Retinal migraine

Brian M Grosberg MD (Dr. Grosberg, Director, Hartford Healthcare Headache Center, Hartford Healthcare Neuroscience Institute received honorariums from Promius for consulting work and from Amgen as a member of an advisory board.)
Seymour Solomon MD (Dr. Solomon of Montefiore Headache Center and Albert Einstein College of Medicine has no relevant financial relationships to disclose.)
Stephen D Silberstein MD, editor. (Dr. Silberstein, Director of the Jefferson Headache Center at Thomas Jefferson University, receives honorariums from Allergan, Avanir Pharmaceuticals, Curelator, Depomed, Dr. Reddy's Laboratories, eNeura,  INSYS Therapeutics, Lilly USA, Supernus Pharmacerticals,  Thernica and Trigemina for consulting. He is also the  principal investigator for a clinical trials conducted by Alder Biopharmaceuticals, Amgen, electroCore Medical, Lily USA and Teva.)
Originally released September 2, 1994; last updated May 17, 2017; expires May 17, 2020

This article includes discussion of retinal migraine, anterior visual system migraine, migraine associated with monocular visual symptoms, ocular migraine, and ophthalmic migraine. The foregoing terms may include synonyms, similar disorders, variations in usage, and abbreviations.

Overview

Retinal migraine is usually characterized by attacks of fully reversible monocular visual loss associated with migraine headache. Retinal migraine is most common in women of childbearing age who have a history of migraine with aura. In the typical attack, monocular visual features consist of partial or complete visual loss lasting less than 1 hour. Although the current diagnostic criteria for retinal migraine require fully reversible visual loss, our findings suggest that irreversible visual loss is part of the retinal migraine spectrum. Nearly half of reported cases with recurrent transient monocular visual loss subsequently experienced permanent monocular visual loss.

Historical note and terminology

Retinal migraine is a rare and poorly understood disorder characterized by attacks of monocular visual impairment associated with migraine headache. Galezowski first described this entity as “ophthalmic megrim” in the late nineteenth century (Galezowski 1882). Since then, a number of patients with monocular visual defects beginning before, during, or after attacks of otherwise typical migraine have been reported with various designations. Carroll introduced the term "retinal migraine" to describe patients with episodes of transient and permanent monocular visual loss, specifically in the absence of migraine headache (Carroll 1970). Most subsequent observers have used the term “retinal migraine” for those cases of monocular visual impairment temporally associated with attacks of migraine. Some have noted that unilateral visual loss was not restricted exclusively to the retina and advocated the term “anterior visual pathway migraine” or “ocular migraine” (Walsh and Hoyt 1969; Corbett 1983). The authors prefer the term “migraine associated with monocular visual symptoms” because it distinguishes between the loss of vision in 1 homonymous hemifield and that of 1 eye and includes sites other than the retina, such as the choroid or the optic nerve.

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