[00:00]
Have you ever suddenly struggled to see clearly and wondered what is this?
[00:05]
Is this migraine aura?
[00:08]
What is this blind spot?
[00:09]
Or a simple blurred vision?
[00:11]
Or something I should actually worry about?
[00:16]
Welcome to Migraine Heroes, a podcast for people living with chronic migraines with
[00:21]
years of pain, misunderstanding and lack of answers.
[00:25]
I'm Diane Ducarme.
[00:27]
I've helped more than a thousand people reduce the burden of migraines and feel more in control.
[00:32]
My mission in life?
[00:34]
To help a million people.
[00:36]
Each episode brings you grounded insight into what your body might be asking for and what
[00:44]
Just to keep you fully supported, this podcast is educational.
[00:48]
For diagnosis or medication, always work with your doctor.
[00:53]
Now take a breath and let's dive in.
[00:58]
In this episode, you will learn how to recognize the characteristics of a visual migraine aura,
[01:03]
including one clue that is surprisingly useful.
[01:06]
What a scatoma actually is, why it is not necessarily the same thing as migraine aura,
[01:12]
and how to tell the difference between a blind spot, shimmering vision, and blurring.
[01:16]
And which visual changes deserve prompt medical attention, because not every vision problem
[01:21]
in someone with migraine should automatically be called migraine.
[01:26]
Stay with me till the end, because by the end of this episode, you will be able to describe
[01:30]
a visual disturbance much more clearly to your doctor, and giving them genuinely useful
[01:35]
diagnostic information.
[01:37]
Now I remember in the very early days when I started working with people living with
[01:42]
migraine, hearing these strange descriptions.
[01:45]
I see dots, I see prisms on the side of my vision, there are shimmering shapes in my
[01:50]
vision, a rainbow, a tunnel.
[01:53]
And when it happens, it can be genuinely frightening.
[01:56]
You may suddenly see dots, sparkling lights, prism flashes, or strange geometric shapes
[02:01]
that seem to appear from nowhere.
[02:03]
And naturally, your first thought may be that something is wrong with your eyes.
[02:07]
Many would have already been to an ophthalmologist, or an optometrist, or sometimes several eye
[02:13]
They have had their eyes checked, sometimes repeatedly, and they are told everything looks
[02:19]
But the dots are still there, the prisms still appear, and the strange visual episodes keep
[02:26]
And eventually they arrive with the same question, if my eyes are fine, then what am I actually
[02:32]
Is this my migraine?
[02:33]
Or something wrong with my eyes?
[02:35]
And that uncertainty can be deeply unsettling.
[02:38]
I once met an artist named Priya Rama, and we recorded a podcast together.
[02:43]
Priya had found a way to create something meaningful from her pain.
[02:48]
She began painting the visual disturbances she was seeing.
[02:52]
Her work is absolutely stunning.
[02:54]
I actually have two of her own pieces in my home.
[02:58]
And Priya told me something I've never forgotten.
[03:00]
She said, when my work is hanging in the gallery, most people walk past it, perhaps sort of
[03:06]
appreciating it as simple art.
[03:09]
But every now and then, someone stops, and they stare at the painting.
[03:15]
They stare, and they stare, and then they start crying.
[03:20]
And they come to me, usually hug me, and say, thank you, thank you so much, this is what
[03:26]
And just imagine what that moment means.
[03:29]
Perhaps that person has spent years trying to explain these strange dots, prisms, lights,
[03:33]
shapes, or distortion to other people.
[03:36]
Perhaps they have wondered whether anyone else sees the world the way they do.
[03:40]
And suddenly, there it is, hanging on a gallery walk.
[03:45]
Someone else has seen it, and someone else has lived it, and someone has turned it into
[03:51]
something visible.
[03:52]
And there's something incredibly validating about that.
[03:55]
Sometimes, before we even have an explanation of what is happening in the body, simply realizing
[04:00]
I'm not the only person who experiences this, it can be deeply moving.
[04:05]
And I think Priya is one of those beautiful souls and examples of someone who's found
[04:09]
purpose in spite of her pain, and she's taking something frightening and difficult and transformed
[04:14]
it into art that can make another person feel seen, understood, and a little less alone.
