Visual disturbances during a migraine.
Visual disturbances, often referred to as “aura,” are a common symptom for many people with migraines. These disturbances can be both distressing and debilitating, affecting vision in a variety of ways. Below is a detailed explanation of the different types of visual disturbances that may occur during a migraine:
1. Scintillating Scotoma
- Definition: A scintillating scotoma is a common type of visual aura. It begins as a small blind spot in the visual field, which then gradually expands.
- Appearance: The blind spot often has a shimmering, flickering border of zigzag patterns, which may be colored or black and white. This area can expand, creating a crescent or “C”-shaped figure that moves across the visual field.
- Location: It typically starts near the center of vision and gradually moves outward. The scotoma can affect one or both eyes, though it often appears to affect both fields of vision simultaneously.
- Duration: This visual disturbance usually lasts for 20 to 30 minutes but can persist for up to an hour.
2. Fortification Spectra
- Definition: Fortification spectra are visual phenomena resembling the fortifications or battlements of a medieval castle, hence the name.
- Appearance: These are often described as a series of sharp, jagged lines that appear in a zigzag pattern. The lines are usually bright and can be multicolored, appearing as shimmering or flashing lights.
- Location: These lines usually start in a small area and gradually spread out, often in a curved or arch-like pattern, affecting the peripheral vision more than the central vision.
- Duration: Like scintillating scotomas, fortification spectra typically last between 20 and 30 minutes but can extend up to an hour.
3. Photopsia
- Definition: Photopsia refers to the perception of flashes of light or bright spots in the visual field.
- Appearance: These can appear as brief, bright flashes, like seeing a camera flash or fireworks. They might also manifest as sparks, stars, or other small, bright shapes that appear to flicker or float.
- Location: These flashes can occur anywhere in the visual field and may affect one or both eyes. They are often seen in peripheral vision but can also appear centrally.
- Duration: Photopsias are usually brief, lasting a few seconds to several minutes, and can occur multiple times during a migraine attack.
4. Negative Scotoma (Blind Spots)
- Definition: A negative scotoma is a part of the visual field where vision is absent, leading to blind spots.
- Appearance: These blind spots are areas where the individual cannot see anything, and they appear as dark or missing portions of the visual field. Unlike scintillating scotomas, they do not have bright or flashing edges.
- Location: Blind spots can occur anywhere in the visual field but are often in the center or towards the periphery. They can affect one or both eyes.
- Duration: The duration of negative scotomas varies; they can last as long as the migraine or fade away as the migraine progresses.
5. Visual Snow
- Definition: Visual snow is a persistent visual disturbance that appears as a static or “snow” across the entire visual field.
- Appearance: It resembles the static seen on a television screen, with tiny, flickering dots covering the entire visual field. This snow can be black and white, colored, or transparent.
- Location: It affects the entire visual field, not confined to one area, and can occur in both eyes.
- Duration: Unlike other visual disturbances, visual snow can persist even between migraine attacks and may become a chronic issue.
6. Tunnel Vision
- Definition: Tunnel vision refers to the loss of peripheral vision, leading to a narrow, tunnel-like field of view.
- Appearance: The person can only see what is directly in front of them, with everything outside this central area being dark or blurry. It can feel like looking through a tunnel.
- Location: Central vision is preserved, while the peripheral vision is diminished or lost.
- Duration: Tunnel vision can last for several minutes to hours and typically resolves as the migraine improves.
7. Metamorphopsia
- Definition: Metamorphopsia is a visual distortion where objects appear warped or misshapen.
- Appearance: Straight lines may appear wavy, and objects may seem larger or smaller than they actually are. Faces or objects may appear distorted or grotesque.
- Location: These distortions can affect any part of the visual field and can vary in intensity.
- Duration: The distortions are usually temporary, occurring during the aura phase or the headache phase of a migraine, and last from several minutes to an hour.
8. Micropsia and Macropsia
- Definition: Micropsia is when objects appear smaller than they actually are, while macropsia is when objects appear larger.
- Appearance: The person perceives objects, people, or parts of their body as being unusually small (micropsia) or large (macropsia). This can be disorienting and disturbing.
- Location: These distortions can affect the entire visual field or just specific objects within it.
- Duration: These symptoms typically occur during the aura phase and can last anywhere from a few minutes to over an hour.
9. Palinopsia
- Definition: Palinopsia is the persistence of a visual image after the object has been removed from sight.
- Appearance: After looking at an object and then looking away, the image of that object lingers in the visual field. This can be like an afterimage or a ghostly version of the object.
- Location: This phenomenon can occur anywhere in the visual field and with any object.
- Duration: The persistence of the image can last from a few seconds to minutes after the person has shifted their gaze.
10. Color Disturbances
- Definition: Some people experience changes in color perception during a migraine aura.
- Appearance: Colors may appear washed out, overly bright, or altered in hue. Some individuals might see flashes of color or find it difficult to distinguish between certain colors.
- Location: Color disturbances can affect the entire visual field or just specific areas.
- Duration: These disturbances usually last for the duration of the aura, typically 20-60 minutes.
11. Visual Hallucinations
- Definition: Visual hallucinations during a migraine aura are rare but can occur.
- Appearance: These can range from simple geometric shapes to more complex images, such as seeing people, animals, or objects that aren’t there.
- Location: Hallucinations can appear in any part of the visual field and may be static or moving.
- Duration: Visual hallucinations during a migraine are typically brief, lasting minutes to an hour.
12. Transient Vision Loss
- Definition: Some people may experience a temporary loss of vision in one or both eyes during a migraine attack.
- Appearance: This can range from partial vision loss, such as losing vision in one eye or losing sight in a specific area of the visual field, to complete blindness.
- Location: Vision loss can be unilateral (affecting one eye) or bilateral (affecting both eyes).
- Duration: Vision loss usually lasts for a few minutes to an hour and gradually returns to normal as the migraine resolves.
Impact on Daily Life
These visual disturbances can significantly impact daily activities, making it difficult to read, drive, work, or even navigate familiar environments. The unpredictability of these symptoms adds to the anxiety and stress of living with migraines, often leading to a diminished quality of life.
Management and Coping Strategies
- Resting in a Dark, Quiet Room: Minimizing visual stimuli can help reduce the severity of visual disturbances.
- Medication: Migraine-specific medications, such as triptans, or preventive medications may help reduce the frequency and severity of visual auras.
- Eye Protection: Wearing sunglasses or tinted lenses can help reduce photophobia and manage other visual symptoms.
- Regular Eye Exams: Keeping up with eye health can help distinguish between migraine-related visual disturbances and other potential eye conditions.
Visual disturbances during a migraine aura can be frightening and disabling, but understanding them can help in managing and anticipating these episodes. Consulting with a healthcare professional for proper diagnosis and treatment is essential for anyone experiencing these symptoms.