Ocular migraine, or migraine with aura, involves visual disturbances that occur with or without migraine pain.

Unusual moving patterns in your field of vision can be startling, especially when you aren’t sure what’s happening. Migraine with aura isn’t a stroke, and it’s not usually a sign that you’re about to have a stroke.

People with a history of migraine with aura may be at higher risk of stroke, so it’s important to understand the signs and symptoms of both. Migraine and stroke can occur together, but it’s rare.

Continue reading to learn more about the link between ocular migraine and stroke, and how to tell the difference.

According to the American Migraine Foundation, about 25 to 30 percent of people with migraine experience aura, and less than 20 percent have it with every attack.

Migraine with aura involves visual distortions that might remind you of looking through a kaleidoscope. It typically affects both eyes. Symptoms can include:

  • sparkling or shimmering spots
  • colorful stars, zig-zag lines, or other patterns
  • fractured or brightly colored images
  • blind spots
  • speech changes

Certain things, like bright or flashing light, can trigger migraine with aura.

An attack usually starts with a small spot that slowly expands. It might dart away when you try to focus on it. You may still see it when you close your eyes.

These can be disturbing, but they’re temporary and not usually harmful.

The attack typically lasts 20 to 30 minutes, after which vision returns to normal.

For some people, this aura is a warning sign that migraine pain and other symptoms will soon hit. Others have aura and pain at the same time.

An attack can also happen by itself, with no pain. This is called acephalgic migraine or silent migraine.

Migraine with aura isn’t the same as retinal migraine, which is more serious. Retinal migraine happens in only one eye and can cause temporary blindness or in some cases, irreversible damage.

Having migraine with aura doesn’t mean you’re having a stroke or that stroke is about to happen. If you have migraine with aura, though, you may be at a higher risk of stroke.

A prospective, longitudinal study published in 2016 compared people with migraine to those without migraine. The mean age of participants was 59.

Results showed a significant association between migraine with visual aura and ischemic stroke over 20 years. No association with stroke was found for migraine without visual aura.

Other research has found links between migraine and stroke, particularly migraine with aura, possibly doubling the risk. One 2019 study focused on young female patients with no other risk factors.

The reason for this increased stroke risk isn’t fully understood. What is known is that both migraine and stroke involve changes to blood vessels. People with migraine with aura may be more likely to develop blood clots from narrowed blood vessels, which increases the risk of stroke.

Migrainous stroke

When migraine with aura and ischemic stroke happen together, it’s called a migrainous stroke or migrainous infarction. It’s caused by restricted blood flow to the brain.

Only about 0.8 percent of all strokes are migrainous strokes, so it’s rare. The risk of migrainous stroke is higher for women age 45 and younger. This may be due to hormonal changes and the use of hormonal contraceptives, which increase the risk of blood clots.

There are times when the symptoms of migraine and stroke can be similar. However, there are some key differences. Here’s what to know about the symptoms for each.

Migraine with auraStroke
symptoms develop slowly and gradually worsensymptoms appear suddenly
positive visual symptoms: something in your vision that isn’t usually therenegative visual symptoms: tunnel vision or vision loss
involves both eyes involves only one eye

Other symptoms of migraine with aura include:

Some other potential stroke symptoms include:

  • hearing loss
  • severe headache, dizziness
  • weakness on one side of the body
  • loss of motor control, loss of balance
  • trouble understanding or speaking
  • confusion

A few things can make it harder to know the difference between migraine and stroke without seeing a doctor. For example:

  • Transient ischemic attack (TIA). Also known as a ministroke, a TIA occurs when there’s a temporary lack of blood flow to part of the brain. The symptoms appear suddenly and pass quickly, sometimes within minutes.
  • Hemiplegic migraine. A hemiplegic migraine causes weakness, numbness, and tingling on one side of the body. These symptoms typically start before a headache.
  • Subarachnoid hemorrhage. A subarachnoid hemorrhage happens when there’s bleeding between the brain and the tissues that cover the brain. It can cause a sudden, severe headache.

Stroke is a life threatening emergency in which every second counts. Seek immediate medical attention if you have warning signs of stroke, such as sudden:

  • vision loss in one eye
  • inability to speak
  • loss of control over one side of your body
  • severe headache

Yes, there are things you can do — starting right now — to lower your risk of stroke. For one thing, be sure to have a complete physical every year and see your neurologist for migraine prevention and treatment. Ask your doctor about:

  • medications that can lessen the frequency of migraine attacks
  • an assessment of your risk factors for stroke
  • birth control methods that don’t increase your risk of blood clots

There are also lifestyle changes you can make to reduce your risk of stroke. Some of the most important include the following:

Monitor and manage conditions that can increase your risk of stroke, such as:

If you’re living with migraine, the following nonprofits provide news, information, and patient support you may find helpful:

For migraine tracking, management, and community engagement, there are many excellent, free migraine apps, including:

Ocular migraine, or migraine with aura, and stroke are two different conditions. Having an attack doesn’t mean you’re having a stroke or are about to have one. However, research has shown that people with migraine with aura are at an increased risk of stroke.

Talk to your doctor about your risk of stroke and steps you can take to lower that risk. Some lifestyle changes that may reduce your stroke risk include managing your weight, getting regular exercise, and not smoking.