A migraine is a neurological condition that comes with a variety of symptoms. Typically, they’re characterized by intense, debilitating headaches. Other symptoms can include nausea, vomiting, numbness, difficulty speaking, tingling, and sensitivity to light and sound. What causes migraines and ocular migraines is currently under debate, as triggers vary from person to person. Unfortunately, experts still can’t quite pinpoint what causes migraines.

Some risk factors come into play when it comes to your chance for getting a migraine. Migraines often run in the family; family history is one of the most common risk factors for having migraines. You should also take note of your lifestyle, such as environment, diet, exercise, existing conditions, and current medications, as these all may play a role.

Top Related Article: How to Achieve Migraine Relief

Migraines also have an impact no matter your age; they can begin in childhood, or early adulthood. Millions of people are impacted by migraines, and the most important thing to understand is that they’re not just bad headaches; they come with debilitating pain and symptoms, including nausea and sensitivity. Ocular migraines are especially dangerous, as they can temporarily impact your vision.

The diagnosis of migraines is determined based on reported symptoms, clinical history, and by ruling out other causes. There are two common categories of migraine headaches: those without aura (previously known as common migraines) and those with aura (previously known as classic migraines). The following explores known causes for migraines and what can be done to treat them or prevent them.

What is a Migraine?

Migraine headaches are often divided into two categories: migraine with aura, and migraine without aura. An “aura” indicates sensations that a person experiences before the onset of a migraine. These sensations can occur anywhere from ten to thirty minutes before a migraine attack. They include:

  • Having trouble thinking
  • Feeling less mentally alert
  • Seeing flashing lights or unusual lines
  • Having an unusual sense of taste, smell, or touch
  • Feeling a tingling or numbness in either the face or hands

The most difficult aspect of migraines is that we don’t know what causes them. Currently, the thought behind the source of migraine symptoms reflects advances in technology that can help us understand how the nervous system and the brain work. Researchers now believe that migraines are neurological disorders that involve nerve pathways and brain chemicals. These disorders extend beyond just bad headaches: they’re comprised of extremely incapacitating collections of neurological symptoms. Everyone is different, and symptoms vary by individual and by attack.

If you experience a migraine, it’s important to consult your doctor or a headache specialist. Many migraines unfortunately go undiagnosed, as people don’t find help until their symptoms become more severe and disabling.

What Causes Migraines?

Migraines can be difficult to deal with, both for those who experience them and for the doctors who try to treat them, because the contributing factors to migraines are highly complex; what causes migraines is different for everyone. Unfortunately, there are also a wide variety of factors that can trigger an attack, so exact causes may be hard to pin down.

However, contributing factors should not be underestimated, and keeping track of what might possibly be causing your migraines can play a large part in getting treatment.

Causes include:

  • Genetic makeup
  • Hormones
  • Food choices
  • Other medical conditions
  • Menstrual cycle
  • Stress
  • Sleep deprivation
  • Alcohol
  • Weather
  • Anxiety

What Determines When Someone Will Get a Migraine Attack?what causes migraines

Migraines have thresholds, and how close a person is to that threshold at any given time is what determines how frequent, severe, and debilitating the headache and other symptoms of the attack will be. The key is to understand your own individual triggers, how close you are to your attack threshold, and to avoid triggers during vulnerable times.

Related Article: Eye Strain Treatment

Knowing your individual threshold will also allow doctors to develop an ideal treatment plan that will involve both preventive and acute treatment, as well as non-drug treatments such as stress management and a healthy diet.

Other factors play into your personal threshold and how close you are to it, including:

  • Lifestyle factors. Your everyday behaviors may be key contributors to the duration, frequency, and severity of migraine attacks. Analyzing aspects to your day to day life and developing a plan to manage relevant factors can minimize migraine impact. Key lifestyle factors that can impact migraines include:
      • Exercise
      • Diet
      • Sleep routines
      • Hydration
      • Stress management
  • Medical factors. There are a number of medical factors that may trigger an attack, and are just as important as your lifestyle. This is why it’s important that headache specialists evaluate all aspects of a patient’s health; certain psychiatric conditions such as anxiety and mood disorders can play a role, as well as sleep apnea. Jaw joint disorders and teeth grinding may also have an effect.

