Impairment in Color Perception in Migraine With and Without Aura

Milena De Marinis, MD; Steno Rinalduzzi, MD; Neri Accornero, MD

Disclosures

Headache. 2007;47(6):895-904. 

In This Article

Abstract and Introduction

Objective: To assess visual perception in 40 patients suffering from migraine with aura (MA), 40 patients suffering from migraine without aura (MO), and 40 controls.
Background: Visual perception abnormalities are a common feature in both MA and MO.
Methods: We performed luminance and color central perimetry. Black and white pattern reversal visual-evoked potentials were also assessed.
Results: Luminance perimetry was similar in patients and controls. Color perimetry instead revealed an impairment in the perception of red ("quantitative perception index") in migraine patients; this impairment was more pronounced in patients with MA (P < .001) than in those with MO (P < .05) and was related to the degree of photophobia recorded before testing. A subgroup of MO patients who had a migraine attack shortly after being tested also displayed a marked impairment in the perception of blue. This subgroup of patients had a statistically significant (P < .001) lower perception of blue than the rest of the MO patients, who had a migraine attack later; they also had a high degree of unpleasant perceptions after testing. Black and white visual evoked potentials were similar in patients and controls.
Conclusion: The impairment in visual perception of red, which was more marked in MA than in MO patients, may be related to the degree of photophobia recorded before testing. The reduced perception of blue, which only occurred in a subgroup of MO patients in the premonitory phase of the migraine attack, probably occurs through mechanisms that involve dopaminergic function. We cannot exclude the possibility that the visual stimulations induced the migraine attack in this subgroup of MO patients shortly after they were tested.

Visual perception abnormalities are a common feature in migraine. Major visual symptoms are typical of migraine with visual aura.[1,2,3,4] Minor disturbances such as blurred vision and depressed visual sensitivity are frequently reported by migraine patients both during and between attacks.[5,6] Positive symptoms, such as scintillating scotoma and colored fortification spectra, are typical of the aura phase of migraine, as are negative symptoms, such as progressive lateral hemianopsia. Interestingly, persistent visual field abnormalities have been reported even after attacks of migraine with visual aura.[6,7,8,9]

Photophobia is very common in migraine both during and between attacks.[10,11] This symptom may interfere with correct visual perception and induce visual discomfort and visual perceptual distortions. Tinted lenses have been found to help reduce both photophobia and headache in migraine patients.[12,13] A variety of visual stimuli may also induce visual discomfort, visual perceptual distortions, and headache in migraine patients.[14,15]

For color perception, the ability to perform the "critical flicker fusion" test, which assesses the maximum temporal frequency of a high luminance flickering target discernible by the observer, is impaired in migraine with aura (MA) and to a lesser degree in migraine without aura (MO) when the red light alone is used.[16] In addition, the discomfort induced by gratings with particular spatial characteristics is greater when the gratings are illuminated by red light in migraine patients both with and without aura. In these conditions, however, impairment in target detection is only observed in patients with MA.[17] Reduced sensitivity to red light has also been found in some patients suffering from MA. In particular, red glasses increase visual evoked potential amplitude in normal subjects though not in migraine patients.[18] In contrast to these observations, an impaired detection of blue and a normal detection of red have recently been reported in migraine patients.[19] Short-wavelength sensitivity deficits have previously been observed in migraine patients studied between attacks by other authors.[20]

Color visual field analysis has been used in a variety of diseases, including migraine, to detect subclinical and early visual impairment.[20] An impaired perception of blue is common in the early phases of diseases with retinal dysfunction, such as glaucoma and diabetes, whereas an impaired perception of red seems to be more common in diseases with foveal involvement.[21,22,23,24,25,26]

In migraine, it is not clear whether visual abnormalities and impaired color perceptions are a consequence of photophobia and visual discomfort induced by peripheral stimuli or of central color visual processing abnormalities due to the disease itself.

In the present study, we performed luminance and color perimetry as well as black and white pattern reversal visual-evoked potentials in patients suffering from migraine either with or without aura tested interictally. We studied various clinical features in these patients, paying particular attention to the degree of photophobia recorded before testing, to the degree of unpleasant perceptions assessed after testing and to the time interval between visual testing and the subsequent migraine attacks.

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