Eye Twitching And Migraine: Is There A Connection?

Migraine comes with a host of odd symptoms, so it's perfectly understandable for you to associate eye twitches with the other signs of an imminent headache. Eye twitching, which is medically known as benign essential blepharospasm, is seldom related to migraine.

This is not to say that a migraine can't cause an eye twitch. It is more likely that the spasms are an indication of another problem. 

What causes eye twitches?

The most common reason your eyelids twitch is ocular myokymia, a benign condition that is exacerbated by being tired, stressed, or consuming too much alcohol or caffeine. If your eyes frequently twitch, and the spasms are not accompanied by migraine, you may have myokymia, which also goes by benign essential blepharospasm (BEB).¹ 

This twitching is doubly annoying to people who have it, as the eyes often twitch simultaneously. Researchers are unsure why this happens but know that it can lead to problems with the muscle groups surrounding the eyes.

Eye twitches seem to pop up at random times and usually only last for a minute or two.

Can a migraine cause eye twitching?

Not every severe headache is a migraine. It's a neurological disease of nerve pathways and brain chemicals. A headache, in many cases, is just one symptom of a migraine. Understanding the different types of migraine helps people determine if their headache is a one-off or part of a migraine. 

Complicated migraine

These are the migraines that come with an aura or the visual changes that indicate that a migraine is imminent. About 25% of migraines start with an aura. This neurological symptom can also mimic a stroke. 

The following are some symptoms of an aura:

• Visual disturbances, e.g., flashing lights, zigzags, blind spots

• Numbness 

• Confusion, trouble speaking

• Vertigo, i.e., spinning sensation or dizziness

Retinal migraine

A retinal, or ocular, migraine is when the person loses sight for a brief period — ten minutes or so — or sees flashing lights in one eye. Although blindness can be scary, it's generally benign. The exact symptoms can vary, from vision blurs or dims or seeing a mosaic-type pattern of blank spots that grow to cause complete vision loss.

The headache can come before, during, or after the retinal attack. 

A retinal migraine is not the same as a complicated migraine with an aura. The retinal type only affects one eye as the aura affects both eyes.

If you experience any of these symptoms for the first time, seek immediate medical attention to determine the exact diagnosis.

Cluster headache

It's also possible that you suffer from cluster headaches, which are not the same as migraines. These are the most debilitating type of headaches, causing pain around the temples that radiates towards the back of the head.

Cluster headaches happen in groups or clusters. They occur as often as every other day, up to several times a day. The pain begins behind the eye and builds up to a peak after ten minutes or so. Signs of a cluster headache onset include these symptoms.

• Restlessness

• Watery, red eyes

• Sweating forehead

• Drooping or swelling eyelid

• Nasal congestion

Eye twitching can also be a common side effect of a cluster headache, although it may be a symptom of an underlying condition.

How long does eye twitching last?

Eye twitches that are stand-alone spasms last for just a minute or two. If the twitching is part of migraine onset, it can last off and on for a few days. 

Some people experience eye twitching during or after what they believe to be a migraine, but it is also possible that they are experiencing a cluster headache, not a migraine.

Possible causes for eye twitching

Myokymia, or blepharospasm, is a clue that something else is happening. The National Institute for Neurological Disorders and Stroke (NINDS), a division of the NIH, defines this syndrome as a progressive neurological disorder characterized by involuntary muscle contractions and spasms of the eyelid muscles. It is a form of dystonia, a movement disorder in which muscle contractions cause sustained eyelid closure, twitching, or repetitive movements. 

The onset of BEB is gradual, beginning with an increased blinking frequency that is usually associated with eye irritation. A person with twitchy eyes may also find it difficult to keep the eye open and experience some sensitivity to light. 

Spasms disappear when the person is sleeping — only to reappear during the day when they are awake. Serious BEB eventually causes spasms so intense that the patient is rendered basically blind during the attacks.

