retinal migraine

Last edited 11/2020 and last reviewed 01/2023

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