Visual Flickering: Is It a Sign of Migraine or Neurological Issue?

Q: Visual Flickering: Is It a Sign of Migraine or Neurological Issue?

Hello, Miss Hsiao-Wen： You mentioned that you experienced a migraine on the night of your first visual aura, but not during the second occurrence. <br>I would like to ask if you have a history of migraines? If this is a new symptom, it may be advisable to seek medical evaluation.

Visual flicker?

There were two instances in the early morning, right after waking up, when I experienced flickering in my vision under dim lighting, resembling the flickering of a failing light bulb or an old television screen malfunction (the flickering was in shades of black and gray, not bright colors).
I visited an ophthalmologist who performed a dilated fundus examination and confirmed that the structure and function of my retina were normal.
The doctor suggested that I consult a neurologist.
On the night of the first visual flicker, I experienced a migraine, but I did not have one during the second instance.
I would like to know if this could be a precursor to visual migraine.
Should I just observe the situation, or would it be advisable to arrange for a detailed examination? Is this a serious and urgent issue? Thank you.

Xiao Wen, 30~39 year old female. Ask Date: 2022/03/23

Dr. Jiang Junyi reply Neurology

Hello, Miss Hsiao-Wen: You mentioned that you experienced a migraine on the night of your first visual aura, but not during the second occurrence.
I would like to ask if you have a history of migraines? If this is a new symptom, it may be advisable to seek medical evaluation.
Generally, common symptoms of migraine with aura include visual disturbances.
These can manifest as bright lights resembling stars or lightning, as well as blurred or distorted vision, which are considered migraine auras.
A few minutes after the aura appears, you may experience tingling, weakness, or numbness in the face, hands, or legs.
During the attack, symptoms such as nausea, vomiting, photophobia, phonophobia, and pallor may accompany the headache.
After the aura subsides, a severe, unilateral throbbing headache typically follows.
These migraine symptoms can last for several hours, and in some cases, up to 2-3 days.
It is recommended to consult a neurologist, particularly one who specializes in headache medicine, for further evaluation and management of these conditions.
Wishing you good health and peace.
Dr.
Jiang Jun-Yi, Department of Neurology, Tzu Chi Hospital, cares about you.

Reply Date: 2022/03/23

More Info

The phenomenon of visual flickering, especially when experienced in dim lighting conditions, can indeed be concerning and may indicate underlying neurological or ophthalmological issues. Given your description of the flickering resembling a malfunctioning light or an old television screen, it is essential to consider several factors that could contribute to this experience.

Firstly, the occurrence of visual flickering in conjunction with a migraine episode suggests a potential link to migraine-related visual disturbances, commonly referred to as "aura." Auras can manifest as various visual symptoms, including flickering lights, zigzag patterns, or even temporary loss of vision. In your case, the fact that the first episode of flickering was followed by a migraine later that evening supports the idea that this could be a form of visual aura. However, the absence of a headache following the second episode does not rule out the possibility of it being related to migraines, as some individuals experience auras without subsequent headaches.

The fact that your eye examination, including a dilated fundus exam, showed no structural abnormalities is reassuring. It suggests that the flickering is less likely to be due to retinal issues. However, since the symptoms have recurred, it is prudent to explore neurological causes, as recommended by your ophthalmologist. Neurological conditions, such as migraines, can sometimes present with visual disturbances that do not have an obvious ocular origin.

In terms of urgency, while visual flickering can be benign, it is essential to monitor the frequency and associated symptoms. If the flickering becomes more frequent, lasts longer, or is accompanied by other neurological symptoms (such as weakness, numbness, or speech difficulties), it would warrant immediate medical attention. Additionally, if you experience any changes in your vision that are persistent or worsening, seeking further evaluation is crucial.

Regarding further investigations, a referral to a neurologist is appropriate. They may recommend imaging studies, such as an MRI of the brain, to rule out any structural abnormalities or other neurological conditions that could be contributing to your symptoms. They may also consider conducting tests to evaluate your neurological function and assess for any signs of migraine-related changes.

In conclusion, while your visual flickering may be related to migraine, it is essential to remain vigilant and seek further evaluation if symptoms persist or worsen. Keeping a detailed log of your symptoms, including their frequency, duration, and any associated factors (such as stress, sleep patterns, or dietary changes), can be helpful for your healthcare provider in determining the best course of action. Always prioritize your health and do not hesitate to seek medical advice when in doubt.

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