Migraine headaches can be anywhere from mild to profound. 


We have all heard of people who could not function during their migraines and simply had to go to a

dark room and sleep until the torture passed.  But, contrary to popular perception, migraines are not

necessarily headaches. 


A migraines is a combination of a nerve (neurological) and blood vessel (vascular) event that usually

occurs in the brain and may be associated with a host of symptoms and observations, one of which is

headaches. The exact mechanism for this neurovascular  disease is not clearly known which leads to

many theories, anecdotes and home remedies.




The ophthalmologist is usually alerted when a migraine is preceded by an aura.  An aura may actually

occur at any time in the course of a migraine, but visual auraus most commonly occur about one hour

prior to the onset of the headache, if there is even a headache at all. Because the visual aura is defined

as a 'scintillating scotoma' it may be interpreted by the suffer as "flashing lights' and sound the alarm

of an impending retinal detachment.


A 'visual aura' is often described as zig zaggy lines, or 'looking through cracked glass'. The visual aura

most often starts just off the center of vision and gradually spreads wider and migrates to the

peripheral vision. While they do impact a person's sense of vision visual auras do not typically obscure

vision entirely. To the migraine sufferer, the visual aura is akin to looking underwater. 


MIgrainous visual auras may be bilateral (seen as if in both eyes) or unilateral (seen as if in only one eye)

and classically last between 10-30 minutes.  Different migraine victims, and even the same migraine

patient, may see different variations of these auras in both duration and appearance.




Migraine headaches may follow the visual aura, and will usually start within one hour of the completion of the aura. 

MIGRAINES DO NOT NECESSARILY NEED TO INVOLVE HEADACHE.  A migraine is a vascular event inide the brain; a migraine headache is an additional manifestation of this event. 


The severity of the headache that is associated with a migraine is highly variable, and need not always be the same. Migraine headaches are typically thought to be severe, requiring the cessation of activity and seclusion in a dark room.  While some headaches are this dramatic, some are described as dull aches or pressure. The headache may be fleeting or last days.


When a person knows that the headache that usually follows his or her aura will be severe, there are medications to take in advance of the onset of the headache that will midigate, or sometimes even prevent, the headache's occurence. These issues are best evaluated by a neurologist and the treatment approach titrated to the person's needs.