Ocular migraine and menopause
Some women start getting ocular migraines out of nowhere around menopause. An ocular migraine causes visual symptoms, such as stars, spots or flashing lights. These visual symptoms are also referred to as ‘aura’. Though they can be frightening, ocular migraines typically are harmless. An aura can precede a classic migraine headache, which can be blindingly painful. What causes ocular migraines? And what can you do about this?
Most often it begins with shimmering lights. This tends to last for a few minutes and then I get nauseous. The only thing that helps is lying in the dark. - Elke (age 50)
Ocular migraine is often misdiagnosed, which makes it difficult to determine its prevalence. What we do know is that like classic migraine, ocular migraine is more common in women. The reason for this is that women tend to experience more frequent and more extreme fluctuations in hormonal levels, which can trigger migraine. Most women get fewer migraines (or they may disappear altogether) once their periods stop.
If you've had ocular migraine before, menopause may cause it to get worse. Though ocular migraines can be frightening, you don’t have to worry. In most cases, they are harmless and don’t cause any damage. An attack typically lasts 10 to 30 minutes, but the post-headache phase can cause you to feel tired or drowsy. Some women experience visual disturbances just before a mild headache or a classic migraine attack.
What is happening in your body?
The exact cause of ocular migraines is not entirely understood. Some scientists believe that they are caused by the blood vessels in the brain suddenly narrowing, reducing blood flow to the eye. During perimenopause the rapid changes in hormone levels, in particular the sudden rise in oestrogen in comparison to progesterone, is also thought to be a factor. Elevated oestrogen levels can affect many areas of the body, including blood vessels in the brain and eyes.
Other causes
Ocular migraines can also be triggered by other menopausal symptoms. Stress can increase the risk of developing migraine, and menopausal women with hot flashes, fatigue and sleep problems have a higher risk of ocular migraines.
Environmental factors, such as certain foods (caffeinated beverages or alcohol), bright lights, external stimuli, and strong smells like perfumes or secondhand smoke can also trigger ocular migraines in some people.
What are symptoms of ocular migraine?
Unlike classic migraine, ocular migraine does not typically cause generalised headache. Ocular migraine can cause headache behind the eye, and often one eye. Other symptoms include:
- Zigzagging lines or patterns with colours
- Shimmering or flashes of light
- Blind spots or black spots
- Blurred or double vision
- Tunnel vision
- Difficulty with speech
- Tingling sensations in arms and/or legs
Symptoms that can occur after an ocular migraine attack:
What can you do?
Ocular migraines cannot be avoided, but there are things you can do to reduce the chance of an attack or to alleviate the symptoms of an attack. Here are some tips to deal with ocular migraines.
- Just had an attack? Rest after you’ve had an ocular migraine attack and avoid exposure to bright lights and strong smells. Placing an ice pack or cold washcloth over your eyes can help ease migraine symptoms.
- Find out what your migraine triggers are. Keep a migraine journal to identify triggers. Keep track of your activities, sleep and food on the day of the attack. Understanding patterns and triggers is essential for effective management.
- Reduce stress. Stress raises oestrogen levels in your body, which can trigger ocular migraines. Find enjoyable ways to relax and relieve stress, or try relaxation techniques such as meditation or mindfulness. Keep in mind that menopause can make you more sensitive to stress, so be sure to take regular breaks and set priorities. Physical activity can also be helpful in bringing stress levels down. A stiff or tight neck can be a migraine trigger. Stretching can help relieve tension.
- Limit screen time. Look away from screens to break the view and reduce eyestrain. Get up and move around every 30 minutes. Incorporate longer breaks away from screens. Take a walk and get some fresh air. Limiting screen time can also help reduce neck pain and stiffness.
- Eat a balanced diet, with sufficient magnesium and omega-3 fatty acids. A lack of magnesium can cause or exacerbate migraine headaches. Magnesium-rich foods include vegetables, nuts, peanuts and whole grain products. Omega-3 has anti-inflammatory actions, which may help prevent migraine attacks or reduce symptoms of an attack. Omega-3 is found in foods such as chia seeds, walnuts, flax seed oil and oily fish. Dietary supplements can help bridge nutritional gaps and provide extra support. Also make sure you drink a lot of water and keep your blood sugar levels stable.
- Avoid warm or hot environments. Warm or hot environments, such as saunas or hot weather, can trigger ocular migraines.
- Consider switching to another type of contraceptive. Oral contraceptives are associated with an increased risk of ocular migraine.
What treatments can help?
Hormone replacement therapy (HRT) can reduce menopausal symptoms quickly and safely in many women. Bioidentical HRT can also prevent ocular migraines from occurring. In addition to medication, you could also consider dietary supplements. Supplements can complement a healthy lifestyle and help reduce symptoms over time.
Can hormone therapy help?
Hormone replacement therapy (HRT) treats symptoms of menopause by replacing lost hormones (oestradiol and progesterone). By stabilising hormone levels, the symptoms that you are experiencing will reduce or even go away altogether. According to experts, HRT is the most effective treatment for hot flashes and night sweats. If you are also suffering from other severe symptoms besides ocular migraine, such as sleep disturbances or mental health symptoms, then hormone therapy could be the answer you have been looking for.
Sources
- Artemis Kliniken. (o. J.). Augenmigräne: Symptome, Auslöser, praktische Sofortmaßnahmen. Abgerufen am 9. Mai 2024, von https://www.artemiskliniken.de/magazin/augenmigraene-symptome-ausloeser-praktische-sofortmassnahmen/#:~:text=Die%20Symptome%20von%20Augenmigr%C3%A4ne%20sind,oder%20Blitze%20im%20Sichtfeld%20wahrnehmen
- Digre, Kathleen B. MD. More Than Meets the Eye: The Eye and Migraine—What You Need to Know. Journal of Neuro-Ophthalmology 38(2):p 237-243, June 2018. | DOI: 10.1097/WNO.0000000000000660
- Donahue H. C. (1949). Migraine and its ocular manifestations. Transactions of the American Ophthalmological Society, 47, 554–605.
- Rossi MF, Tumminello A, Marconi M, Gualano MR, Santoro PE, Malorni W, Moscato U. (2022). Sex and gender differences in migraines: a narrative review. PMID: 35676560.
- Silberstein SD. (2000). Sex hormones and headache. PMID: 11139745.
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Tips and advice
Hormones and menopause: what is happening in your body?
Your body goes through a lot of changes during menopause. This period in a women's life marks the transition from a reproductive to non-reproductive stage. Progesterone and oestrogen play a key role in your reproductive health. During the menopausal transition, the amount of oestrogen and progesterone produced declines rapidly. However, certain levels of sex hormones are still needed for your body to function. Fortunately, nature has a great solution for this.
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FAQ
When should I see my doctor?
If you are concerned about your health, it is always best to see your GP. This also applies if you have frequent ocular migraines, the visual effects last longer than an hour, or your symptoms are different or more severe than normal. Seek help if your migraines keep coming back. A doctor may be able to prescribe preventative medication for ocular migraines.
Is ocular migraine dangerous?
Ocular migraine usually isn't dangerous, but the symptoms can get in the way of certain activities, such as driving. If you have vision problems you should avoid driving until your headache passes and your vision is back to normal.
