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Sharma K, Uniyal R, Garg RK, Verma R, Paliwal VK, Malhotra HS, Sharma PK, Kumar N, Pandey S, Rizvi I. Does Calcified Neurocysticercosis Affect Migraine Characteristics and Treatment Responsiveness? A Case-Control Study. Am J Trop Med Hyg 2022; 107:1190-1195. [PMID: 36216323 PMCID: PMC9768286 DOI: 10.4269/ajtmh.22-0335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 07/25/2022] [Indexed: 12/30/2022] Open
Abstract
Recently, inflammation and free-radical release has been described in the surrounding brain parenchyma of seemingly inert calcified lesions of neurocysticercosis. These free radicals can induce migraine by stimulating calcitonin gene-related peptide release. This stipulated mechanism led us to hypothesize that calcified neurocysticercosis may increase migraine severity. This case-control study included patients (migraine with calcified neurocysticercosis) and control subjects (migraine without calcified neurocysticercosis) in a 1:1 ratio. Headache frequency, visual analog scale (VAS) score, and Migraine Disability Assessment (MIDAS) score were assessed at baseline and at the end of 3 months. To compare treatment responsiveness between patients and control subjects, we treated both groups identically so that difference in treatment would not confound the results. Each group comprised 78 patients. Baseline headache frequency (11.3 ± 3.3 versus 7.9 ± 3.4), VAS score (7.5 ± 1.1 versus 6.0 ± 1.2), and MIDAS score (15 ± 7.6 versus 9.6 ± 4.5) were significantly greater in patients than control subjects. Interestingly, the change from baseline to the end of 3 months in headache frequency (6.0 ± 1.7 versus 2.8 ± 1.4), VAS score (2.6 ± 0.02 versus 1.4 ± 0.01), and MIDAS score (8.3 ± 5.0 versus 3.6 ± 2.0) were significantly greater in patients than control subjects. Our study emphasizes that calcified lesions of neurocysticercosis are not inert, and cause an increase in the frequency and severity of migraine attacks. Interestingly, these patients also showed a better response to treatment with amitriptyline, possibly resulting from its anti-inflammatory action. Further studies are warranted to explore possible inflammatory mechanisms in calcified neurocysticercosis, which influences migraine physiology.
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Affiliation(s)
- Kamini Sharma
- Department of Neurology, King George Medical University, Lucknow, Uttar Pradesh, India
| | - Ravi Uniyal
- Department of Neurology, King George Medical University, Lucknow, Uttar Pradesh, India
| | - Ravindra Kumar Garg
- Department of Neurology, King George Medical University, Lucknow, Uttar Pradesh, India
| | - Rajesh Verma
- Department of Neurology, King George Medical University, Lucknow, Uttar Pradesh, India
| | - Vimal Kumar Paliwal
- Department of Neurology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | | | - Praveen Kumar Sharma
- Department of Neurology, King George Medical University, Lucknow, Uttar Pradesh, India
| | - Neeraj Kumar
- Department of Neurology, King George Medical University, Lucknow, Uttar Pradesh, India
| | - Shweta Pandey
- Department of Neurology, King George Medical University, Lucknow, Uttar Pradesh, India
| | - Imran Rizvi
- Department of Neurology, King George Medical University, Lucknow, Uttar Pradesh, India
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Matsuda M, Murahashi T, Nakagaki Y, Endo H, Nakagaki Y. Scintillating scotoma following optic nerve compression caused by an unruptured anterior communicating artery aneurysm: a case report. EGYPTIAN JOURNAL OF NEUROSURGERY 2022. [DOI: 10.1186/s41984-022-00147-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Scintillating scotoma caused by optic nerve compression by aneurysm is rare. We report a case of scintillating scotoma following optic nerve compression caused by an unruptured anterior communicating artery aneurysm.
Case presentation
A 64-year-old woman visited our department with a scintillating scotoma. Magnetic resonance imaging demonstrated no new lesions, although her previously diagnosed anterior communicating artery aneurysm had increased in size. Thus, we performed neck clipping. The operative view showed that the aneurysm compressed the right optic nerve. Her symptoms disappeared after the operation. These findings suggest that scintillating scotoma may be caused by compression of the optic nerve by the anterior communicating artery aneurysm.
