Migraines and Vision Effects Symptoms

History

Migraine headaches typically occur on one side of the head and cause throbbing pain, but the features often vary. Migraineurs (people who get migraine headaches) often experience a bilateral event, meaning that the pain can be felt anywhere around the head or neck.

Early symptoms are experienced by 60% of migraineurs. Forewarning of a migraine may occur hours to days before a headache event. Although the specific symptoms vary, they tend to remain the same for a given individual over time. These warning symptoms may include the following:

• Photophobia, phonophobia, osmophobia (sensitivity to light, sound, and/or smells, respectively)
• 
  
• Lethargy (weariness, fatigue, lack of energy)
• 
  
• Mental and mood changes - Depression, anger, joy
• 
  
• Polyuria (urinating often and in large amounts)
• 
  
• Soreness and stiffness of neck muscles
• 
  
• Anorexia (diminished appetite, aversion to food)
• 
  
• Constipation or diarrhea
• 
  

Aura is experienced by 10-20% of migraineurs. Aura is defined as focused symptoms that grow over 5-15 minutes and generally last about an hour. In most cases, the migraine headache follows the aura. However, the two events can happen at the same time, or the aura may develop after the headache starts. With aura, visual symptoms are most common and include the following:

• Negative scotomata (blurred or absent areas in the vision field), tunnel vision, or even complete blindness
• 
  
• Positive visual problems, the most common of which consists of an absent arc or band of vision with a shimmering or glittering zigzag border: This is often combined with photopsias (a sensation of lights, sparks, or colors due to electrical or mechanical stimulation of the ocular [eye] system) or visual hallucinations that may take various shapes. This is a highly characteristic syndrome that always occurs before the headache phase of an attack and is specific to a diagnosis of classic migraine. It is called a "fortification spectrum" because the jagged edges of the hallucinated arc resemble a fortified town with bastions around it.
• 
  
• Photophobia
• 
  
• Photopsia (uniform flashes of light) or simple forms of visual hallucinations that occur commonly with positive visual phenomena
• 
  

Motor symptoms like hemiparesis (weakness on one side of the body) and aphasia (poor or absent understanding and/or production of speech, writing, or signs) may occur but much less frequently.

Some people have auras only, without headaches. Treatment is usually unnecessary once the diagnosis is recognized and the migraineur reassured about it. If the aura always occurs on the same side, the risk of brain tumor or other abnormality is greater (about 15%) than in persons with routine headaches (1%).

Typical headache characteristics are as follows:

• On one side of the head in 60-70% of migraineurs
• 
  
• Slow onset (lasting 4-72 hours)
• 
  
• Described as throbbing or pulsing pain but can evolve into a continuous ache or bandlike pattern

Other associated symptoms include nausea, vomiting, paleness, and light-headedness.

Physical examination findings

Upon examination, the doctor may discover the following:

• Head/neck muscle tenderness
• 
  
• Horner syndrome (a syndrome characterized by contraction of the pupil and drooping of the eyelid and occurring on the same side as the headache)
• 
  
• Conjunctival injection (bloodshot or red eyes)
• 
  
• Heart rate that is too fast or too slow
• 
  
• Blood pressure that is too high or too low
• 
  
• Hemisensory (loss of feeling on one side of the body) or hemiparetic (weakness affecting one side of the body) deficits

The following physical examination findings are considered particularly worrisome, suggesting that the problem is not migraine but a potentially more serious condition:

• Dim scotoma (blurred or absent areas in the vision field) lasting a few seconds to several minutes
• 
  
• Tenderness of the arteries in the temple (in elderly persons)
• 
  
• Meningismus (pain caused by irritation of the layers [meninges] surrounding the brain and spinal cord)
• 
  
• Increased lethargy (unrelated to medication use)
• 
  
• Mental status changes
  
  
• High blood pressure