Intermittent Angle-Closure Glaucoma in the Presence of a White Eye, Posing as Retinal Migraine

Retinal Migraine Reappraised

Retinal migraine is usually characterized by attacks of fully reversible monocular visual loss associated with migraine headache. Herein we summarize the clinical features and prognosis of 46 patients (six new cases and 40 from the literature) with retinal migraine based upon the International Classification of Headache Disorders-2 (ICHD-2) criteria. In our review, retinal migraine is most common in women in the second to third decade of life. Contrary to ICHD-2 criteria, most have a history of migraine with aura. In the typical attack monocular visual features consist of partial or complete visual loss lasting <1 h, ipsilateral to the headache. Nearly half of reported cases with recurrent transient monocular visual loss subsequently experienced permanent monocular visual loss. Although the ICHD-2 diagnostic criteria for retinal migraine require reversible visual loss, our findings suggest that irreversible visual loss is part of the retinal migraine spectrum, perhaps representing an ocular form of migrainous infarction. Based on this observation, the authors recommend migraine prophylactic treatment in an attempt to prevent permanent visual loss, even if attacks are infrequent. We also propose a revision to the ICHD-2 diagnostic criteria for retinal migraine.

Migraine headaches: diagnosis and management

BACKGROUND

Patients often complain to their optometrist about their headaches, of which migraines are a common type. They may ask if their pain is from visual causes or whether the visual auras they experience are normal.

METHODS

The literature on migraine is reviewed to provide the optometrist with current information to manage these patients.

RESULTS

Included in the review are migraine epidemiology, pathophysiology, categorization, clinical presentation, diagnosis, and treatment.

CONCLUSION

Optometrists can help their migraine patients with a thorough examination, advice, proper referrals, and optical management when appropriate.