What are the positive visual symptoms of migraine headache aura?

Updated: Oct 21, 2019
  • Author: Jasvinder Chawla, MD, MBA; Chief Editor: Helmi L Lutsep, MD  more...
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Answer

The most common positive visual phenomenon is the scintillating scotoma. This consists of an arc or band of absent vision with a shimmering or glittering zigzag border. The disturbance begins in the paracentral area, and gradually enlarges and moves across the hemifield, eventually breaking up and resolving. It is often combined with photopsias (uniform flashes of light) or visual hallucinations, which may take various shapes (see the images below).

Migraine headache. Example of a visual migraine au Migraine headache. Example of a visual migraine aura as described by a person who experiences migraines. This patient reported that these visual auras preceded her headache by 20-30 minutes.
Migraine headache. Example of visual changes durin Migraine headache. Example of visual changes during migraine. Multiple spotty scotomata are described by a person who experiences migraines.

Scintillating scotoma occurs prior to the headache phase of an attack and is pathognomonic of a classic migraine. It is sometimes called a "fortification spectrum," because the serrated edges of the hallucinated "C" resemble a "fortified town with bastions around it."

Heat waves, fractured vision, macropsia, micropsia, and achromatopsia are other visual symptoms that may occur.


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