Symptoms of Migraines

While there are many types of headaches and they are not the same, they all share at least one thing in common: they cause pain. However, when a headache also causes other unwanted symptoms, such as nausea and vomiting, this is a sure sign that you may be suffering from a migraine.

If you feel throbbing that begins on one side, causes nausea, or causes sound or light sensitivity, you may be experiencing a migraine. Visual disturbances, such as flickering points of lights, sometimes precede migraines and serve as a type of warning. Other symptoms of migraines include:

  • Moderate to severe pain that affects the whole head or shifts from one side to the other
  • Pounding, throbbing pain
  • Blurred vision
  • Sensitivity to light, noise, or odors
  • Nausea or vomiting, stomach upset, and abdominal pain
  • Loss of appetite
  • Paleness
  • Fatigue
  • Dizziness
  • Fever
  • Sensations of being very warm or very cold
  • Bright flashing dots or lights, blind spots, wavy or jagged lines

Migraine symptoms do not only involve symptoms that occur as the migraine itself is happening; other symptoms may begin one to two days before the head pain itself. This is known as the prodrome stage. Symptoms during this stage include:

  • Depression
  • Food cravings
  • Fatigue or low energy
  • Frequent yawning
  • Hyperactivity
  • Irritability
  • Neck stiffness

For migraines that have an aura, the aura occurs after the prodrome stage. During an aura, you may have issues with your vision, movement, speech, and sensation. Examples of these problems include:

  • Feeling a prickling or tingling sensation in your face, arms, or legs
  • Difficulty speaking clearly
  • Temporarily losing your vision
  • Seeing shapes, light flashes, or bright spots

The next phase to migraines is known as the attack phase. This is the most acute or severe of all phases, as it is when the actual migraine pain occurs. For some people, this stage can overlap with, or occur during, an aura. Attack phase symptoms can last anywhere from hours to days, varying by individual. Symptoms may include:

  • Nausea
  • Dizziness, or feeling faint
  • Increased sensitivity to light and sound
  • Vomiting
  • Pulsing and throbbing head pain
  • Pain on one side of your head, either on the left side, right side, front, back, or in your temples

After the attack phase, a person will typically re-experience the postdrome phase. During this phase, there are usually changes in feelings and moods. These can range from feeling euphoric and extremely happy, to feeling very apathetic and fatigued. A mild, dull headache may persist for a while.

The length and intensity of all of these phases can occur to different degrees in different people. Sometimes, a phase is skipped. It’s even possible that a migraine attack occurs without causing a headache. As with many medical conditions, migraines vary from individual to individual, and this is partly why their causes and treatment may be so hard to pinpoint.

what causes a migraine

The Nausea and Pain of Migraines

People describe the pain of migraines as:

  • Pulsating
  • Perforating
  • Throbbing
  • Pounding
  • Debilitating
  • Like a dull, steady ache

The pain may start out mild, but without treatment, it will develop into more moderate or severe pain. It also most commonly affects the forehead area during migraines, and is usually on one side of the head, but may impact both sides or shift.

Most migraines last about four hours. If they’re not treated, or your body does not respond to treatment, the endurance of your migraines may worsen and they can become as long-lasting as three days to a week. This is why it’s essential to seek medical help if you ever experience a migraine, even if the symptoms fade naturally after an hour or so.

Related Article: Holistic Medicine

When it comes to nausea, more than half of the people who get migraines get nausea as a symptom or end up vomiting. While these symptoms may start at the same time as the head pain does, usually they begin about one hour before the migraine itself hits.

Nausea and vomiting can be as troubling as the headache itself. If you only have nausea, you will be able to take your migraine or pain medications that your doctor prescribed to you. Vomiting, however, prevents you from being able to take pills or keep them in your body long enough so they’re absorbed. If you’re forced to delay taking medication, your migraine is unfortunately likely to become more severe.

The Difference Between Migraines and Headacheswhat causes ocular migraines

When you suffer from pressure or pain in your head, it can be difficult to tell whether you’re experiencing a typical headache, or it’s the worse condition of migraine. In fact, many people don’t realize at first that they are experiencing migraines, as they just assume they’re having “bad” headaches. Differentiating is important, as it can help you get faster and better treatment, and can prevent future headaches from occurring in the first place. So, how can you tell the difference?

A headache is an unpleasant pain in your head that causes pressure and aching. This pain can range from mild to severe, and it typically occurs on both sides of your head. Specific areas include the forehead, temples, and back of the neck, and the pain may last anywhere from thirty minutes to a week.

