Retinal Migraine Reappraised

Cephalalgia ◽  
2006 ◽  
Vol 26 (11) ◽  
pp. 1275-1286 ◽  
Author(s):  
BM Grosberg ◽  
S Solomon ◽  
DI Friedman ◽  
RB Lipton
Keyword(s):  
Diagnostic Criteria ◽  
Migraine Headache ◽  
Visual Loss ◽  
Prophylactic Treatment ◽  
Visual Features ◽  
Headache Disorders ◽  
Migrainous Infarction ◽  
History Of ◽  
Reversible Visual Loss

Retinal migraine is usually characterized by attacks of fully reversible monocular visual loss associated with migraine headache. Herein we summarize the clinical features and prognosis of 46 patients (six new cases and 40 from the literature) with retinal migraine based upon the International Classification of Headache Disorders-2 (ICHD-2) criteria. In our review, retinal migraine is most common in women in the second to third decade of life. Contrary to ICHD-2 criteria, most have a history of migraine with aura. In the typical attack monocular visual features consist of partial or complete visual loss lasting <1 h, ipsilateral to the headache. Nearly half of reported cases with recurrent transient monocular visual loss subsequently experienced permanent monocular visual loss. Although the ICHD-2 diagnostic criteria for retinal migraine require reversible visual loss, our findings suggest that irreversible visual loss is part of the retinal migraine spectrum, perhaps representing an ocular form of migrainous infarction. Based on this observation, the authors recommend migraine prophylactic treatment in an attempt to prevent permanent visual loss, even if attacks are infrequent. We also propose a revision to the ICHD-2 diagnostic criteria for retinal migraine.

scholarly journals Current Perspective on Retinal Migraine

Vision ◽  
2021 ◽  
Vol 5 (3) ◽  
pp. 38
Author(s):  
Yu Jeat Chong ◽  
Susan P. Mollan ◽  
Abison Logeswaran ◽  
Alexandra B. Sinclair ◽  
Benjamin R. Wakerley
Keyword(s):  
Risk Factors ◽  
Migraine Headache ◽  
Visual Loss ◽  
Clinical Presentation ◽  
Management Strategies ◽  
Visual Disturbance ◽  
Current Understanding ◽  
Headache Disorders ◽  
Current Perspective

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

Migrainous infarction of the eye: Two cases of monocular ischemic complications associated with retinal migraine

Cephalalgia ◽  
2021 ◽  
pp. 033310242110562
Author(s):  
Nikita Chhabra ◽  
Chia-Chun Chiang ◽  
Marie A Di Nome ◽  
Odette Houghton ◽  
Rachel E Carlin ◽  
...  
Keyword(s):  
Visual Loss ◽  
Vision Loss ◽  
Central Retinal Artery Occlusion ◽  
Retinal Artery Occlusion ◽  
Artery Occlusion ◽  
Monocular Vision ◽  
Ischemic Optic Neuropathy ◽  
Migrainous Infarction ◽  
Ischemic Complications ◽  
History Of

Background Retinal migraine is defined by fully reversible monocular visual phenomena. We present two cases that were complicated by permanent monocular vision deficits. Cases A 57-year-old man with history of retinal migraine experienced persistent monocular vision loss after one stereotypical retinal migraine, progressing to finger-count vision over 4 days. He developed paracentral acute middle maculopathy that progressed to central retinal artery occlusion. A 27-year-old man with history of retinal migraine presented with persistent right eye superotemporal scotoma after a retinal migraine. Relative afferent pupillary defect and superotemporal visual field defect were noted, consistent with ischemic optic neuropathy. Conclusion Retinal migraine can complicate with permanent monocular visual loss, suggesting potential migrainous infarction of the retina or optic nerve. A thorough cerebrovascular evaluation must be completed, which was unrevealing in our cases. Acute and preventive migraine therapy may be considered in retinal migraine patients, to mitigate rare but potentially permanent visual loss.