[04:20]
And trust me, she really shines.
[04:23]
So let's start with some definitions.
[04:25]
We're going to start with migraine aura and build up from there.
[04:28]
You're going to see why.
[04:29]
So migraine aura is a temporary neurological disturbance.
[04:33]
It can affect vision, sensation, language, we've talked about that, and more rarely,
[04:37]
other neurological functions.
[04:39]
And visual symptoms are the most common form of aura, and according to the International
[04:44]
Classification of Headache Disorders, a typical aura is fully reversible.
[04:49]
It usually develops gradually, and an individual aura symptom commonly lasts between approximately
[04:54]
five to 60 minutes.
[04:56]
And here's the first important idea.
[04:59]
Migraine aura is not primarily an eye problem.
[05:03]
In the typical visual aura, what you're experiencing is thoughts to arise largely from an activity
[05:08]
in the visual processing areas of the brain, particularly the cortex at the back of the
[05:14]
And one major explanation involves a phenomenon called cortical spreading depolarization,
[05:19]
a slowly propagating change in the electrical and chemical activity of nervous cells and
[05:25]
supporting cells across the cerebral cortex.
[05:27]
This phenomenon is widely considered an important biological correlate of migraine aura, and
[05:33]
that it helps explain something fascinating.
[05:36]
Your eyes can be structurally fine, while your experience of vision becomes dramatically
[05:41]
Now, aura often does something, a useful distinction between what neurologists sometimes describe
[05:47]
as positive and negative visual symptoms.
[05:51]
A positive symptom, in that jargon, means that something has appeared in your vision
[05:56]
that is not actually in the outside world.
[05:59]
You might see, for example, flashing lights, or sparkles, or shimmering, or zigzag lines,
[06:04]
or geometric patterns, or a flickering border.
[06:08]
A negative symptom means that something is missing, so part of your visual field might
[06:14]
become gray, or blank, or dark, or just simply absent.
[06:18]
And many migraine auras contain both.
[06:22]
Something shimmering appears, and behind it, vision may become incomplete.
[06:26]
Research describing patients with visual aura has documented scintillating scatomas,
[06:31]
we're going to talk about that, zigzag patterns, blurred areas, and tunnel-like disturbances
[06:36]
among the reported experiences, and definitely what I've heard as well.
[06:41]
And so that brings us to our second word, scatoma.
[06:45]
So what exactly is a scatoma?
[06:47]
A scatoma is an area of reduced or absent vision within your visual field.
[06:52]
So think of your visual field as the entire picture available to you, while you're looking
[06:58]
And a scatoma is a piece missing from that picture.
[07:01]
And here's the crucial point, the scatoma is going to describe the symptom, but it does
[07:05]
not describe the cause.
[07:07]
A migraine can produce a scatoma, which is still not the cause.
[07:11]
But retinal disease can also produce one.
[07:14]
Optic nerve problems can produce one.
[07:16]
Other neurological disorders can produce one.
[07:19]
So saying I experience scatoma is like saying I experience pain.
[07:24]
It tells us what happened, but not necessarily where it came from, at least from a Western
[07:32]
Now, one particularly famous migraine phenomenon is called scintillating scatoma.
[07:37]
Scintillating essentially refers to the sparkling, the flickering, the shimmering quality.
[07:42]
So rather than a complete quiet blind spot, imagine, and you may have seen this, an area
[07:47]
of altered or missing vision surrounded by a moving, flashing, zigzag edge.
[07:53]
And that pattern is highly associated with migraine aura.
[07:56]
Although any new visual symptoms still deserves appropriate clinical assessment.
[08:01]
The important concept is aura is the neurological event.
[08:04]
A scatoma can be one feature in that event.
[08:08]
There are therefore not competing diagnoses in the way people sometimes imagine.
[08:12]
You can have migraine aura containing a scatoma.
[08:16]
Now then, what is blurred vision?
[08:18]
Blurred vision is different again.
[08:19]
Blurred vision generally means that the image is still there, but it's lost its sharpness.
[08:24]
So imagine looking at a camera that has slipped slightly out of focus.
