How are ocular migraines normally treated following a diagnosis?
If the diagnosis of ocular migraine is made, recommended treatment will mostly be focussed on treating symptoms, as well as reducing the risk of future attacks. Ocular migraines typically resolve on their own, but symptoms can be managed.
For the most part, this can involve the use of prescribed medications. Those recommended are typically used for all forms of migraine, and not necessarily specific to ocular migraines.
Before any medications are prescribed, a doctor will take into account any existing medical conditions, the severity of symptoms experienced during an ocular migraine attack, frequency (if relevant – i.e. have these symptoms happened before and how often?) and the degree to which an attack interferes with a person’s ability to function. Severity and frequency will be some of the primary factors taken into consideration, as well as things which may significantly increase risk for a future attack.
For women, a doctor will also consider what can and can’t be prescribed while pregnant or breastfeeding (where applicable).
Known triggers will also be factored into a treatment plan recommendation.
Medication for ocular migraines
If deemed appropriate, medication options include:
Pain-relievers
Many pain-relievers are designed to target symptoms of pain in general and can thus be used for a variety of medical conditions. Pain-relieving drugs are also referred to as acute or abortive treatment medications, and can be taken during a migraine attack with the aim of stopping symptoms.
A doctor may prescribe or recommend the following to be taken if migraine systems develop again:
- For mild to moderate migraine pain (NSAIDs / nonsteroidal anti-inflammatories): Aspirin, ibuprofen, acetaminophen or indomethacin (also available in suppository form). Some combination medications may also be recommended and include Excedrin Migraine (aspirin, acetaminophen and caffeine). These pain-relievers are not recommended for long-term (repeated) use as they can lead to side-effects such as gastrointestinal bleeding, ulcers or dependency (causing medication-overuse headaches / chronic headaches). Many painkiller medications are thus not suitable to be taken for longer than 10 days per month. (2)
- Triptan medications: These medications target blood vessel constriction and work to block pain within the brain. In this way, triptans provide pain relief and help to alleviate other migraine associated symptoms. Triptan medications can be prescribed in pill, injection and nasal spray forms. Some, which a doctor may prescribe include sumatriptan (Imitrex, Immigran), almotriptan (Axert), frovatriptan (Frova), rizatriptan (Maxalt), zolmitriptan (Zomig), naratriptan (Amerge), or eletriptan (Relpax). These medications may be prescribed if an individual is at high risk of serious complications such as a heart attack or stroke. Side-effects can include nausea, dizziness, drowsiness, muscle weakness and adverse reactions at the site of an injection.
- Ergot medications: These types of medications have been noted as most effective when symptoms of migraine last for more than 48-hours. The sooner these medications are taken once a migraine starts, the better. These medications consist of ergotamine and caffeine and should be used exactly as recommended by a prescribing doctor. Medications which may be recommended include Migergot or Cafergot. Side-effects can include worsened symptoms of nausea and vomiting. Medication-overuse headaches is also a risk if not taken correctly. An ergot derivative is Dihydroergotamine (D.H.E. 45, Migranal), which is known to have fewer side-effects than ergotamine. This medication is also available as an injection or nasal spray.
- Opioid medications: These medications typically contain narcotics and can sometimes provide adequate migraine symptom relief. One ingredient of these types of medications is codeine and may be more tolerable for some individuals unable to take triptans or ergots. A doctor will recommend that these medications be taken exactly as prescribed and will likely monitor a person using them. Narcotics are known to be habit-forming.
- Glucocorticoids: Pain relief can also be achieved with the use of glucocorticoid medications such as prednisone or dexamethasone. These medications should be used as prescribed and monitored, so as to avoid side-effects.
- Anti-nausea medications: If applicable, these medications can help to get symptoms of nausea under control during the course of a migraine attack. These can be taken in combination with others while experiencing a migraine. Some common medications which may be recommended include metoclopramide (Reglan), chlorpromazine, or prochlorperazine (Compro).
While taking medications to treat a migraine attack, a doctor may also recommend that a person rest and try and sleep in a dark room while symptoms begin to ease.