A prospective study on osmophobia in migraine versus tension-type headache in a large series of attacks

Cephalalgia ◽  
2019 ◽  
Vol 40 (4) ◽  
pp. 337-346 ◽  
Author(s):  
Alberto Terrin ◽  
Federico Mainardi ◽  
Carlo Lisotto ◽  
Edoardo Mampreso ◽  
Matteo Fuccaro ◽  
...  
Keyword(s):  
Prospective Study ◽  
Diagnostic Criteria ◽  
Migraine Without Aura ◽  
Tension Type Headache ◽  
Headache Disorders ◽  
Headache Attack ◽  
Accompanying Symptoms ◽  
Type Headache ◽  
A Prospective Study

Background In literature, osmophobia is reported as a specific migrainous symptom with a prevalence of up to 95%. Despite the International Classification of Headache Disorders 2nd edition proposal of including osmophobia among accompanying symptoms, it was no longer mentioned in the ICHD 3rd edition. Methods We conducted a prospective study on 193 patients suffering from migraine without aura, migraine with aura, episodic tension-type headache or a combination of these. After a retrospective interview, each patient was asked to describe in detail osmophobia, when present, in the following four headache attacks. Results In all, 45.7% of migraine without aura attacks were associated with osmophobia, 67.2% of migraineurs reported osmophobia in at least a quarter of the attacks. No episodic tension-type headache attack was associated with osmophobia. It was associated with photophobia or phonophobia in 4.3% of migraine without aura attacks, and it was the only accompanying symptom in 4.7% of migraine without aura attacks. The inclusion of osmophobia in the ICHD-3 diagnostic criteria would enable a 9.0% increased diagnostic sensitivity. Conclusion Osmophobia is a specific clinical marker of migraine, easy to ascertain and able to disentangle the sometimes challenging differential diagnosis between migraine without aura and episodic tension-type headache. We recommend its inclusion among the diagnostic criteria for migraine as it increases sensitivity, showing absolute specificity.

scholarly journals International Classification of Headache Disorders - ICHD-4. Will medication-overuse headache survive?

2021 ◽  
pp. 72-74
Author(s):  
Mario Fernando Prieto Peres ◽  
Thaiza Agostini Córdoba de Lima ◽  
Marcelo Moraes Valença
Keyword(s):  
Clinical Practice ◽  
Diagnostic Criteria ◽  
Critical Analysis ◽  
Medication Overuse ◽  
Medication Overuse Headache ◽  
International Classification ◽  
Headache Disorders ◽  
Critical View

The article is a critical analysis of the diagnostic criteria for medication-overuse headache. This is an important discussion to improve the criteria in the next update, as well as providing a critical view for neurologists when applying the criteria to their clinical practice.

Persistent Idiopathic Facial Pain

2018 ◽  
pp. 279-286
Author(s):  
Trevor Van Oostrom
Keyword(s):  
Differential Diagnosis ◽  
Diagnostic Criteria ◽  
Psychological Factors ◽  
Facial Pain ◽  
Treatment Options ◽  
Headache Disorders ◽  
Diagnostic Challenge ◽  
Persistent Idiopathic Facial Pain ◽  
Case Based

Persistent idiopathic facial pain (PIFP) is an enigmatic condition which has caused a great deal of suffering yet has been difficult to define and remains a challenging disorder to treat. In addition, the presentation of PIFP has considerable overlap with many other causes of facial pain making the malady a diagnostic challenge. The condition is often resistant to treatment and patients often have comorbid syndromes or psychological factors. This chapter reviews the history and development of the current diagnostic criteria of PIFP according to the latest edition of the International Classification of Headache Disorders (ICHD). Using a case-based approach, the pathophysiology, epidemiology, differential diagnosis, and treatment options of PIFP are explored.

Migraine and vertigo

2020 ◽  
pp. 128-137
Author(s):  
Yoon-Hee Cha
Keyword(s):  
Migraine Headache ◽  
Clinical Characteristics ◽  
Vestibular Migraine ◽  
Headache Disorders ◽  
Temporal Profile ◽  
Growing Body ◽  
Vestibular Symptoms ◽  
The Common ◽  
Treatment Responses

The phenomena of migraine headache and vertigo share many epidemiological, anatomical, and clinical characteristics. The historically parallel development of the neuroscience of each field has formally intersected in the development of consensus criteria for vestibular migraine and the inclusion of vestibular migraine in the International Classification of Headache Disorders. Differences exist in the temporal profile of head pain and vertigo as manifestations of migraine, which can obscure the association. However, the growing body of evidence on the common demographic, neurochemical signature, and treatment responses of pain and vestibular symptoms indicate that they exist as symptoms of a common syndrome, one which can only be fully understood by recognizing the significance of each kind of manifestation.