The most common headache type is a tension headache, which is caused by muscle contractions and are often chronic. However, there are other types of headaches, including:

  • Cluster headaches. These headaches are severely painful. They impact one side of the head, and come in clusters, which means that cycles of headache attacks are experienced, followed by headache-free periods.
  • Chiari headaches. Chiari headaches are caused by the birth defect Chiari Malformation. This defect causes the skull to push against parts of the brain, which causes pain in the back of the head.
  • Sinus headaches. These headaches are most often confused with migraines. They co-occur with symptoms of sinus infections such as stuffy nose, fever, cough, congestion, and facial pressure.
  • Thunderclap headaches. These are very severe headaches that develop in sixty seconds or less. They may be symptoms of a subarachnoid hemorrhage, which is a severe medical condition caused by stroke, an aneurysm, or other injury. You should get help immediately if you experience this type of headache.

When it comes to migraines, the biggest defining difference is that a migraine may involve any of the headaches above, in addition to other symptoms. Symptoms associated with a migraine headache include:

  • Pains in the temples
  • Pain behind one eye
  • Pain behind one ear
  • Nausea
  • Sensitivity to light and/or sound
  • Temporary vision loss
  • Seeing spots or flashing lights
  • Vomiting

When compared to tension or other headache types, migraine pain also tends to be much more severe. Some people may be debilitated by their migraines and be unable to go to work or school, or even leave their room. Some people experience migraines so severe they seek help in emergency rooms; luckily, this is very rare. Other differences include the pain’s quality: a migraine has intense pain that may be throbbing, which makes performing even simple daily tasks very difficult.

See Also: Headaches Behind the Eyes

Another key difference between headaches and migraines is that people who suffer from migraines may experience symptoms a day or two before the actual migraine occurs. Headaches tend to happen very quickly, and do not have symptoms that come several days before the onset. The positive thing about this is that people who have migraines have a warning and may be able to prepare for their migraine if they notice early symptoms. Known as the “prodrome phase,” these subtle signs include:

  • Depression
  • Constipation
  • Irritability
  • Neck stiffness
  • Unusual food cravings

Differences in Triggers and Treatments for Migraines vs. Headaches

Besides the symptoms and pain, there are also differences in what causes migraines, and in how to treat them. People who have experienced migraines report various factors associated with them that help migraines stand out from normal headaches. These are called migraine triggers, and can include:

  • Alcohol
  • Emotional anxiety
  • Contraceptives
  • Menopause
  • Hormonal changes
  • Stress
  • Lack of sleep, or jet lag
  • Hunger
  • Certain smells
  • Medication overuse
  • Weather

In fact, some people have reported that they tend to get migraines when it rains or it is going to rain.

When it comes to treating headaches, headaches will go away with over-the-counter treatments. These include aspirin, ibuprofen, and acetaminophen. Most headaches are also stress-induced, so taking steps to reduce stress can help relieve pain and reduce risk for future headaches. These techniques include:

  • Massage
  • Meditation
  • Heat therapy, such as taking a warm shower or applying warm compresses
  • Relaxation exercises
  • Neck stretching

Migraines, however, are unfortunately more difficult to treat. Due to extra symptoms such as nausea, migraines are not healed by over the counter medication such as aspirin, and taking a shower may not help the pain go away. Treating migraines is much more complicated and can require prescriptions from a doctor for medication.

What is an Ocular Migraine?

Ocular migraines are specific type of migraine that may occur along with or after a typical migraine headache. You’ll know you’re experiencing an ocular migraine if you experience a visual disturbance and have temporary vision loss or blindness in one eye for short time, typically less than an hour. Regular migraine attacks can cause vision problems, including flashing lights and blind spots. However, these symptoms usually appear in both eyes, which is the key difference.

Luckily, ocular migraines are a rare problem and they are not considered to be a serious condition. Some research suggests that in many cases, the symptoms are actually due to other problems. If you believe you may be having ocular migraines, see your doctor; they will be able to rule out other conditions which cause similar symptoms. Be ready to describe exactly what has been going on. You may hear your doctor call ocular migraines by other names, such as visual, retinal, ophthalmic, or monocular migraines.

