Retinal Migraine - The Basics
by Teri Robert, MyMigraineConnection Lead Expert
Diagnosing
Migraine
One of the difficulties encountered at times when discussing Migraines occurs
when a Migraineur is given a diagnosis that isn't actually accurate in
diagnostic terms, but is really a descriptive term. Such terms may be used
fairly frequently, but they fall short of a diagnosis and may also be used
differently from one doctor to another. That's one reason why most doctors
diagnose based in the International Headache Society's International
Classification of Headache Disorders, 2nd Edition (ICHD-II). A
"standard" diagnosis also makes communications and transitions easier
when patients need to consult other doctors or change doctors.
There are several terms that are sometimes used, supposedly as
Migraine diagnoses, that involve visual symptoms. Most of them aren't actually
standard Migraine diagnoses. Retinal Migraine, however, is an actual Migraine
diagnosis. What becomes confusing about it is that it's sometimes misused,
resulting in a misdiagnosis. The term "retinal Migraine" is often
misused to mean any Migraine that involves any visual symptoms or a Migraine
with visual symptoms but without the headache phase of the attack.
Retinal Migraine Symptoms:
Retinal Migraine is Migraine where there are repeated attacks of
visual disturbances preceding the headache phase of the Migraine attacks.
A retinal Migraine attack begins with monocular (in one eye)
visual symptoms that can include:
1. scintillations (seeing twinkling lights)
2. scotoma (areas of decreased or lost vision)
3. temporary blindness.
The headache phase of a retinal Migraine
begins during or within 60 minutes of the visual symptoms. The headache phase
presents symptoms consistent with Migraine without aura:
· Headache duration of 4-72 hours
· At least two of these characteristics:
1. unilateral
(on one side) location
2. pulsatile
quality (pulsing or throbbing)
3. moderate
or severe pain intensity
4. aggravation
by or causing avoidance of routine physical activity such as walking or
climbing stairs
At least one of these characteristics:
1. nausea
and/or vomiting
2. photophobia
(increased sensitivity to light) and phonophobia (increased sensitivity to
sound)
The primary differentiating factors between
retinal Migraine and Migraine with aura are:
1. The visual symptoms of retinal Migraine are monocular.
2. Total, but temporary, monocular blindness may occur in retinal
Migraine.
Diagnosing
Retinal Migraine:
There are no diagnostic tests to confirm
retinal Migraine. Diagnosis is accomplished by reviewing the patient's personal
and family medical history, studying their symptoms, and conducting an
examination. Retinal Migraine is then diagnosed by ruling out other causes for
the symptoms. With retinal Migraine, it is essential that other causes of
transient blindness be fully investigated and ruled out.
Retinal Migraine
Treatment:
For infrequent attacks, medications used for
other forms of Migraine are often employed to relieve the other symptoms. These
medications can include NSAIDs, antinausea medications,Midrin,
ergotamines the triptans. The choice ofmedications is somewhat affected by the age of the
patient. When Migraines are frequent, the same preventive therapies used for
other Migraines can be explored.
The more technical explanation:
In the ICHD-II, retinal Migraine is described as,
In the ICHD-II, retinal Migraine is described as,
Repeated attacks
of monocular visual disturbance, including scintillations, scotomata or
blindness, associated with Migraine headache.
The diagnostic criteria for
retinal Migraine under ICHD-II are:
A. At
least 2 attacks fulfilling criteria B and C
B. Fully
reversible monocular positive and/or negative visual phenomena (e.g.,
scintillations, scotoma or blindness) confirmed by examination during an attack
or (after proper instruction) by the patient’s drawing of a monocular field
defect during an attack
B.
C. Headache
fulfilling criteria B–D for Migraine without aura begins during the visual
symptoms or follows them within 60 minutes
D. Normal
ophthalmological examination between attacks
The relevant
diagnostic criteria for Migraine without aura are:
B. Headache
attacks lasting 4–72 hours (untreated or unsuccessfully treated)
C. Headache
has at least two of the following characteristics:
1. unilateral
location
2. pulsating
quality
3. moderate
or severe pain intensity
4. aggravation
by or causing avoidance of routine physical activity (e.g., walking or climbing
stairs
D. During
headache at least one of the following:
1. nausea
and/or vomiting
2. photophobia
and phonophobia
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