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What About Optical, Ocular, and Ophthalmic Migraines?


There are different types of Migraines, and some should be approached and treated differently than others. That makes it important that Migraine be properly diagnosed. A common problem is that some doctors don't stick with the standard or "official" diagnoses.

In any health field, there needs to be standardization in diagnosing. If every doctor used different diagnostic criteria and classifications, there would be total chaos. It would be impossible to communicate with patients, other doctors, researchers, etc. In the field of Migraine disease and headaches, the gold standard for diagnosis and classification is the International Headache Society's International Classification of Headache Disorders, 2nd Edition (ICHD-II).

Questions often arise about ocular, optical, and ophthalmic Migraines. These questions, however, are difficult if not impossible to answer because there are no such Migraine classifications in the ICHD-II, no such diagnosis listed there. Although there are doctors who use these diagnoses, they use them differently, making it difficult for anyone else to enter a discussion or answer questions.


Mary Jane reports having been diagnosed with ocular Migraines. Her Migraines typically beginning with six to 18 hours of mood swings, excessive yawning, food cravings, and unusually frequent urination followed by tiny blind spots in her vision (scotoma) and  extreme sensitivity to light (photophobia) and sound (phonophobia). These symptoms are followed by a headache that is on one side (unilateral), throbbing with her pulse (pulsatile), and moderate to severe in intensity. Her ICHD-II diagnosis? Migraine with aura. She sometimes has the same symptoms, but without the headache. The ICHD-II diagnosis for those Migraine attacks is still Migraine with aura, but the descriptive term acephalgic (meaning without head pain) is added, acephalgic Migraine with aura.

Lou went to the optometrist and was told she had optical Migraines. She reports having quickly developing intense headaches on the right side of her head, focused around her eye. She also reports extreme nausea and vomiting. Her optometrist diagnosed her with optical Migraines. Her ICHD-II diagnosis? Migraine without aura.

Dianna was told she had ophthalmic Migraines. Her first symptom was complete blindness in one eye (monocular). This was followed by phonophobia, nausea, and a mild headache. The blindness resolved by the time the headache was over. Her ICHD-II diagnosis? Retinal Migraine.

If you've been diagnosed with ocular, optical, or ophthalmic Migraines, you may encounter some confusion when talking with other Migraineurs or seeing doctors other than the doctor who diagnosed your Migraines. The examples above are not meant to be applied to anyone else, but to show how differently terms are used when they're not used with any established criteria. To better educate yourself about Migraine disease, particularly how it affects you, ask your doctor if he's familiar with the International Headache Society's International Classification of Headache Disorders. If he is, he should be able to give you an ICHD-II diagnosis. If not, you may want to seek a second opinion from a doctor who is familiar with the ICHD-II.

Medical review by John Claude Krusz, PhD, MD


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Teri Robert, 2011. Last updated March 1, 2011.



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