Ocular Migraine and Stroke Risk : Unveiling the Connection and Prevention Strategies

1. What is Ocular Migraine?

   Ocular migraine is also known as retinal migraine. It is a type of migraine with aura that is characterized by visual disturbance or vision loss in one eye. The visual symptoms precede or accompany a migraine headache.

   Ocular migraine typically involves reversible and painless visual disturbance, which may include flashing lights, zigzag lines, blind spots, or temporary blindness in one eye.

   The visual symptoms of ocular migraine usually last for less than an hour and are followed by or coincide with a headache.

   Ocular migraine is generally benign but should be evaluated by a healthcare professional to rule out the potential causes to manage the condition effectively.

2. Prevalence of Ocular Migraine

   Ocular migraine is relatively rare than other forms of migraine. It accounts for 1-2% of all migraine cases.⁽⁶⁾ Tracking the exact cause of migraines can be challenging due to variations in how individuals experience and report these episodes.

   Some studies reported slightly higher rates of ocular migraine in certain populations highlighting the need for further research.⁽⁷⁾ It is needed to know about prevalence, triggers, and patterns essential for improving our understanding and management of this condition.

If a person has a migraine with aura, it does not mean a person is having a stroke or a stroke is about to happen. However, if a person has migraine with aura, he can be at a higher risk of stroke.

A study published in 2016 compared people with migraine to those without migraine.⁽¹⁾ The result showed a significant association between migraine and visual aura and ischemic stroke over 20 years. No association was found for migraine without visual aura.

Other research found links between migraine and stroke, particularly migraine with aura, possibly doubling the risk. This study focused on female patients.⁽²⁾ When aura and ischemic stroke happen together, it is called migraine stroke or infarction. The reason for its occurrence is the restricted flow of blood to the brain. It is a rare occurrence as only 0.8% of all strokes are migrainous strokes.⁽³⁾ The risk for migrainous stroke is higher for women aged 45 years and younger. This may be due to hormonal changes and the use of contraceptives that may increase the risk of blood clots.

Sometimes the symptoms of migraine and stroke can be similar.  The symptoms of migraine with aura develop slowly and gradually worsen. There are symptoms of vision that aren’t usually there. It involves both eyes. The symptoms of stroke appear suddenly. There is tunnel vision or vision loss and the symptoms involve only one eye. The other symptoms of migraine with aura include:

• Sensitivity to light
• Nausea
• Difficulty in concentrating
• One-sided head pain

The potential symptoms of stroke include:

• Hearing loss
• Confusion
• Trouble in understanding or speaking
• Loss of control over motor activities or loss of balance
• Weakness affecting one side of the body
• Severe headache or dizziness

There are a few things that may make it harder to differentiate between migraine and stroke without seeing a doctor.

• Transient Ischemic Attack (TIA): It is also known as ministroke and occurs when there is a temporary lack of blood flow to the part of the brain. The symptoms appear suddenly and pass away quickly within minutes.
• Hemiplegic Migraine: It causes weakness, numbness, and tingling on one side of the body. The symptoms start before a headache.
• Subarachnoid Hemorrhage: It happens with bleeding between the brain and tissues that cover the brain. It can lead to sudden and severe headaches.

A stroke is a life-threatening emergency in which every second counts. Seeking medical attention is very necessary. The warning signs of stroke include:

•  Vision loss
• Severe headache
• Inability to speak
• Losing control over one side of the body

According to an article published in 2017, there are no clear guidelines on to how to lower the risk of stroke in people with ocular migraine.⁽⁴⁾ However, steps can be taken to lower the risk of stroke.

Getting a complete physical examination every year and seeing a neurologist for migraine is a very important step in prevention and treatment. One should be enquired about the following:

• Medication that can lessen the frequency of migraine
• Assessment of risk factors for migraine
• Birth control methods that don’t increase the risk of a blood clot

Lifestyle changes can be introduced to reduce the risk of stroke. Some of the important lifestyle changes include:

• Quitting smoking
• Maintaining weight
• Limiting salt intake
• Eating a balanced diet
• Getting regular exercise
• Minimizing alcohol intake
• Cessation of smoking

The conditions that increase the risk of stroke should be managed. These include:

• High cholesterol
• Diabetes
• Carotid artery disease
• Atrial fibrillation
• Sickle cell anemia
• Peripheral artery disease
• Heart disease
• Sleep apnea

To manage the above conditions, compliance with medication and understanding of the medication interaction is important. The patient should know about the interaction between the medications.

The patients can be educated about the link between ocular migraine and a higher risk of stroke. This is crucial for raising awareness and promoting proactive health management. Knowing about the triggers and early warning signs, patients can take preventive measures.

A comprehensive approach to patient education and adherence to medical recommendations helps in empowering individuals with ocular migraine and this can actively manage health and reduce the risk of stroke. This can be helpful to them in making informed decisions about their lifestyle and treatment options.

There is usually a good outcome for functionality in people who have ischemic stroke related to ocular migraine.⁽⁵⁾

Understanding the intricate relationship between ocular migraine and heightened stroke, having an awareness, and management of the condition is important. The link between the two involves a multidimensional approach towards health and well-being.

By comprehending the prevalence and frequency of ocular migraine, an insight into the significance of the condition within the spectrum of migraine disorders can be gained. Recognizing the unique characteristics and potential triggers equips individuals with the knowledge to navigate their experience effectively.

Acknowledging the association between ocular migraines and elevated risk of stroke unveils critical implications for both the patients and healthcare providers. Identifying high-risk groups empowers to tailor interventions that are not only timely but also potentially life-saving.

Patient education and adherence to medical recommendations are pivotal components in mitigating the increase in risk. Through lifestyle modification, medication management, and consistent monitoring, individuals can play an active role in their own health. Open communication should be encouraged by healthcare providers as it fosters a collaborative approach to care and ensures that treatment plans are personalized and aligned with specific the needs of each individual.