1.4 Retinal migraine

Description:

Repeated attacks of monocular visual disturbance, including scintillations, scotomata or blindness, associated with migraine headache.

Diagnostic criteria:

A. At least 2 attacks fulfilling criteria B and C

B. Fully reversible monocular positive and/or negative visual phenomena (eg, scintillations, scotomata 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

C. Headache fulfilling criteria B-D for 1.1 Migraine without aura begins during the visual symptoms or follows them within 60 minutes

D. Normal ophthalmological examination between attacks

E. Not attributed to another disorder

© 2003 International Headache Society (quoted from International Headache Society, 2004)

Visual field defects depend on the location of the disturbances in the visual pathway. Field defects in retinal migraine correspond to the one shown in (A) but not in (B-D).

Visual disturbances are typical (though not necessary) symptoms in two thirds of any migraine subform. However, the set of diagnostic criteria that must be fulfilled does not differentiate between the various visual symptoms, except for two subforms including 1.4 retinal migraine (the other subform being 1.2.6 basilar-type migraine). In the classification it is commented that "[s]ome patients who complain of monocular visual disturbance in fact have hemianopia" pointing at the complexity of a verbal description. The development of computer-assisted procedures may establish easier diagnostic criteria.

References

Gan KD, Mouradian MS, Weis E, Lewis JR. Transient monocular visual loss and retinal migraine. CMAJ 2005; 173: 1441-1442. [PDF]
International Headache Society. The International Classification of Headache Disorders, 2nd edition. Cephalalgia 2004; 24 (suppl. 1): 1-160.

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