Conclusion
Although scintillating scotoma is a common condition, aneurysms should be considered as a potential cause.
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de Jong PTVM, Thee EF, Straver B. Ebstein anomaly associated with retinal venular dilatation, migraine, and visual snow syndrome: a case report. BMC Ophthalmol 2022; 22:75. [PMID: 35164715 PMCID: PMC8845237 DOI: 10.1186/s12886-022-02288-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 01/31/2022] [Indexed: 11/29/2022] Open
Abstract
Background To present a case with Ebstein anomaly, a rare congenital heart disorder, with ophthalmological and neurophthalmological signs and symptoms. To date, retinal venous dilatation and visual snow syndrome have not been previously been published in this anomaly. Case presentation A 10-year-old white girl was diagnosed with Ebstein anomaly. From age 12, she regularly suffered from migraines with auras and photophobia. At age 16 she started to see short-term bouts of white snow, that after a year were present all day. At age 20, she was found to have a decreased retinal arteriovenous ratio. Conclusions Retinal arterial tortuosity and venular dilatation are common in congenital heart disease but have not been described in Ebstein anomaly, nor has the visual snow syndrome.
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Affiliation(s)
- P T V M de Jong
- Department of Ophthalmology, Amsterdam University Medical Center, AMC, Meibergdreef 9, 1105, AZ, Amsterdam, The Netherlands. .,Department of Retinal Signal Processing, The Netherlands Institute of Neuroscience, KNAW, Amsterdam, The Netherlands.
| | - E F Thee
- Department of Ophthalmology, Erasmus University Medical Center, Molewaterplein 40, 3015, GD, Rotterdam, The Netherlands.,Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - B Straver
- Department of Pediatric and Congenital Cardiology, Amsterdam University Medical Center, AMC, Meibergdreef 9, 1105, AZ, Amsterdam, The Netherlands
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Vosoughi A, Micieli A, Micieli JA. Migraine-Like Positive Visual Phenomena Related to Focal Cortical Lesions with Undetectable Visual Field Defects. Case Rep Ophthalmol 2021; 12:653-658. [PMID: 34413757 PMCID: PMC8339477 DOI: 10.1159/000517792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 06/07/2021] [Indexed: 11/19/2022] Open
Abstract
Migraines are commonly associated with a visual aura that has a characteristic clinical presentation. Cortical lesions within or in close proximity to the retrochiasmal visual pathways may also present in a manner that mimics migrainous visual phenomena and, in some cases, may be too small to manifest with a visual field defect on formal testing. We present 4 patients (3 females and 1 male) with an average age of 48.5 (range 28-67) years who had migraine-like visual disturbances related to a right temporal meningioma, occipital cavernoma, occipital lobe infarction, and demyelination in the optic radiations, which was the presenting sign of multiple sclerosis. No patient underwent neurosurgical intervention, and 1 patient (occipital lobe infarct) had complete resolution of the symptom after initial presentation. All patients had normal visual fields at follow-up and no thinning evident on optical coherence tomography. Our cases emphasize the importance of a history in assessing patients with transient positive visual phenomena and identify pathology that may present without visual field defects. Clinical features that should raise a doubt about a diagnosis of migraine visual aura include the absence of headache, brief visual disturbance lasting <5 min or those lasting >60 min, and age >40, especially with no past medical history of migraine.
