Ocular migraine

[David Baxter PhD]

Just over the past year, I've expeienced four episodes - three in a short period of time last summer and then again this afternoon - of what my doctor suggested might be ocular migraine.

I just found this which describes them pretty much exactly:

Ocular Migraine

Ocular Migraine is a variant of migraine that is not uncommon. It is believed to be caused by the same mechanism as classical migraine; vascular spasm. Instead of the spasm affecting the surface of the brain, these episodes affect the ocular blood supply or the blood supply to the vision center in the brain.

Typically, these episodes begin with a visual disturbance that begins in the peripheral vision. It often consists of a semi-circular, jagged, shimmering light, which enlarges and becomes more central. This disturbance usually obscures the vision within the jagged area. The light is often described a pale pastel in color.

In the typical episode, the visual disturbance lasts 15 ? 20 minutes and then disappears. A mild headache may or may not follow the disturbance. Many ocular migraine sufferers complain only of fatigue after the visual disturbance.

Do any of you know anything about this? I'm especially curious because I've nenver had anything like it before last summer and there's no history of migraine in my family, as far as I know.

 

[Retired]

Very interesting and something I was not familiar with. The jagged light experience sounds similar to what I've heard described as the aura some people get as a premonition of their migraine.

My own migraines are not accompanied by an aura so I have only read about them.

 

[Daniel E.]

It seems the most popular type of ocular migraine is retinal migraine, which is discussed in the journal article below:

Transient monocular visual loss and retinal migraine

 

[David Baxter PhD]

Thanks, guys. I get the impression that the "retinal migraines" as described are more classic migraines. The description of "ocular migraine" corresponds more closely with my experience - the headache is quite mild, if present at all - it's the short-lived visual disturbance followed by significant fatigue and lassitude that's more disruptive.

 

[Daniel E.]

Thanks, guys. I get the impression that the "retinal migraines" as described are more classic migraines.

Yes, it does give that impression though exceptions are made:

The International Headache Society's definition of retinal migraine is given in Box 1.1. The society's definition is limited because it does not account for patients who have visual symptoms without headaches or who have permanent visual scotomas; although rare, both of these presentations have been well documented in the literature. http://www.cmaj.ca/cgi/content/full/173/12/1441

However, according to the book Living Well with Migraine Disease and Headaches, the problem with the term "ocular migraine" is that it is not a diagnosis per se, just a descriptive diagnosis. The book states two examples of a retinal headache, with the second example lacking headache. The second example is of a patient named Jason:

Jason's symptoms are much like Irene's with one major exception -- he seldom experiences the headache phase. Still, his diagnosis is the same, retinal migraine. To this may be added the descriptive (not diagnostic) term acehphalgic, which simply means "without head pain." Thus, most of Jason's are acephalgic retinal migraine attacks.

Interesting Note: Jason's original diagnosis was "ocular migraine." If we adhere to the International Headache Society classifications, there is no diagnosis of "ocular migraine." It's understandable that his ophthalmologist used the term, since when he skips the headache phase, all his symptoms are visual. The problem with using a "descriptive diagnosis" as opposed to one form of the accepted listing is that other doctors can't be sure exactly what the original physician intended.

BTW, an old article abstract from 1981:

Acephalgic migraine. Fifteen years experience. O'Connor PS, Tredici TJ.

Ophthalmology. 1981 Oct;88(10):999-1003.

Sixty-one patients with acephalgic migraine have been seen and thoroughly evaluated at the USAF School of Aerospace Medicine over the past 15 years. Patient age ranged in years from 21 to 61, with the number of spells varying between 1 and 100 and lasting from 15 seconds to 3 hours. These phenomena were present for 2 weeks to 25 years. Ocular involvement was represented by scintillation, transient hemianopia, bilateral central scotomata, classic amaurosis fugax, diplopia, altitudinal field loss, tunnel vision; temporal crescent involvement, and several patients who developed a transient central scotoma in one eye with alterations in color perception. Other neurologic involvement occurred in 29%. Permanent neurologic deficit occurred in only one patient. Positive family history for migraine was present in only 24%. Headache is not a necessary feature of migraine attacks. One should consider migraine in any acute episodic neurologic disorder.

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=7335315&dopt=Abstract

The book states two examples of a retinal headache..

Meant to type "retinal migraine" not "retinal headache."

This is the most lucid explanation regarding the confusing terminolgy:

OPHTHALMIC (OCULAR) MIGRAINE

Ocular migraine is a term which may have different meanings to different physicians. Many times migraineurs will have just the visual warning signs or aura of their migraine attack without the headache. This occurs more frequently as one gets older and can be a frightening phenomenon. This is also referred to as acephalgic migraine, or migraine aura without headache.

Some physicians refer to ocular migraine as retinal migraine, where there are repeated attacks of one-sided blind spots or blindness lasting less than an hour and associated with a headache.

It is important to rule out eye disease or a disorder of the blood vessels leading to the eye as possible causes.

http://www.headaches.org/consumer/topicsheets/ophthalmic.html

 

[David Baxter PhD]

Thanks, Daniel. You always were one of our best resources for this type of research.

 

[Retired]

Great stuff, Daniel! I learned a great deal from your posting. Thank you!