Flashes and Floaters ~ Caused by Migraines By Eye Physicians and Surgeons, P.A. on November 05, 2018

Dr. Paula Ko, one of our Retinal Specialists at EPS, wrote an article on flashes, floaters and migraines which was published in the Fourth Quarter edition of The New Castle County Women’s Journal.  In this article Dr. Ko writes about two categories of migraine headaches.

Category 1 – Classic Headaches

In this category the patient experiences a visual aura that is followed by a severe headache.  These headaches usually begin in childhood, adolescence or early adulthood.

Category 2 – Ocular Migraines

In this category the migraine occurs when patient has a visual disturbance but is not followed by a headache.  It also occurs more commonly in patients that are 60 years of age or older.

Usually patient has already had the first headache or ocular migraine earlier in life and they have a family history of it as well.


The cause of migraines is not clear. However Dr. Ko informs us of 3 theories:

Theory 1:  Brain chemistry imbalance – especially regarding Serotonin.

Theory 2:  Possible relationship to trigeminal nerve.  This nerve releases chemicals that cause pain.

Theory 3:  An older theory is that of vasospasms in the brain’s vascular system.  When brain blood vessels constrict, causing a migraine, then there is less flow to the occipital cortex which controls vision.  Dark spots or floaters can appear in both eyes concurrently.  Another occurrence affecting the peripheral vision is a zig zag pattern of flickering lights.  Patients become light sensitive.  Dimming of the vision is another symptom.  The severe headache begins after the symptoms settle.  In an ocular migraine the headache never comes and usually the visual symptoms disappear – they rarely become permanent.

When is an appointment a good idea?

Dr. Ko states that retina specialists examine patients with flashes and floaters quite often.  When a patient calls and describes having flashes and floaters they are seen quickly.  This is because it is possible the patient has a retinal tear or detachment which needs to be repaired.  It is not uncommon that the patient is experiencing a migraine and not an emergent problem.  At times, the patient needs to be referred to a neurologist for evaluation.

In closing, Dr. Ko states that “not all flashes and floaters are created equally.” The reaction or response of the physician relies on the description of symptoms. 

For further information please follow the link provided and read Dr. Ko’s complete article.


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