[08:28]
You can still see letters.
[08:30]
You can still see there's a person's face.
[08:33]
You can still see there's a chair, but the edges are fuzzy.
[08:36]
That is different from scatoma, where part of the information may actually seem absent.
[08:42]
It is also different from the classic positive phenomenon of visual aura, where you may see
[08:47]
lights, patterns, movements, or distortion that are not coming directly from the object
[08:51]
you're looking at.
[08:52]
Now I'm working at the moment with a woman in the United States, what is called a thrive
[08:57]
And recently we had one of our one-on-one follow-up and her parents were there too.
[09:01]
They're incredibly sweet, always listening, always so attentive to their daughter.
[09:06]
It's really gorgeous.
[09:08]
And if you can come with your parents or your partner, I think is really nice.
[09:11]
And so she was commenting on many of her symptoms, things that had improved or et cetera.
[09:16]
And I asked her, what about your blurred vision?
[09:19]
What about the dizziness?
[09:20]
Because sometimes when people have less of a symptom, they sort of forget mentioning
[09:24]
And she stopped for a moment, she was reflecting and she said, that's interesting you ask.
[09:30]
It's more like my focus has de-zoomed.
[09:32]
I was having a camera and it was really zoomed in and everything was therefore super sensitive
[09:37]
and moving around all the time.
[09:39]
And now it has de-zoomed.
[09:40]
And I loved that expression.
[09:42]
So she has vestibular migraine and there is still dizziness and there's still a bit of
[09:47]
blurring, but she was trying to describe that the whole visual experience no longer felt
[09:51]
so intense and so intensely closed, so strained, so locked in.
[09:55]
So my focus has de-zoomed and the whole world feels more grounded.
[09:59]
So not completely, not yet, but a lot better.
[10:01]
And that really matters in our work because a lot better means, okay, just more of it
[10:05]
were in the right direction.
[10:06]
Now here's another clue to help you distinguish all of this.
[10:10]
It's to watch for the timeline.
[10:12]
So this may be one of the most important parts of today's episode.
[10:15]
So with typical migraine aura, the visual phenomenon frequently evolves gradually.
[10:20]
It does not necessarily appear as one finished picture.
[10:24]
Perhaps you first notice a tiny bright patch, then it grows, then a zigzag pattern develops,
[10:31]
then it drifts across a part of your visual field, then it gradually disappears.
[10:36]
And neurologists in the British Journal of General Practice in 2020 emphasize that gradual
[10:43]
evolution of symptoms over more than several minutes is one of the key characteristic clues
[10:49]
that suggests migraine aura.
[10:52]
So think migration, evolution, and then resolution.
[10:55]
So migraine aura often has sort of a story unfolding.
[10:59]
It's going to develop, it moves, it spreads, and then it resolves.
[11:04]
The International Classification of Headache Disorders similarly describes typical aura
[11:08]
characteristics including gradual spread, reversibility, and individual symptoms generally lasting
[11:13]
between 5 and 60 minutes.
[11:15]
It does not mean every visual event lasting 20 minutes is migraine.
[11:20]
And by the way, just as a side note, some of them are silent, so they don't come with
[11:24]
And it does not mean that migraine aura will always behave perfectly according to a textbook,
[11:28]
but the timeline gives your doctor valuable information.
[11:31]
Now, is it in one eye or both eyes?
[11:34]
Now we come to another very important distinction.
[11:38]
When visual aura arises from the visual cortex of the brain, the disturbance commonly affects
[11:43]
the same region of the visual field of both eyes, even though your perception may make
[11:49]
it feel as though it belongs to one eye only.
[11:52]
So that difference can be surprisingly difficult to recognize during an attack.
[11:56]
The International Classification of Headache Disorders actually notes that people may mistakenly
[12:00]
describe a visual disturbance as affecting one eye when it's really affecting the corresponding
[12:04]
part of the visual field of both eyes.
[12:07]
And so true temporary visual loss confined to one eye deserves particular attention.
[12:12]
So there's a rare condition called retinal migraine, which involves full reversible visual
[12:16]
disturbance confined to one eye.
