Retinal Migraine vs. Migraine With Aura: How to Tell the Difference

Migraines are a painful and disruptive neurologic condition. Many people who have migraines experience auras. Auras are sensory experiences that can include vision changes. 

But if you’re having headaches and vision changes in just one eye, you could actually be experiencing a retinal migraine. It’s important to know if you’re having classic migraine with auras or a retinal migraine because the two need very different treatments. 

What is a retinal migraine?

A retinal migraine is a rare condition that affects the retina. The retina is the back of the eye. Its job is to send light signals to the brain so that people can see images. 

People who have retinal migraines experience temporary vision changes in one eye that can last anywhere from 5 minutes to 1 hour. These vision changes can include:

• Partial or complete loss of vision in one eye

• A large blind spot (scotoma) in one eye

• Flashing or twinkling lights in one eye

As you might have guessed based on its name, people also experience headaches with these vision changes. The headache might start at the same time as the vision changes or up to 1 hour later. 

Are retinal migraines and migraines with aura the same thing?

Retinal migraine and migraine with aura are not the same thing. But they are both types of migraine. 

Classic migraines with auras are much more common than retinal migraines. Only 1 out of every 200 people who get migraines experience retinal migraines. 

But about ⅓ of people who get migraines experience classic auras with vision symptoms like:

• Small blind spots with bright colors or jagged lines around the edges

• Flashing lights

• Blurry or foggy vision 

• Distorted vision that makes things look bigger or smaller than they actually are

In classic migraines with auras, vision changes affect both eyes. People experiencing retinal migraines only have vision changes in one eye. 

How does a retinal migraine differ from ocular migraine?

Ocular migraine is an old term for retinal migraine. So the two terms mean the same thing. Ophthalmic migraines and anterior visual pathway migraines are two other old names for retinal migraines. 

What causes a retinal migraine?

It’s not clear why people develop retinal migraines. Current evidence suggests that there’s a temporary block in the blood supply to the retina, and this causes both the vision changes and headache. 

Vision goes back to normal once the blood vessels relax and blood can get through them again. 

Certain things can trigger retinal migraines. But since so few people experience retinal migraines and triggers can vary from person to person, there’s no complete list of retinal migraine triggers. There’s evidence that triggers for classic migraines can also trigger retinal migraines, but the overlap isn’t 100%. 

Evidence shows triggers for a retinal migraine include: 

• Stress

• Smoking 

• High blood pressure

• Hormonal contraception

• High altitude

• Dehydration

• Low blood sugar

Who gets retinal migraines?

Retinal migraines aren’t common, and it’s not clear what causes them. So there’s not a lot of information available about who is most at risk for developing them. 

Research shows that people who experience retinal migraines have some things in common, like:

• Age: Younger people (under 40 years old) tend to experience retinal migraines more often than older people.

• Sex: Women report retinal migraines more often than men.

• Genetics: Most people with retinal migraines have family members who have a history of classic migraines. 

• Medical conditions: Retinal migraines tend to be more common among people with certain medical conditions, like lupus, sickle cell disease, or hardened arteries (atherosclerosis). 

When should you seek help for a retinal migraine?

If you ever experience a sudden vision change in one eye, see an eye doctor or go to the emergency room right away. 

There are many medical conditions that can cause vision changes in one eye, and all of them are more common than a retinal migraine. Some of them are life-threatening, like strokes, blood clots, and tumors. Without immediate treatment, others — like retinal detachment — can lead to permanent vision loss.  

Once you’re sure your vision change is just from a retinal migraine, you can breathe easy. Retinal migraines aren’t dangerous. It’s very rare to have any lasting vision loss from a retinal migraine. 

But experiencing retinal migraines can disrupt your daily life. If you’re having more than one retinal migraine per month, it’s time to see your eye doctor. You may need treatment to prevent retinal migraine attacks.

How do you treat a retinal migraine?

Finding the right treatment for your retinal migraines can be tricky. Since so few people experience retinal migraines, there’s not enough evidence for experts to use to develop treatment guidelines. 

Experts recommend avoiding medications that treat classic migraines, like triptans, because they can affect blood vessels. Beta blockers and ergot derivatives aren’t options either because they can also affect blood vessels and, in theory, trigger permanent vision loss.

But there are still things that can help you lessen your retinal migraine episodes, like:

• Avoid triggers. Staying away from common triggers can keep your retinal migraine episodes at bay. If you smoke, consider quitting. If you’re taking hormonal contraceptives, think about switching to a nonhormonal form of birth control like a diaphragm or nonhormonal IUD. If you’re not sure what your triggers are, keep track of your retinal migraines with a headache diary. This can help you pinpoint your own triggers. 

• Try over-the-counter pain relievers. Over-the-counter pain medications may help lessen your headache during a retinal migraine. Some evidence shows that aspirin is a great option for treating retinal migraines. But aspirin isn’t the best option if you take certain medications. Your eye doctor may have suggestions for you. 

• Try a calcium channel blocker. If you have frequent retinal migraines, you might want to think about taking a daily medication to prevent migraines. Calcium channel blockers like nifedipine or verapamil can help. These are prescription medications, so you’ll need to work with your eye doctor to start treatment. 

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Written by:

Nishika Reddy, MD

Nishika Reddy, MD, is an attending physician at the University of Utah. She provides comprehensive and cornea medical care at the Moran Eye Center and serves as clinical assistant professor.

Edited by:

Patricia Pinto-Garcia, MD, MPH

Patricia Pinto-Garcia, MD, MPH, is a medical editor at GoodRx. She is a licensed, board-certified pediatrician with more than a decade of experience in academic medicine.

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