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Affiliation(s)
- Amir Vosoughi
- Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Andrew Micieli
- Division of Neurology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Jonathan A Micieli
- Division of Neurology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada.,Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada.,Kensington Vision and Research Centre, Toronto, Ontario, Canada
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Thomsen AV, Sørensen MT, Ashina M, Hougaard A. Symptomatic migraine: A systematic review to establish a clinically important diagnostic entity. Headache 2021; 61:1180-1193. [PMID: 34254302 DOI: 10.1111/head.14187] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 06/07/2021] [Accepted: 06/09/2021] [Indexed: 01/03/2023]
Abstract
OBJECTIVE To determine if a clinical presentation indistinguishable from migraine can occur due to an underlying condition or pathology, that is, "symptomatic migraine." BACKGROUND It is currently not clear whether migraine truly can be caused by an underlying condition or pathology. Characterization of the etiology and clinical features of possible symptomatic migraine is of significant clinical importance and further may help elucidate the pathophysiology of migraine. METHODS We devised operational diagnostic criteria for "symptomatic migraine" and "possible symptomatic migraine" requiring strong evidence for a causal relation between underlying cause and migraine symptoms adhering strictly to diagnostic criteria. PubMed was searched for case reports of symptomatic migraine from inception to March 2020. Only articles published in English or German were included. No restrictions were placed on study design. Relevant references in the articles were also included. Papers were systematically reviewed by two independent reviewers for detailed clinical features of migraine as well as the proposed underlying conditions and the effects of treatment of these conditions. RESULTS Our search retrieved 1726 items. After screening, 109 papers comprising 504 cases were reviewed in detail. Eleven patients with migraine with aura (MWA) fulfilled our working criteria for symptomatic migraine, and 39 patients fulfilled our criteria for possible symptomatic migraine. The most common etiologies of symptomatic migraine were arteriovenous malformations, carotid stenosis, dissection or aneurysm, brain infarctions, meningioma, and various intra-axial tumors. CONCLUSIONS Symptomatic MWA, indistinguishable from idiopathic MWA, may occur due to cortical lesions or microembolization. We found no clear evidence supporting the existence of symptomatic migraine without aura although we did identify possible cases. Our findings are limited by the available literature, and we suggest that prospective studies are needed.
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Affiliation(s)
- Andreas Vinther Thomsen
- Danish Headache Center, Department of Neurology, Rigshospitalet Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Glostrup, Denmark
| | - Morten Togo Sørensen
- Danish Headache Center, Department of Neurology, Rigshospitalet Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Glostrup, Denmark
| | - Messoud Ashina
- Danish Headache Center, Department of Neurology, Rigshospitalet Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Glostrup, Denmark
| | - Anders Hougaard
- Danish Headache Center, Department of Neurology, Rigshospitalet Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Glostrup, Denmark
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Moran R. Transient visual disturbances as a primary manifestation of metastatic brain tumours. Clin Exp Optom 2021; 104:550-551. [PMID: 33689615 DOI: 10.1080/08164622.2021.1878830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Affiliation(s)
- Rebecca Moran
- Department of Ophthalmology and Optometry, St Barnabas Hospital, Bronx, NY, USA
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Luciani M, Negro A, Spuntarelli V, Bentivegna E, Martelletti P. Evaluating and managing severe headache in the emergency department. Expert Rev Neurother 2021; 21:277-285. [PMID: 33297780 DOI: 10.1080/14737175.2021.1863148] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Introduction: Headache is the fifth most common reason to visit an emergency department (ED). In most of the cases, headache is benign and has a primary origin, with migraine as the most common diagnosis. Inappropriate use of ED for non-emergency conditions causes overcrowding, unnecessary testing, and increased medical costs.Areas covered: All stages of headache management in ED, from the reasons to go there, the diagnosis that is made and the investigations necessary to make it, to get to the therapies administered and those prescribed at discharge, if there were any. Finally, the authors evaluated the habit of recommending medical follow-up and how often the headache is still present at discharge or returns within 24 hours.Expert Opinion: Primary headaches are underdiagnosed, misdiagnosed, and the majority do not receive drug therapy either in ED or on discharge, and in cases where the therapy is prescribed is not specific. Increase the number of primary care medical services, spread the 'headaches culture' among GPs and ED doctors, the adoption of ICHD in the diagnostic protocols used in EDs and a fast referral to a headache center could decrease the inappropriate use of ED and improve the headache management in the emergency units.