Symptoms of Ocular Migraines

If you’re experiencing a migraine, it can be difficult to tell if it’s an ocular migraine specifically. Warning signs include:

  • Vision problems that affect just one eye
  • A migraine that comes with an aura or a change in vision
  • A headache that lasts from four to seventy-two hours that tends to:
    • Affect one side of your head
    • Feel moderately or very painful
    • Feel worse when you move around
    • Throb or pulsate
  • Nausea
  • Vomiting
  • Being sensitive to light or sound
  • Seeing flashing or shimmering lights, zigzagging lines, or stars
  • Seeing psychedelic images

Out of all the people who report having migraines, one out of every five also report experiencing these symptoms or auras. It’s also common to experience an aura ten to thirty minutes before an ocular migraine sets in. Aura symptoms include:

  • Disrupted sense of touch, taste, or smell
  • Feeling mentally foggy or fuzzy
  • Numbness or tingling in the hands or face
  • Seeing blind spots, flashing lights, shimmering spots, or zig-zag lines

What Causes Ocular Migraines?

Unfortunately, just as with all types of migraines, experts aren’t quite sure what causes ocular migraines and the case is still currently under study. Some doctors theorize that ocular migraines have the same causes as classic migraines. It has also been well established that ocular migraines are typically the result of migraine activity occurring within the visual cortex of the brain.

Overall, the problem has been linked to:

  • Changes that spread across the nerve cells in the retina
  • Spasms in blood vessels in the retina  
  • Genetics. A personal or family history of migraines is a known risk factor for ocular migraines; a genetic link will increase your chances of having them.
  • Hormone levels. Migraines have been linked to the hormone estrogen, which controls chemicals in the brain that have an effect on the sensation of pain. In women, hormones fluctuate because of the menstrual cycle, menopause, and pregnancy, as well as oral contraceptives and hormone replacement therapies. A change to your hormone levels may offset ocular migraines.
  • Triggers. Most people are able to identify their individual migraine triggers, and research has shown that it’s likely a combination of triggers and factors that tend to cause migraines. Triggers vary from person to person, and they may include:
    • Loud sounds
    • Powerful odors
    • Bright lights
    • Changing weather
    • Stress, anxiety, or relaxation after a period of stress
    • Alcoholic beverages, especially red wine
    • Too much caffeine, or a withdrawal from caffeine
    • Artificial sweeteners
    • Foods containing nitrates (lunch meats, hot dogs)
    • Food containing monosodium glutamate, or MSG (broths, fast food, seasonings and spices)
    • Foods containing tyramine (hard sausages, soy products, smoked fish, aged cheeses)

You can attempt to identify your personal migraine triggers for what causes ocular migraines by keeping a headache diary; many doctors often recommend this. The diary should include notes on sleep habits, exercise, diet, environment (lights and sounds), and menstruation.

It’s rare, but people who have the ocular type of migraine may have a higher risk of permanent vision loss in one eye. It’s unknown to experts whether medications that prevent migraines, such as antidepressants or anti-seizure medications, can help prevent vision loss. If you tend to have ocular migraines, even if they go away on their own, it’s a good idea to alert your doctor and talk about your symptoms.

How Are Ocular Migraines Diagnosed?

When you speak with your doctor, they will ask you about your symptoms and examine your eyes. First, they’ll try to rule out other conditions that cause similar problems, such as:

  • Spasms in the artery that bring blood to the retina
  • Amaurosis fugax: temporary blindness due to a lack of blood flow to the eye, which can occur because of a blockage in an artery that leads to the eye
  • Other blood vessel problems related to autoimmune diseases
  • Giant cell arteritis, a problem that causes inflammation in blood vessels that can lead to vision problems and blindness
  • Conditions that keep your blood from clotting normally, such as polycythemia and sickle cell disease
  • Drug abuse

How Do You Treat Ocular Migraines?

Typically, the symptoms of ocular migraines go away on their own within thirty minutes; most people don’t need treatment for them. If you experience an ocular migraine, it’s best to stop what you’re doing and rest your eyes until your vision goes back to normal.  When you have a headache, you can take a pain reliever that your doctor has prescribed.

If you do experience vision loss and it occurs in one eye only, this could be due to a serious condition that isn’t related to migraines. Visit your doctor right away for prompt treatment, or go to an urgent care or emergency room.