Preventative medications
Preventative treatment may be considered if a person experiences severe attacks. If a person experiences at least 4 or more migraine attacks in a monthly period, has attacks which last longer than 12 hours at a time (including prolonged aura symptoms), or is not responding well to pain-relieving medications, a doctor may consider preventative therapy.
Preventative medications can help to reduce migraine attack severity, frequency and duration, as well as improve the effectiveness of pain-relieving medications taken during a migraine.
Preventative options involve medications which can be taken on a regular (sometimes daily) basis. Improvements may become noticeable after a period of time (often a few weeks) once treatment using these medications has commenced.
Preventative medications can be useful, for instance, for women who experience migraines when approaching menstruation (in their cycle). A predictable hormonal trigger, preventative medications can then help to keep severity of migraines under better control (i.e. these medications are not designed to prevent headache altogether).
Migraine prevention medications can include:
- Beta blockers: These medication types, normally prescribed for cardiovascular conditions (coronary artery disease or hypertension), can help to reduce the intensity and frequency of migraine symptoms. Some options include propranolol (Inderal LA or Innopran XL), timolol (Betimol) or metoprolol tartrate (Lopressor). Some calcium channel blockers, such as Verapamil (Calan or Verelan), normally prescribed for treating hypertension, can help to prevent migraine with aura.
- Antidepressants: Tricyclic medications have also been useful for reducing the frequency of migraine. These medications are designed to target serotonin and other chemicals in the brain. An antidepressant medication which has achieved some success in preventing migraine is Amitriptyline. Other forms of this type of medication may be prescribed should a person not be able to tolerate side-effects of this medication all that well. Side-effects include dry mouth, sleepiness or drowsiness, weight gain and constipation.
- Anti-seizure: Frequency of migraines can be adequately managed with medications such as valproate (Depacon) or topiramate (Topamax). Dosages of these medications will need to be very carefully managed due to the nature of side-effects, which can include problems with nausea, weight loss, tremor, dizziness, memory and concentration difficulty, diarrhoea and hair loss.
Preventative medications used over a period of time will be well-monitored by a treating doctor. He or she will have discussed usage benefits over potential risks and side-effects before prescribing an option which can help to achieve the desired result. Medications can have mild to severe side-effects and thus, must be well managed. Periodic follow-ups may also be required to assess how well a person is managing on the medication. After a period of time, it may be determined that preventative treatment has achieved good results (i.e. considerably reduced migraine frequency). In this instance, a doctor may recommend medication tapering (an easing off of medication use). Should migraines return, a doctor will re-look at options for preventative treatment. If not, recommendations for medication to treat symptoms as they occur may be more beneficial.
Proactively dealing with known ocular migraine triggers
If during diagnosis, a doctor is able to identify a trigger (or multiple triggers) for ocular migraine, he or she will advise that the affected person actively avoids all that are within their own control in order to reduce risk or prevent potential attacks in the future. Reducing exposure to a particular trigger, such as specific food, smoke, lack of sleep, dehydrated state or strenuous exercise, can considerably alleviate the possibility of future migraine attacks.
Making an effort to maintain a nutritious and balanced diet, and get plenty of sleep and regular exercise will not only improve a person’s overall health condition, but can also contribute to keeping future ocular migraines at bay (especially if emotional stress is a trigger).
Coping with and preventing ocular migraines
Ocular migraine is a condition that requires further, in-depth research. There is still much that is not entirely known relating to its direct causes, and as such influences both diagnostic and treatment procedures.
Unless a serious underlying condition is determined as a direct link to ocular migraines, most instances are not considered serious, and can be sufficiently managed, with a low risk of more serious complications or damage to eyes and surrounding tissues developing.
The most effective way a person can treat an ocular migraine when it happens is to safely take rest once symptoms begin. A dark and quiet environment where one can close and rest the eyes (reducing exposure to irritations such as bright light or sound) can be very helpful and as is taking a recommended pain-reliever as soon as possible. Some find that massaging the scalp or placing pressure at the temples helps to relieve pain. A damp cloth or towel (either warm or cold, depending on the affected individual’s preference) placed on the forehead can also be soothing. Before resuming any normal activity, a person should wait for visual disturbances to pass completely.
Reference
2. PubMed Health. 19 November 2015. Migraine - Overview: https://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0072557/ [Accessed 13.10.2017]