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Affiliation(s)
| | - Andrea Negro
- Department of Clinical and Molecular Medicine, Sapienza University, Rome, Italy.,Regional Referral Headache Centre, Sant'Andrea Hospital, Rome, Italy
| | - Valerio Spuntarelli
- Department of Clinical and Molecular Medicine, Sapienza University, Rome, Italy
| | - Enrico Bentivegna
- Department of Clinical and Molecular Medicine, Sapienza University, Rome, Italy
| | - Paolo Martelletti
- Department of Clinical and Molecular Medicine, Sapienza University, Rome, Italy.,Regional Referral Headache Centre, Sant'Andrea Hospital, Rome, Italy
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Sugimoto K, Morais A, Sadeghian H, Qin T, Chung DY, Ashina M, Hougaard A, Ayata C. Intravascular Endothelin-1 does not trigger or increase susceptibility to Spreading Depolarizations. J Headache Pain 2020; 21:127. [PMID: 33109086 PMCID: PMC7590662 DOI: 10.1186/s10194-020-01194-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Accepted: 10/19/2020] [Indexed: 11/22/2022] Open
Abstract
Objectives Spreading depolarizations (SD) likely manifest as aura in migraineurs. Triggers are unknown although vascular events have been implicated. Direct carotid puncture has been reported to trigger migraine with aura. The potent vasoconstrictor endothelin-1 (ET-1), which can be released from the endothelium under pathological conditions, may play a role. Here, we tested whether intracarotid ET-1 infusion triggers SD and whether systemic ET-1 infusion increases the susceptibility to SD. Methods Carotid infusions were performed in mice (C57BL/6, male) through a catheter placed at the carotid bifurcation via the external carotid artery. Intracarotid ET-1 (1.25 nmol/ml) was infused at various rates (2–16 μl/min) with or without heparin in the catheter and compared with vehicle infusion (PBS with 0.01% acetic acid) or sham-operated mice (n = 5). Systemic infusions ET-1 (1 nmol/kg, n = 7) or vehicle (n = 7) infusions were performed in rats (Sprague-Dawley, male) via the tail vein. Electrical SD threshold and KCl-induced SD frequency were measured after the infusion. Results Intracarotid infusion of saline (n = 19), vehicle (n = 7) or ET-1 (n = 12) all triggered SDs at various proportions (21%, 14% and 50%, respectively). These were often associated with severe hypoperfusion prior to SD onset. Heparinizing the infusion catheter completely prevented SD occurrence during the infusions (n = 8), implicating microembolization from carotid thrombi as the trigger. Sham-operated mice never developed SD. Systemic infusion of ET-1 did not affect the electrical SD threshold or KCl-induced SD frequency. Conclusion Intravascular ET-1 does not trigger or increase susceptibility to SD. Microembolization was the likely trigger for migraine auras in patients during carotid puncture.
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Affiliation(s)
- Kazutaka Sugimoto
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 149 13th Street, 6408, Charlestown, MA, 02129, USA.,Department of Neurosurgery, Yamaguchi University School of Medicine, Yamaguchi, Japan
| | - Andreia Morais
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 149 13th Street, 6408, Charlestown, MA, 02129, USA
| | - Homa Sadeghian
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 149 13th Street, 6408, Charlestown, MA, 02129, USA
| | - Tao Qin
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 149 13th Street, 6408, Charlestown, MA, 02129, USA
| | - David Y Chung
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 149 13th Street, 6408, Charlestown, MA, 02129, USA.,Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, USA
| | - Messoud Ashina
- Danish Headache Center, Department of Neurology, Rigshospitalet Glostrup, Glostrup, Denmark
| | - Anders Hougaard
- Danish Headache Center, Department of Neurology, Rigshospitalet Glostrup, Glostrup, Denmark
| | - Cenk Ayata
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 149 13th Street, 6408, Charlestown, MA, 02129, USA. .,Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, USA.