One thing that's important to note is that this temporary blindness is a form of dystonia. It is a movement disorder characterized by muscle contractions that cause slow and repetitive movements. It is not caused by any dysfunction of the eye itself but by spasms of the muscles in the eyelid.

Symptoms of eye twitching often go away when you are sleeping or concentrating on a difficult task. Many people find that certain tasks may make their eye twitching briefly disappear. These might be activities such as talking, singing, or touching another body part.

Short-term causes of BEB

If your eyes twitch, no matter your migraine status, you want to know what's causing these spasms that are usually more aggravating than anything else. The root causes of BEB may include:

Dry eye

When there is not enough moisture, the eyes may become irritated, causing dry eyes.

Eye irritation

Chemicals and pollutants that inflame the eye can be the culprit for BEB. Seasonal allergies are also liable to irritate the eye. 

Eye injury

These are contusions or injuries to the soft tissue around the eyelid. A head injury can also result in BEB.

Muscle fatigue

If you spend a lot of time looking at a computer screen, your eyes and muscles get tired, which can lead to twitching.

Alcohol and caffeine

Both act as diuretics, so when you overindulge in either, you excrete more fluids — you have to go to the bathroom a lot. This leads to dehydration, which can cause muscle cramps, followed by twitching or spasms.

Lack of sleep

If you aren't getting enough sleep, your entire body is fatigued, which means your eyelids are tired, too, and more apt to twitch.

Vision problems

Prescription lenses can correct this type of BEB.

Medication

Eye twitching can also be a side effect of some medications. SSRIs or anti-depressants and some blood pressure medications that act as a diuretic are common BEB culprits. Some SSRIs are also prescribed for migraines. 

Don't stop taking prescription drugs if you start to experience BEB, but call your healthcare provider if you take any of these drug classes:

• Antihistamines

• Calcium blockers

• Dopamine agonists

• Noradrenaline

Long-term neurological causes

Sometimes, BEB is an underlying symptom of a more serious neurological disorder. If eye twitching happens every day or is accompanied by other involuntary spasms, you need to see your doctor and discuss your symptoms. Possible neurological disorders include:

• Multiple sclerosis

• Parkinson's disease

• Meige syndrome

• Bell's palsy

• Stroke, brain inflammation, or head injury

Treatment

If your BEB symptoms are occasional and not serious, you may not need to see your doctor. Just make a couple of lifestyle changes (less caffeine and alcohol, better sleep) to decrease the occurrences. 

If your BEB is causing problems in your life, such as occasional blindness, some therapies lessen symptoms. 

Some BEB management therapies, such as sensory tricks, eye drops, and special glasses that reduce twitching symptoms, are used alone or with medication. 

Botulinum toxin injections

Botox injections are gaining traction as a treatment for twitchy eyes. Similar to other injection sites, it paralyzes the muscles. Sometimes, Botox is used in conjunction with other therapies.

Medication

Research indicates that one-third of BEB patients take an oral medication for treatment, specifically dopamine depleters (tetrabenazine) and anticholinergic drugs that block neurotransmitters. The results of these medications are usually temporary. 

Surgery

There is a surgical option if all other therapies have failed for severe BEB. A protractor myectomy² is a surgical procedure that removes all or part of the eyelid muscles. 

When to see your doctor

See your doctor if your eyelids twitch even though you've cut out caffeine, get plenty of rest, and have no other migraine triggers. These are other signs you need to check in with your doctor:

• Spasms last longer than a week

• Eye discharge

• Facial spasms in other areas of the face

They can diagnose the underlying cause of your eye twitching, determine if further diagnostic tests are needed, or prescribe medication.

The lowdown

Eyelid twitching, or BEB, may or may not accompany migraine. It is uncommon for BEB to be a precursor to migraine, although, in some cases of a retinal attack, the symptoms can mimic BEB. It's more likely that your symptoms indicate a different medical condition that could be neurological.

Physical and emotional triggers like dehydration, insomnia, and stress can set off eye twitches, but these triggers are not necessarily present if the root cause is neurological.  Talk with your doctor about your symptoms to find the best course of treatment.