retinal migraine

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Retinal migraine

  • otherwise known as ophthalmic migraines, anterior visual pathway migraines, or ocular migraines
  • - repeated attacks of monocular visual disturbance, including scintillations, scotomata or blindness, associated with migraine headache
  • causes monocular visual loss for 10–20 minutes which can be associated with diffuse or unilateral headache (1)
  • often there is also a history of one of the more conventional forms of migraine, and exercise may precipitate the attacks (2)
  • cause of the amaurosis of ocular migraine is thought to be vasospasm of the retinal circulation or ophthalmic artery
  • retinal migraine is an extremely rare cause of transient monocular visual loss
    • cases of permanentmonocular visual loss associated with migraine have been described. Appropriate investigations are required to exclude other causes of transient monocular blindness
  • Diagnostic criteria:
    • A. Attacks fulfilling criteria for Migraine with aura and criterion B below
    • B. Aura characterized by both of the following:
      • 1. fully reversible, monocular, positive and/or negative visual phenomena (e.g. scintillations, scotomata or blindness) confirmed during an attack by either or both of the following:
        • a. clinical visual field examination
        • b. the patient’s drawing of a monocular field defect (made after clear instruction)
      • 2. at least two of the following:
        • a. spreading gradually over >= 5 minutes
        • b. symptoms last 5–60 minutes
        • c. accompanied, or followed within 60 minutes, by headache
    • C. Not better accounted for by another ICHD-3 diagnosis, and other causes of amaurosis fugax have been excluded

Notes:

  • some patients who complain of monocular visual disturbance in fact have hemianopia. Some cases without headache have been reported, but migraine as the underlying aetiology cannot be ascertained

Reference:

  • Burger SK et al. Transient monocular blindness caused by vasospasm. N Engl J Med 1991;325:870–3
  • Jehn A et al. Exercise-induced vasospastic amaurosis fugax. Arch Ophthalmol 2002;120:220–2.
  • Headache Classification Committee of the International Headache Society (IHS). The international classification of headache disorders, 3rd edition. Cephalalgia 2018; 38: 1-211

Last edited 11/2020 and last reviewed 11/2020

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