1.2.4 Retinal migraine

Description:

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

Diagnostic criteria:
  1. Attacks fulfilling criteria for 1.2 Migraine with aura and criterion B below
  2. Aura characterized by both of the following:
    1. fully reversible, monocular, positive and/or negative visual phenomena (eg, scintillations, scotomata or blindness) confirmed during an attack by either or both of the following:
      • – clinical visual field examination
      • – the patient’s drawing of a monocular field defect (made after clear instruction)
    2. at least two of the following:
      • – spreading gradually over ≥5 minutes
      • – symptoms last 5-60 minutes
      • – accompanied, or followed within 60 minutes, by headache
  3. Not better accounted for by another ICHD-3 diagnosis, and other causes of amaurosis fugax have been excluded.
Comments:

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.

1.2.4 Retinal migraine is an extremely rare cause of transient monocular visual loss. Cases of permanent monocular visual loss associated with migraine have been described. Appropriate investigations are required to exclude other causes of transient monocular blindness.