, et al. Management of central retinal artery occlusion: a scientific statement from the American Heart Association. Stroke. 2021.
- Schurks M, Rist PM, Bigal ME, et al. Migraine and cardiovascular disease: systematic review and meta-analysis. BMJ. 2009.
- Centers for Disease Control and Prevention. US Medical Eligibility Criteria for Contraceptive Use, 2024.
- American Migraine Foundation. Guide to migraine triggers and how to manage them.