[12:18]
But retinal migraine is quite uncommon, and other causes of temporary one-eye vision loss
[12:23]
need to be excluded.
[12:25]
So this is one of the reasons I don't want you to simply decide, oh, I have migraine,
[12:29]
therefore this must be retinal migraine.
[12:31]
New one-eye vision loss needs medical evaluation.
[12:36]
So if we simplify everything we've covered, aura describes a neurological process.
[12:42]
A visual aura frequently changes, develops, spreads, or creates unusual visual phenomena.
[12:49]
Scatoma describes a missing or reduced area of the vision, but it can also occur for completely
[12:55]
different reasons.
[12:57]
A blurred vision describes loss of clarity of focus.
[13:00]
So these are not perfect diagnostic rules, but they're a really useful language.
[13:05]
So when should you not assume it is migraine?
[13:08]
And this part matters.
[13:10]
If you have experienced the same medically evaluated aura pattern for years, you may
[13:14]
have come very familiar with your own sequence.
[13:17]
So do seek medical assessment and potentially urgent medical assessment for sudden or concerning
[13:22]
visual change, particularly when it's accompanied by symptoms such as new weakness, facial drooping,
[13:28]
sort of altered consciousness, or a dramatically different neurological pattern, or sudden
[13:33]
significant vision loss.
[13:35]
And this is ambiguous because sometimes vision loss, it still can be corrected peacefully,
[13:40]
but you need to rule out and make sure.
[13:43]
Again, rare, but I prefer to mention it so you can know and you can feel those nuances
[13:48]
and those circumstances.
[13:49]
Now let's us change lenses and go east for a minute.
[13:54]
Traditional transmission does not describe migraine aura in terms of cortical spreading
[13:58]
depolarization, visual cortex activity, or electrical signaling between nerve cells,
[14:04]
even though you would argue like acupuncture is rewiring electricity inside the body and
[14:11]
But it's going to use a very different language.
[14:13]
And I think it is useful to be clear here.
[14:16]
This is a traditional explanatory framework, not an alternative scientific diagnosis of
[14:21]
sudden vision loss, but it is very powerful because it can lead to results.
[14:26]
It has gone through thousands of years of experimentation and validation and making
[14:32]
And the body is a very old machine.
[14:33]
So in traditional Chinese medicine, vision has historically been connected particularly
[14:37]
with the functional system associated with the liver.
[14:40]
And so when Chinese medicine uses the word liver in this context, it is describing something
[14:45]
broader than the anatomical liver measured on a blood test.
[14:49]
It refers to a traditional network of functions involving movement, regulation, emotional
[14:54]
responsiveness, nourishment, and the smooth circulation of what is called Qi, so your
[14:58]
energy and your blood.
[14:59]
And so one classical idea is that the eyes depend upon adequate nourishment while also
[15:05]
requiring the body's internal movement to remain smooth and obstructed.
[15:11]
Oftentimes, when I was doing all of the onboarding calls, I'd say to people, the eyes are connected
[15:17]
And one way we know that in Western folklore is that when someone has their eyes, the whites
[15:23]
of their eyes, with a lot of blood cells, a lot of blood veins dilated, we know they've
[15:29]
had some form of toxicity, recreational or not, but something's off with their liver.
[15:35]
When someone has a jaundice, we also know from the eyes, we can guess.
[15:40]
And so in Western folklore, we do have that relationship as well.
[15:43]
And so traditional Chinese medicine gives us an interesting philosophical image.
[15:48]
For clear vision, Chinese medicine would say you need both enough nourishment and enough flow.
[15:53]
So too little nourishment and vision may feel weak or unclear.
[15:56]
So if you think back of all of that electricity and those wires and those cables and the depolarization,
[16:03]
they seem to say, hey, you know, to have that all working, you need this to be nourished
[16:08]
And so too much rising activity, internal agitation, stagnation, and symptoms may feel
[16:13]
more dynamic, flashing, distorting, moving, pulsating.
[16:16]
And again, that's a traditional interpretation, not a modern neurological mechanism.
[16:20]
But listen to the metaphor for a moment.
[16:23]
When the water is well supplied and the surface is calm, it reflects the world clearly.