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10
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Hougaard A, Younis S, Iljazi A, Sugimoto K, Ayata C, Ashina M. Intravenous Endothelin-1 Infusion Does Not Induce Aura or Headache in Migraine Patients With Aura. Headache 2020; 60:724-734. [PMID: 31994720 DOI: 10.1111/head.13753] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 12/20/2019] [Accepted: 12/20/2019] [Indexed: 01/19/2023]
Abstract
OBJECTIVE To investigate whether intravenously infused provokes migraine aura and migraine headache in migraine patients with aura. BACKGROUND Migraine with aura has been associated with endothelial dysfunction and increased stroke risk. The initiating mechanism of migraine aura symptoms is not known. Experimental provocation of migraine headache using vasoactive peptides has provided tremendous advances in the understanding of migraine pathophysiology but substances that can induce migraine aura have not been identified. Endothelin-1 (ET-1), an endogenous, potent vasoconstrictor peptide released from the vascular endothelium, has been proposed to trigger migraine aura. This hypothesis is based on reports of increased plasma ET-1 levels early during the migraine attacks and the observation that ET-1 applied to the cortical surface potently induces the cortical spreading depolarization, the underlying electrophysiological phenomenon of migraine aura, in animals. Further, endothelial damage due to, for example, carotid puncture and vascular pathology is known to trigger aura episodes. METHODS We investigated whether intravascular ET-1 would provoke migraine aura in patients. Using a two-way crossover, randomized, placebo-controlled, double-blind design, we infused high-dose (8 ng/kg/minutes for 20 minutes) intravenous ET-1 in patients with migraine with typical aura. The primary end-point was the difference in incidence of migraine aura between ET-1 and placebo. Experiments were carried out at a public tertiary headache center (Danish Headache Center, Rigshospitalet Glostrup, Denmark). RESULTS Fourteen patients received intravenous ET-1. No patients reported migraine aura symptoms or migraine headache during or up to 24 hours following the ET-1 infusion. Four patients reported mild to moderate headache only on the ET-1 day, 3 patients reported moderate headache on the placebo day, and 1 patient reported mild headache on both days. No serious adverse events occurred during or after infusion. CONCLUSIONS Provocation of migraine aura by procedures or conditions involving vascular irritation is unlikely to be mediated by ET-1.
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Affiliation(s)
- Anders Hougaard
- Danish Headache Center, Department of Neurology, Rigshospitalet Glostrup, Glostrup, Denmark
| | - Samaira Younis
- Danish Headache Center, Department of Neurology, Rigshospitalet Glostrup, Glostrup, Denmark
| | - Afrim Iljazi
- Danish Headache Center, Department of Neurology, Rigshospitalet Glostrup, Glostrup, Denmark
| | - Kazutaka Sugimoto
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA.,Department of Neurosurgery, Yamaguchi University School of Medicine, Yoshida, Japan
| | - Cenk Ayata
- Stroke Service, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA
| | - Messoud Ashina
- Danish Headache Center, Department of Neurology, Rigshospitalet Glostrup, Glostrup, Denmark
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Micieli A, Kingston W. An Approach to Identifying Headache Patients That Require Neuroimaging. Front Public Health 2019; 7:52. [PMID: 30931292 PMCID: PMC6428716 DOI: 10.3389/fpubh.2019.00052] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Accepted: 02/21/2019] [Indexed: 01/03/2023] Open
Abstract
Headache is one of the most common clinical scenarios faced by a neurologist or neurologist in training. However, the decision process on when to complete neuroimaging can be difficult in clinical practice. This article focuses on a well-organized and evidence-based approach to identify patients with headache that require neuroimaging and will lend confidence to the clinician faced with these scenarios in clinical practice. The approach includes neuroimaging in episodic migraine, chronic migraine, identifying secondary headache disorders in clinic and the emergency department, and discusses pitfalls to over imaging. The article concludes with a flowchart to summarize an overall clinical approach.
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Affiliation(s)
- Andrew Micieli
- Division of Neurology, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - William Kingston
- Department of Neurology, Woman's College Hospital, Toronto, ON, Canada
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12
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Case 46. Neuroophthalmology 2017. [DOI: 10.1007/978-1-4471-2410-8_46] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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13
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Nguyen BN, Lek JJ, Vingrys AJ, McKendrick AM. Clinical impact of migraine for the management of glaucoma patients. Prog Retin Eye Res 2015; 51:107-24. [PMID: 26232725 DOI: 10.1016/j.preteyeres.2015.07.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Revised: 07/23/2015] [Accepted: 07/27/2015] [Indexed: 12/19/2022]
Abstract
Migraine is a common and debilitating primary headache disorder that affects 10-15% of the general population, particularly people of working age. Migraine is relevant to providers of clinical eye-care because migraine attacks are associated with a range of visual sensory symptoms, and because of growing evidence that the results of standard tests of visual function necessary for the diagnosis and monitoring of glaucoma (visual fields, electrophysiology, ocular imaging) can be abnormal due to migraine. These abnormalities are measureable in-between migraine events (the interictal period), despite patients being asymptomatic and otherwise healthy. This picture is further complicated by epidemiological data that suggests an increased prevalence of migraine in patients with glaucoma, particularly in patients with normal tension glaucoma. We discuss how migraine, as a co-morbidity, can confound the results and interpretation of clinical tests that form part of contemporary glaucoma evaluation, and provide practical evidence-based recommendations for the clinical testing and management of patients with migraine who attend eye-care settings.
