Migraine and anisocoria

Neuro-Ophthalmic Symptoms of Primary Headache Disorders: Why the Patient With Headache May Present to Neuro-Ophthalmology

BACKGROUND

Primary headache disorders can cause many ophthalmic symptoms that lead many patients to present for neuro-ophthalmic evaluation. Neuro-ophthalmologists frequently encounter these patients in clinical practice.

EVIDENCE ACQUISITION

A literature review was completed in PubMed using the following terms paired with "migraine" and "headache:" dry eye, eye pain, monocular diplopia, binocular diplopia, photophobia, visual field defect, tunnel vision, floaters, amaurosis fugax, transient visual obscuration, autonomic symptoms, anisocoria, visual snow, Alice in Wonderland syndrome, and palinopsia.

RESULTS

Patients with migraine experience a wide range of visual disturbances including aura and more complex perceptual abnormalities such as Alice in Wonderland syndrome and visual snow. Visual disturbances may consist of positive and/or negative phenomena and may be binocular or monocular. Migraine and other primary headache disorders can be associated with photophobia, eye pain, dry eye, autonomic features, and anisocoria.

CONCLUSIONS

Patients with primary headache disorders may experience a wide range of visual and ophthalmic symptoms. An understanding of the typical features of these disorders allows providers to help patients find appropriate treatment without unnecessary testing and to recognize when atypical presentations require additional evaluation.

The borderland of migraine with aura: episodic unilateral mydriasis

We present the case of a patient who had a 3-year history of episodes of transitory unilateral mydriasis with omolateral blurred vision followed by headache. Thereafter, during the last 4 years, the patient developed a migraine with visual aura, without further episodes of transitory mydriasis. We suggest that the transitory mydriasis previously present could be considered as an unusual form of migrainous aura. A possible pathogenetic mechanism is proposed.

Migraine headaches: diagnosis and management

BACKGROUND

Patients often complain to their optometrist about their headaches, of which migraines are a common type. They may ask if their pain is from visual causes or whether the visual auras they experience are normal.

METHODS

The literature on migraine is reviewed to provide the optometrist with current information to manage these patients.

RESULTS

Included in the review are migraine epidemiology, pathophysiology, categorization, clinical presentation, diagnosis, and treatment.

CONCLUSION

Optometrists can help their migraine patients with a thorough examination, advice, proper referrals, and optical management when appropriate.