Flashes & Floaters Caused By Migraines
By Dr. Paula C. Ko, M.D.
Migraine headaches can be broken down into two categories. A classic migraine occurs when a patient gets a visual aura followed by a severe headache. This typically starts in childhood, adolescence, or early adulthood. An ocular migraine occurs when a patient gets visual symptoms without a subsequent headache. I’ve noticed that this is more commonly seen in patients over 60 years-old. When a patient is diagnosed with an ocular migraine, usually earlier in life they had classic migraine headaches. The patient experiences ocular migraines many years after the classic migraine headaches have resolved. Additionally, many of these patients have a family history of migraines.
It is not clear what causes migraines. One theory is that it is due to imbalances in brain chemicals, specifically Serotonin. Another is that it is related to the trigeminal nerve that releases chemicals that cause pain. An older theory is that migraines occur due to vasospasms in the brain’s vascular system. A classic migraine may occur when brain blood vessels constrict which can cause decreased flow to the occipital cortex, a part of the brain that control vision. Patients can get dark floaters or spots in their vision. Typically this in both eyes presenting at the same time. Patients also commonly see a “scintillating scotoma” which is a zig-zag pattern of flickering lights that mainly occurs in the outside periphery of the vision in each eye. This can block the peripheral vision. Patients can be very light sensitive. Lastly, patients can notice a dimming of the vision in one or both eyes. The visual symptoms usually last for approximately 20 minutes. Once the visual symptoms subside, the severe headache starts. The headache can last between 4-72 hours. Conversely, in an ocular migraine, the patient never gets the headache. In the majority of the cases, the visual symptoms are transient, but uncommonly they can last for more than a day and, very rarely, become permanent.
As a retina specialist, we commonly examine people who experience flashes and floaters. If a patient calls in the office with these symptoms, they are seen quickly due to the possibility of a retinal tear or detachment which requires emergency treatment. Upon a thorough examination, retinal tear and detachment can be ruled out. Not uncommonly, the cause of the flashes and floaters are due to migraines. With good history taking, sometimes symptoms described over the phone can determine if a patient needs to be examined or reassured that they are experiencing a migraine and do not need to be seen by the eye doctor. If a migraine is a new phenomenon, the patient should be examined by their primary care doctor for a physical and neurological exam. The majority of patients with migraines have no neurological issues but rarely migraines can be a sign of a bigger problem.
In summary, as a retina specialist, not all flashes and floaters are created equally. If a patient has an acute shower of floaters or flashes in only one eye which don’t go away, the flashes occur more at night or in the dark, there is a “shadow,” or the vision is hazy, then we think it is a retina/vitreous issue such as retinal tear or detachment. If a patient has transient visual symptoms in both eyes with a scintillating scotoma, dark splotches, dimming of vision, associated with light sensitivity that lasts for about 20 minutes and completely resolves, and is sometimes followed by a headache then we think migraine.
Dr. Glazer-Hockstein graduated Cum Laude from Jefferson Medical College. She was a member of the Hobart Armory Hare Honor Medical Society and was elected to the Alpha Omega Alpha Honor Society. She also received the Carol R. Mullen prize in ophthalmology. She completed her residency at the Scheie Eye Institute, University of Pennsylvania. During that time she was elected Chief Resident. After residency, Dr. Glazer-Hockstein completed a two years medical retina fellowship at the Scheie Eye Institute, University of Pennsylvania.
Dr. Glazer-Hockstein has published multiple articles in peer-review journals and has lectured on a variety of retinal disease subjects. Her specialization includes but is not limited to: macular degeneration, retinal vascular disease, and diabetic retinopathy.
Paula C. Ko, MD is with Eye Physicians & Surgeons, P.A., 1207 North Scott Street, Wilmington, DE 19806. Dr. Ko graduated with honors from the Ohio State University College of Engineering in 1984. Dr. Ko received her M.D. degree from the Ohio State University College of Medicine in 1989, again with honors. Following her residency in Ophthalmology at Temple, Dr. Ko served a prestigious fellowship at Georgetown University in diseases of the retina and vitreous, and is Certified by the American Board of Ophthalmology.
Dr. Ko has an area of special expertise in retinal problems, especially diabetic eye disease, macular degeneration, and retinal detachment. Dr. Ko has lectured extensively, and has published many papers on these topics. Dr. Ko is active in resident training, and is on staff at Temple University, as well as at the Medical Center of DE. Dr. Ko is at the forefront of ophthalmic technology, and utilizes the most advanced procedures, including laser treatment and intraocular injections, in the care of her patients.