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Affiliation(s)
- Bao N Nguyen
- Department of Optometry and Vision Sciences, The University of Melbourne, Parkville, Victoria, Australia.
| | - Jia Jia Lek
- Department of Optometry and Vision Sciences, The University of Melbourne, Parkville, Victoria, Australia
| | - Algis J Vingrys
- Department of Optometry and Vision Sciences, The University of Melbourne, Parkville, Victoria, Australia
| | - Allison M McKendrick
- Department of Optometry and Vision Sciences, The University of Melbourne, Parkville, Victoria, Australia
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Lawlor M, Perry R, Hunt BJ, Plant GT. Strokes and vision: The management of ischemic arterial disease affecting the retina and occipital lobe. Surv Ophthalmol 2015; 60:296-309. [DOI: 10.1016/j.survophthal.2014.12.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2014] [Revised: 12/10/2014] [Accepted: 12/16/2014] [Indexed: 11/16/2022]
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15
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Taylor FR, Cooper WM, Kaniecki RG. Abstracts and Citations. Headache 2015. [DOI: 10.1111/head.12575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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16
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Kowacs PA, Utiumi MA, Piovesan EJ. The visual system in migraine: from the bench side to the office. Headache 2015; 55 Suppl 1:84-98. [PMID: 25659971 DOI: 10.1111/head.12514] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/24/2014] [Indexed: 11/26/2022]
Abstract
BACKGROUND Throughout history, migraine-associated visual symptoms have puzzled patients, doctors, and neuroscientists. The visual aspects of migraine extend far beyond the aura phenomena, and have several clinical implications. METHODS A narrative review was conducted, beginning with migraine mechanisms, then followed by pertinent aspects of the anatomy of visual pathways, clinical features, implications of the visual system on therapy, migraine on visually impaired populations, treatment of visual auras and ocular (retinal) migraine, effect of prophylactic migraine treatments on visual aura, visual symptoms induced by anti-migraine or anti-headache drugs, and differential diagnosis. RESULTS A comprehensive narrative review from both basic and clinical standpoints on the visual aspects of migraine was attained; however, the results were biased to provide any useful information for the clinician. CONCLUSION This paper achieved its goals of addressing and condensing information on the pathophysiology of the visual aspects of migraine and its clinical aspects, especially with regards to therapy, making it useful not only for those unfamiliar to the theme but to experienced physicians as well.
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Affiliation(s)
- Pedro A Kowacs
- Neurological Institute of Curitiba (INC), Curitiba, Brazil; Neurology Section, Hospital Clinics of the Federal University at Paraná (HC-UFPR), Curitiba, Brazil
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Palinopsia revamped: A systematic review of the literature. Surv Ophthalmol 2015; 60:1-35. [DOI: 10.1016/j.survophthal.2014.06.003] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2014] [Revised: 06/23/2014] [Accepted: 06/24/2014] [Indexed: 02/07/2023]
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Vongvaivanich K, Lertakyamanee P, Silberstein SD, Dodick DW. Late-life migraine accompaniments: A narrative review. Cephalalgia 2014; 35:894-911. [PMID: 25505036 DOI: 10.1177/0333102414560635] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2014] [Accepted: 10/27/2014] [Indexed: 12/15/2022]
Abstract
BACKGROUND Migraine is one of the most common chronic neurological disorders. In 1980, C. Miller Fisher described late-life migraine accompaniments as transient neurological episodes in older individuals that mimic transient ischemic attacks. There has not been an update on the underlying nature and etiology of late-life migraine accompanimentsd since the original description. PURPOSE The purpose of this article is to provide a comprehensive and extensive review of the late-life migraine accompaniments including the epidemiology, clinical characteristics, differential diagnosis, and treatment. METHODS Literature searches were performed in MEDLINE®, PubMed, Cochrane Library, and EMBASE databases for publications from 1941 to July 2014. The search terms "Migraine accompaniments," "Late life migraine," "Migraine with aura," "Typical aura without headache," "Migraine equivalents," "Acephalic migraine," "Elderly migraine," and "Transient neurological episodes" were used. CONCLUSION Late-life onset of migraine with aura is not rare in clinical practice and can occur without headache, especially in elderly individuals. Visual symptoms are the most common presentation, followed respectively by sensory, aphasic, and motor symptoms. Gradual evolution, the march of transient neurological deficits over several minutes and serial progression from one symptom to another in succession are typical clinical features for late-life migraine accompaniments. Transient neurological disturbances in migraine aura can mimic other serious conditions and can be easily misdiagnosed. Careful clinical correlation and appropriate investigations are essential to exclude secondary causes. Treatments are limited and still inconsistent.