There’s been little research on the best way to treat or prevent ocular migraines. You doctor may recommend some of these drugs:

  • Drugs that treat epilepsy, such as Depakote, Depakene, or Topamax
  • Blood pressure medicines that are known as beta blockers
  • Tricyclic antidepressants, such as Elavil or Pamelor

Treatment For Migraines

A comprehensive migraine treatment plan will include more than acute and preventive treatments; it should also have tools that will help you manage. You should consider non-drug treatments, like lifestyle modifications, and take a look at all of the potential contributing factors. Comprehensive plans will address all issues and give you your best chance to get better.

Tools such as meal planning, which helps you maintain a balanced diet and identify foods that may trigger migraines, and a headache diary to keep track of headache days and symptoms, are effective ways to manage and treat your migraines without the use of medication. Since migraine causes and triggers vary individually, the key to your personal treatment is to identify what offsets your migraines.

It’s important to note that migraines can’t be cured. Together, you and your doctor can help you manage your migraines so you get them less often and can alleviate symptoms when they occur. Treatment can also help migraines to be less severe. Your total treatment plan depends on:

  • Your age
  • The type of migraine you tend to have
  • How often you have migraines
  • How severe they are: how long they last, how much pain you experience, and how often they prevent you from going to school or work
  • Whether they include nausea and vomiting and other symptoms
  • Other health conditions you have
  • Medications you may be taking

A treatment plan will include a combination of:

  • Self-care remedies for migraines
  • Lifestyle adjustments, including stress management and avoiding triggers
  • Over the counter pain or migraine medications
  • Prescription migraine medications that you’ll take every day for prevention
  • Prescription migraine medications that you’ll take as soon as a headache starts, to keep it from becoming severe and to ease the symptoms
  • Additional prescription medications to help with nausea or vomiting
  • Counseling
  • Hormone therapy, if migraines occur in relation to your menstrual cycle
  • Alternative care, which may include meditation, biofeedback, acupressure, or acupuncture

Can Migraines Be Prevented?

While we don’t fully understand what causes migraines and they cannot be fully cured or prevented, there are some prevention tips that you can follow. Prevention is often the best treatment for migraine headaches. Examples of preventive methods include:

  • Taking steps to reduce stress
  • Making changes to your diet, such as eliminating foods and substances known to cause headaches or which are particular triggers for you, such as alcohol and caffeine
  • Taking prescription medications, such as blood pressure lowering medicines, antiepileptic medications, antidepressants, or CGRP antagonists

The Key to Treating and Coping with Migraines: Identify and Treat Early

Identifying and treating head pain that is not just a simple headache, as early as possible, is key to coping with migraines and to engaging in preventative treatments. These treatments will reduce the severity and minimize the chance of getting another headache. Pay attention to symptoms, how the migraine occurs, and what seems to trigger it, then speak with your doctor.

Even if your migraines exist by themselves and are not a symptom of an underlying condition, they can still be very debilitating and may negatively impact your life. Typically migraines will go away on their own within half an hour, but you should rest and avoid triggers such as bright lights until all disturbances are gone.

As you speak with your doctor, they may recommend either over the counter treatments, or prescription medications that can be used for treatment. Over the counter drugs like Excedrin or ibuprofen can reduce the symptoms of migraine once you already have them. Otherwise, your doctor can prescribe:

  • Beta blockers, to relax blood vessels
  • Anti-epileptics or antidepressants
  • Calcium channel blockers, which prevent blood vessels from constricting

As you experience a migraine and don’t want to take medication or don’t have access to any, you can:

  • Lie down or sit in a dark and quiet room
  • Put pressure on your temples
  • Put a damp towel on your forehead
  • Massage your scalp with a lot of pressure


Migraines, whether ocular or not, are concerning conditions that may become debilitating. While the causes for these intense occurrences of head pain have not been pinpointed, there is treatment available so you may reduce the severity of them and prevent them from occurring again.

If you think you’re experiencing migraines, contact your doctor immediately. Together, you can discuss what causes migraines and what causes ocular migraines. You can come to a conclusion as to underlying triggers, and how best to deal with them. This is especially important if you are experiencing drastic vision loss or impacts to your vision in one eye.

Migraines may be painful and frightening, but there is treatment available. Your doctor can help you manage them, and to put you on a track to prevent them from impacting you in the future.  

Dr. Barry

Dr. Barry

November 13, 2018