What is retinal migraine?

Updated: Oct 16, 2019
  • Author: Rima M Dafer, MD, MPH, FAHA; Chief Editor: Helmi L Lutsep, MD  more...
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Retinal migraine (also called ophthalmic or ocular migraine) is a fairly common cause of transient monocular blindness in young adults. [54, 55] This disorder is manifested by recurrent attacks of unilateral visual disturbance or blindness lasting from minutes to 1 hour, associated with minimal or no headache. This phenomenon is frightening to patients, who usually seek medical help to exclude amaurosis fugax due to ischemia of the retinal arteries. [56, 57, 58]

Patients describe a gradual visual disturbance in a mosaic pattern of scotomata that gradually enlarge, producing total unilateral visual loss. Postural changes, exercise, and oral contraceptive agents may precipitate attacks. Rarely, when patients with retinal migraine are evaluated and examined during an attack of visual loss, optic pallor or narrowing of the retinal vessels can be seen.

Retinal migraine is thought to result from transient vasospasm of the choroidal or retinal arteries. A history of recurrent attacks of transient monocular visual disturbance or blindness, with or without a headache and without other neurologic symptoms, is suggestive of retinal migraine. A personal or family history of migraine confirms the diagnosis.

Ruling out eye disease or vascular causes, especially when risk factors for arteriosclerosis exist, is important. That is, the condition must be differentiated from ocular or vascular causes of transient monocular blindness, mainly carotid artery disease. [59, 60]

Carotid Duplex ultrasonography, transcranial Doppler ultrasonography, magnetic resonance angiography (MRA), or computed tomography angiography (CTA) of the brain may be helpful. Fluorescein or cerebral angiography is rarely necessary. A hypercoagulability workup and evaluation of the erythrocyte sedimentation rate may be useful in excluding other coagulation disorders associated with retinal vasculopathy.

Vasoconstrictive agents such as triptans and ergots should be avoided. Pharmacologic prophylaxis has only anecdotal support; when it is considered, calcium channel blockers are preferred. [54, 60]

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