[16:28]
But if the water becomes depleted, the reflection becomes incomplete.
[16:32]
And so if a strong wind suddenly moves across the surface, the picture becomes distorted.
[16:37]
The tree is still there, the moon is still there, but their image becomes unstable.
[16:42]
And Chinese medicine has long used natural imagery like wind and rising and heat or deficiency,
[16:49]
stagnation, nourishment, and to describe changing patterns within the human body, just like
[16:57]
And migraine, with its movement, throbbing, sensory sensitivity, nausea, visual disturbance,
[17:03]
and sometimes dramatic transition from one state to another, fits remarkably well in
[17:07]
to that kind of language.
[17:08]
Not because Asian physicians knew about cortical depolarization, they did not, but because
[17:12]
they were exceptionally attentive to patterns of change.
[17:15]
This is where Western neurology and traditional Chinese medicine unexpectedly share something
[17:20]
The timeline matters.
[17:21]
Did something occur suddenly?
[17:27]
Does it come after exhaustion, after emotional strain, around menstruation, after missing
[17:31]
meals, after poor sleep?
[17:33]
Does it occur when the body has been pushed too far?
[17:36]
Traditional Chinese medicine often asks not simply, what symptom do you have, but under
[17:40]
what conditions does your system produce this symptom?
[17:43]
And that can be a useful question for anyone living with migraine.
[17:47]
And yes, some of these concepts can feel a little esoteric at first, and it's difficult
[17:52]
to unpack all of that in one episode.
[17:54]
But what I find so powerful is that they offer magnificent tools for looking at root causes
[18:00]
and tackling them.
[18:01]
There's something extraordinary in the rigor behind thousands of years of clinical observation,
[18:05]
identifying something, watching carefully, adjusting, testing again, and passing those
[18:09]
observations forward.
[18:10]
And today we have the privilege of being able to benefit from that accumulated wisdom while
[18:15]
also bringing it into conversation with modern science.
[18:17]
And if I may say something very openly, one thing I sometimes feel is missing in Western
[18:22]
medicine yet is enough attention to why the same symptom may be happening for different
[18:29]
reasons in different people.
[18:30]
We can be tempted to see the same symptom and reach for the same solution, but the reality
[18:35]
is often far more individual, and the underlying drivers can vary tremendously from one person
[18:42]
And so can their intensity.
[18:44]
That means the support, the dosage, the sequence, and the pace may need to be very different
[18:49]
There can also be a domino effect where one imbalance contributes to another.
[18:52]
And if we only address the final symptoms without looking at the chain, the results
[18:57]
may not be sustainable.
[18:58]
So here's your practical experiment for today.
[19:00]
I'd like you to create a note on your phone called My Visual Pattern or on a piece of
[19:05]
And if a visual disturbance happens again, and only when you are somewhere safe, record
[19:11]
First, you record what exactly did I see?
[19:14]
Was it blur, flashing lights, zigzag, shimmering, distortion, or missing area?
[19:19]
Second, did it change or move?
[19:22]
Third, how long did that last?
[19:25]
Fourth, was it truly one eye or part of the visual field?
[19:30]
If it is safe and medically appropriate in the moment, people sometimes discover this
[19:34]
by briefly checking each eye separately.
[19:37]
But do not delay urgent assessment of new alarming vision loss simply performing this
[19:42]
And fifth, what happened next?
[19:44]
Headache, nausea, light sensitivity, numbness, speech difficulty, complete recovery.
[19:50]
You're not using this journal to diagnose yourself.
[19:52]
You're creating a better description.
[19:55]
Because my eyesight became weird, gives your clinician very little information, but a shimmering
[20:00]
zigzag began near the center of my vision, slowly expanded toward the right over 20 minutes,
[20:06]
seemed present with either eye open, disappeared completely, and headache followed 20 minutes
[20:13]
That is extraordinarily more informative.
[20:14]
But your goal is not to become your own neurologist.
[20:17]
Your goal is to become an excellent observer of your own body.
[20:22]
And remember, every small step you take moves you closer to freedom.
[20:27]
You are powerful, you are resilient, and you're not alone.
[20:31]
Keep rising, Migrant Hero.
