Retinal, ophthalmic, or ocular migraine

Evaluation of retinal vessel and perfusion density in migraine patients by optical coherence tomography angiography

BACKGROUND

Migraine is a neurovascular disease and has been reported as a risk factor for ocular vascular complications. Our study aimed to compare the retinal vessel density and perfusion density between migraine patients and healthy subjects by optical coherence tomography angiography (OCTA).

METHODS

In this prospective study, 23 patients with migraine with aura (MWA) and 31 patients with migraine without aura (MWOA), and 32 age- and gender-matched healthy controls (HC) were enrolled. The vessel density (VD) and perfusion density (PD) were evaluated in a 6 × 6 mm scan of the macula and optic nerve head (ONH) with the Cirrus HD-OCT 5000 device. The measurement area is divided into three areas: center (c), inner ring (ir), outer ring (or) (with diameters of 1, 3, and 6 mm respectively), and nine subfields, according to the Early Treatment Retinopathy Study grid.

RESULTS

The macular cVD, cPD, and temporal orVD in MWA and MWOA groups were significantly reduced than those of HC. On optic nerve head OCTA, patients with MWA had decreased cVD, average irVD, inferior irVD, and temporal orVD compared with HCs while MWOA had reduced cVD than HC group. In addition, PD was not significantly different among MWA, MWOA, and HC groups in any measure in the optic nerve head. The Migraine Disability Assessment Score (MIDAS) and attack frequency were significantly inversely correlated with cVD, cPD, irVD, and irPD of macula and ONH.

CONCLUSIONS

Vessel and perfusion density of macula were reduced in both MWA and MWOA. Vessel density, but not perfusion density of ONH was decreased in MWA. The migraine severity and attack frequency were significantly inversely correlated with vessel and perfusion density of macula and ONH.

Retinal migraine, a contentious clinical entity

" Retinal migraine (ophthalmic migraine, ocular migraine, anterior visual pathway migraine) is a rarely encountered medical condition, but with an interesting and complex clinical presentation. The goal of this article is to compile the literature on retinal migraine, detailing nomenclature, pathophysiology, differential diagnosis, and medical investigations including newer imaging modalities, like optical coherence tomography (OCT). We will approach topics of great concern such as risk factors, complications, treatment, and management of this condition. Retinal migraine is mainly a diagnosis of exclusion and it must be isolated from transient monocular vision loss (TMVL) developed from other causes, for instance, papilledema, giant cell arteritis, carotid artery disease (amaurosis fugax), intermittent angle closure glaucoma, and others. Its treatment is similar to migraine treatment; topiramate, amitriptyline, and nortriptyline are some of the pharmacological drugs successfully used."

Transient visual field loss after COVID-19 vaccination: Experienced by ophthalmologist, case report

PURPOSE

The first reported case of bilateral transient visual field defect, experienced by an ophthalmologist, which developed shortly after COVID-19 vaccination (CoronaVac, Sinovac Biotech Ltd., Beijing, China) and confirmed by computerized automated perimetry.

OBSERVATION

The patient is a 42-year-old Thai ophthalmologist. He developed blurred vision within an hour after the second dose of COVID-19 vaccination. We described his self-observed of sequential symptoms, chronologic events, and management steps. The visual field of left congruous hemianopia with respect to vertical midline was detected with computerized automated perimetry. The possible mechanism could be related to an acute vasospasm of the artery in the postchiasmatic visual pathway, triggered by COVID-19 vaccine, Corona Vac.

CONCLUSION AND IMPORTANCE

With increasing use of the COVID-19 vaccine in the near future, it would be prudent for medical staff and ophthalmologists to be considered and aware of this associated condition.

Current Perspective on Retinal Migraine

Retinal migraine was first formally described in 1882. Various terms such as "ocular migraine" and "ophthalmic migraine" have since been used interchangeably in the literature. The lack of a consistent consensus-based definition has led to controversy and potential confusion for clinicians and patients. Retinal migraine as defined by the International Classification of Headache Disorders (ICHD) has been found to be rare. The latest ICHD defined retinal migraine as 'repeated attacks of monocular visual disturbance, including scintillation, scotoma or blindness, associated with migraine headache', which are fully reversible. Retinal migraine should be considered a diagnosis of exclusion, which requires other causes of transient monocular visual loss to be excluded. The aim of this narrative review is to summarize the literature on retinal migraine, including: epidemiology and risk factors; proposed aetiology; clinical presentation; and management strategies. It is potentially a misnomer as its proposed aetiology is different from our current understanding of the mechanism of migraine.

Migraine with Aura or Sports-Related Concussion: Case Report, Pathophysiology, and Multidisciplinary Approach to Management

The evaluation and management of athletes presenting with clinical features of migraine headache with aura in the setting of sports-related head trauma is challenging. We present a case report of a 15-yr-old boy with a history of migraine with visual aura that developed acute visual disturbance and headache after a head injury during an ice hockey game. The patient underwent comprehensive assessment at a multidisciplinary concussion program, including neuro-ophthalmological examination, neurocognitive testing, and graded aerobic treadmill testing. Clinical history and multidisciplinary assessment was consistent with the diagnosis of coexisting sports-related concussion and migraine with brainstem aura. The authors discuss the pearls and pitfalls of managing patients who develop migraine headache with visual aura after sports-related head injury and the value of a comprehensive multidisciplinary approach to this unique patient population.

Spectrum of migraine variants and beyond: The individual syndromes in children

"Migraine-related conditions" are probably the second most common condition after seizure encountered in pediatric neurology requiring frequent Emergency Department visits. Among migraines, migraine-related condition presents with an acute onset sign or symptom other than headache or visual aura of unknown etiology. A delay in diagnosis is a common occurrence. Previously, the authors proposed a common clinical profile and suggested that the future review should seek the applicability of the common profile in aid to clinical diagnosis of migraine-related individual syndromes. Authors describe the clinical characteristics and differential diagnosis of the spectrum of migraine variants and beyond in children.

A migraine variant with abdominal colic and Alice in Wonderland syndrome: a case report and review

BACKGROUND

Abdominal migraine is a commonly described migraine variant in children and young adults, but associations with Alice in Wonderland syndrome and lilliputian hallucinations are exceptional.

CASE PRESENTATION

A 20 years-old male experienced frequent and prolonged attacks of abdominal colic associated with autonomic manifestations started at the age of ten. At the age of 17, he additionally described prolonged attacks (>or= 7 days) of distortions of shape, size or position of objects or subjects. He said "Quite suddenly, objects appear small and distant (teliopsia) or large and close (peliopsia). I feel as I am getting shorter and smaller "shrinking" and also the size of persons are not longer than my index finger (a lilliputian proportion). Sometimes I see the blind in the window or the television getting up and down, or my leg or arm is swinging. I may hear the voices of people quite loud and close or faint and far. Occasionally, I experience attacks of migrainous headache associated with eye redness, flashes of lights and a feeling of giddiness. I am always conscious to the intangible changes in myself and my environment". There is a strong family history of common migraine. Clinical examination, brain-MRI and EEG were normal. Transcranial magnetic stimulation and evoked potentials revealed enhanced cortical excitability in multiple brain regions. Treatment with valproate resulted in marked improvement of all clinical and neurophysiological abnormalities.

CONCLUSIONS

The association between the two migraine variants (abdominal migraine and Alice in Wonderland Syndrome) might have clinical, pathophysiological and management implications. I think this is the first description in the literature.