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Affiliation(s)
- Kiratikorn Vongvaivanich
- Comprehensive Headache Clinic, Neuroscience Center, Bangkok Hospital, Bangkok Hospital Group, Thailand
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Abstract
Hubert Airy's iconic drawing of his own migraine visual aura for which he coined the term, "teichopsia," conveys important lessons for the contemporary clinician. His observations of the expansion ("build-up"), minification/magnification, and color/achromatopsia of migrainous teichopsia are consistent with (and possibly anticipatory of) the later discoveries of cortical spreading depression, cortical magnification of primary visual cortex (V1), and specialized cortical centers for color vision.
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[Late onset visual aura associated with a carotid artery stenosis reversible after endarterectomy]. Rev Neurol (Paris) 2013; 169:350-2. [PMID: 23465845 DOI: 10.1016/j.neurol.2012.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2012] [Revised: 09/28/2012] [Accepted: 10/12/2012] [Indexed: 10/27/2022]
Abstract
BACKGROUND Visual aura is the most common type of aura. Onset of visual aura occurring for the first time in an elderly person is atypical, even though late-life migraine accompaniments are well-recognized. OBSERVATION We report the case of a 72-year-old woman with a past history of migraine without aura since adolescence (one attack per month), who experienced for the first time of her life multiple visual aura over a period of more than one year. These auras were always left homonymous hemianopia which developed gradually over 5 mins followed by severe migraine headache without strict lateralization. The patient was known to have a moderate right carotid artery stenosis. In October 2007, she suffered a minor ischemic stroke in the right carotid artery territory due to progression to severe stenosis of the right internal carotid artery. After carotid endarterectomy, she had no further migraine attacks with aura. DISCUSSION We discuss the mechanism of aura in our case with probable microemboli due to the severe right internal carotid artery stenosis responsible for repeated cortical spreading depression. CONCLUSION Clinicians should bear in mind to systematically explore all patients with late onset aura including patients who have previously suffered from migraine without aura and also to explore patients who have a dramatic increase of aura even if they are already migrainers with aura.
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Abstract
Armed with information obtained from the targeted headache history, clinicians can almost always make an accurate diagnosis or at least determine sick from well. Through using the information obtained, clinicians can craft a safe and cost-effective treatment plan that has a high likelihood of success.
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Affiliation(s)
- Steven D Waldman
- School of Medicine, University of Missouri-Kansas City, Kansas City, MO 64108, USA.
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22
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Abstract
Flashing lights (photopsia) and floaters are common visual phenomena and patients frequently present to hospital with these symptoms. This article provides a guide for the non-specialist to the different pathologies that may result in photopsia and floaters.
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Ziaei M, Elgohary MA, Bremner FD. Palinopsia as the initial manifestation of non-hodgkin's lymphoma. Int Ophthalmol 2012. [PMID: 23188189 DOI: 10.1007/s10792-012-9682-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
A 37-year old general practitioner thought to be in good health presented to the ophthalmology department with palinopsia, headaches and transient visual obscurations. A CT scan revealed a large destructive lesion centred on the occiput and stealth guided excisional biopsy of the occipital lesion showed diffuse large B cell, Non-Hodgkin's lymphoma (NHL) infiltration. To the best of our knowledge this is only the second report of a patient with NHL presenting with palinopsia.
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Affiliation(s)
- Mohammed Ziaei
- Department of Eye, University College London Hospital, Third Floor, Central Wing, 250 Euston Road, London, NW1 2PQ, United Kingdom,
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From migraine to epilepsy: a threshold mechanism? Neurol Sci 2011; 33:915-8. [DOI: 10.1007/s10072-011-0851-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2010] [Accepted: 10/31/2011] [Indexed: 10/15/2022]
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