Ocular Migraine: Clinical Insight, ICD-10 Coding, and Documentation Support

Updated on: August 1, 2025

Ocular migraine, also referred to as retinal migraine or visual migraine, presents a unique diagnostic challenge. Unlike typical migraines, ocular migraines are characterized by temporary vision disturbances, often in one eye, with or without accompanying headache.

For clinicians, documenting and coding ocular migraine correctly is essential—not only for patient safety and follow-up but also for reimbursement and care coordination. In this article, we’ll cover:

• What defines an ocular migraine

• Clinical symptoms and red flags

• ICD-10 codes to use

• Sample documentation workflow

• How DocScrib can enhance your migraine-related SOAP notes

What Is an Ocular Migraine?

An ocular migraine is a rare form of migraine that primarily affects vision. It typically presents as temporary monocular visual disturbances, such as:

• Flashes of light

• Scintillating scotomas (shimmering blind spots)

• Temporary partial or complete vision loss in one eye

These episodes usually last less than 60 minutes, may or may not be followed by a migraine headache, and are fully reversible.

🔍 Important Distinction:
Ocular migraines are not the same as migraine with aura (which involves binocular visual disturbances). Differentiating them is critical for diagnosis and documentation.

Clinical Presentation

Red Flags to Rule Out:

• Amaurosis fugax (retinal artery occlusion)

• Transient ischemic attack (TIA)

• Papilledema or optic neuritis

• Temporal arteritis in older patients

Causes and Triggers

Common ocular migraine triggers include:

• Stress

• Dehydration

• Hormonal fluctuations

• Bright lights or screen exposure

• Hypoglycemia

• Certain foods (e.g., caffeine, chocolate, MSG)

Ocular migraines may have a vascular origin, linked to transient vasospasm of the retinal artery.

ICD-10 Coding for Ocular Migraine

✅ Best practice: Start with G43.109 for ocular migraine with aura. Update as more clinical detail becomes available.

Clinical Documentation Example

Subjective:
“Patient reports two episodes this month of sudden partial vision loss in the left eye, lasting ~10 minutes each. One episode followed by dull headache. No weakness, speech slurring, or trauma.”

Objective:
Normal fundoscopic exam. No papilledema. Visual acuity intact post-event. BP stable. Neuro exam non-focal.

Assessment:
Likely ocular migraine vs. amaurosis fugax. Differential includes TIA, retinal pathology.
ICD-10: G43.109, consider H53.149

Plan:

• Order MRI brain and carotid Doppler to rule out vascular pathology

• Ophthalmology referral

• Start migraine prophylaxis (e.g., propranolol) if episodes persist

• Educate patient on triggers and when to seek emergency care

Diagnostic Workup

Depending on age and risk factors:

• MRI Brain – Rule out stroke, structural lesions

• Fundoscopy – Check for retinal detachment or ischemia

• Ophthalmology referral – Visual field testing

• Carotid Doppler/CTA – If vascular TIA suspected

• ESR/CRP – Rule out temporal arteritis in elderly

Documentation Tips for Ocular Migraines

✅ Specify if symptoms are monocular or binocular
✅ Clarify if aura is present or not
✅ Include duration, frequency, and impact on ADLs
✅ Document neurologic and ophthalmic exam findings clearly
✅ Note diagnostic steps (e.g., imaging, referrals)

Common Documentation Mistakes

🚫 Using “migraine” without specifying aura or intractability
🚫 Omitting duration and laterality of visual symptoms
🚫 Not linking visual symptoms to follow-up or imaging
🚫 Coding as general “headache” when clinical detail supports migraine

How DocScrib Streamlines Ocular Migraine Documentation

Ocular migraines are easy to under-document. In fast-paced clinical settings, visual symptoms are often described vaguely or coded incorrectly. DocScrib helps by:

✅ Recognizing ocular migraine descriptions via dictation
✅ Auto-suggesting accurate ICD-10 codes (e.g., G43.109, H53.149)
✅ Generating structured SOAP notes from your voice in seconds
✅ Flagging red-flag symptoms that require urgent referral
✅ Saving time in primary care, neurology, and urgent care settings

Smarter migraine documentation. Accurate billing. Better care.
👉 Book a free demo with DocScrib today

ICD-10 Quick Reference: Migraine Types

FAQs

Q1: How do I differentiate between ocular migraine and TIA?
Ocular migraines usually present with positive visual phenomena (e.g., flashing lights) that resolve within an hour, while TIAs often present with sudden vision loss and may include other neurologic deficits. Imaging is key to ruling out serious causes.

Q2: Can ocular migraines happen without headache?
Yes. These are called acephalgic migraines, where the aura occurs without pain.

Q3: Should I refer all ocular migraines?
Not always. Refer if first episode, older age (>40), vascular risk factors, or if symptoms are worsening or not clearly migraine-related.

Q4: Does DocScrib support neurologists and ophthalmologists?
Yes. DocScrib is specialty-agnostic and can adapt templates for both neurology and eye care professionals.

Final Thoughts

Ocular migraines can be frightening for patients and diagnostically tricky for providers. The key lies in clear clinical documentation, accurate ICD-10 coding, and well-structured SOAP notes that support follow-up and referral.

With DocScrib, you can document ocular migraines in seconds—ensuring nothing slips through the cracks.

👉 Schedule your demo with DocScrib now and streamline your neurologic and ophthalmologic notes.