scholarly journals ICHD-3 is significantly more specific than ICHD-3 beta for diagnosis of migraine with aura and with typical aura

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Carl H. Göbel ◽  
Sarah C. Karstedt ◽  
Thomas F. Münte ◽  
Hartmut Göbel ◽  
Sebastian Wolfrum ◽  
...  
Keyword(s):  
Emergency Room ◽  
Diagnostic Criteria ◽  
Migraine With Aura ◽  
University Hospital ◽  
Headache Disorders ◽  
Ischemic Attack ◽  
Diagnostic Work ◽  
The University ◽  
Work Up

Abstract Background In the emergency room, distinguishing between a migraine with aura and a transient ischemic attack (TIA) is often not straightforward and mistakes can be harmful to both the patient and to society. To account for this difficulty, the third edition of the International Classification of Headache disorders (ICHD-3) changed the diagnostic criteria of migraine with aura. Methods One hundred twenty-eight patients referred to the emergency room at the University Hospital of Lübeck, Germany with a suspected TIA were prospectively interviewed about their symptoms leading to admission shortly after initial presentation. The diagnosis that resulted from applying the ICHD-3 and ICHD-3 beta diagnostic criteria was compared to the diagnosis made independently by the treating physicians performing the usual diagnostic work-up. Results The new ICHD-3 diagnostic criteria for migraine with aura and migraine with typical aura display an excellent specificity (96 and 98% respectively), and are significantly more specific than the previous ICHD-3 beta classification system when it comes to diagnosing a first single attack (probable migraine with aura and probable migraine with typical aura). Conclusions The ICHD-3 is a highly useful tool for the clinical neurologist in order to distinguish between a migraine with aura and a TIA, already at the first point of patient contact, such as in the emergency department or a TIA clinic.

scholarly journals Grey Zones in the Diagnosis of Adult Migraine without Aura Based on the International Classification of Headache Disorders-Iii Beta: Exploring the Covariates of Possible Migraine without Aura

2015 ◽  
Vol 20 (1) ◽  
pp. e1-e7 ◽  
Author(s):  
Aynur Ozge ◽  
Elif Aydinlar ◽  
Bahar Tasdelen
Keyword(s):  
Abdominal Pain ◽  
Diagnostic Criteria ◽  
Motion Sickness ◽  
Migraine Without Aura ◽  
Clinical Characteristics ◽  
Diagnostic Value ◽  
Infantile Colic ◽  
Headache Disorders ◽  
Final Version

BACKGROUND: Exploring clinical characteristics and migraine covariates may be useful in the diagnosis of migraine without aura.OBJECTIVE: To evaluate the diagnostic value of the International Classification of Headache Disorders (ICHD)-III beta-based diagnosis of migraine without aura; to explore the covariates of possible migraine without aura using an analysis of grey zones in this area; and, finally, to make suggestions for the final version of the ICHD-III.METHODS: A total of 1365 patients (mean [± SD] age 38.5±10.4 years, 82.8% female) diagnosed with migraine without aura according to the criteria of the ICHD-III beta were included in the present tertiary care-based retrospective study. Patients meeting all of the criteria of the ICHD-III beta were classified as having full migraine without aura, while those who did not meet one, two or ≥3 of the diagnostic criteria were classified as zones I, II and III, respectively. The diagnostic value of the clinical characteristics and covariates of migraine were determined.RESULTS: Full migraine without aura was evident in 25.7% of the migraineurs. A higher likelihood of zone I classification was shown for an attack lasting 4 h to 72 h (OR 1.560; P=0.002), with pulsating quality (OR 4.096; P<0.001), concomitant nausea/vomiting (OR 2.300; P<0.001) and photophobia/phonophobia (OR 4.865; P<0.001). The first-rank determinants for full migraine without aura were sleep irregularities (OR 1.596; P=0.005) and periodic vomiting (OR 1.464; P=0.026). However, even if not mentioned in ICHD-III beta, the authors determined that motion sickness, abdominal pain or infantile colic attacks in childhood, associated dizziness and osmophobia have important diagnostic value.CONCLUSIONS: In cases that do not fulfill all of the diagnostic criteria although they are largely consistent with the characteristics of migraine in clinical terms, the authors believe that a history of infantile colic; periodic vomiting (but not periodic vomiting syndrome); recurrent abdominal pain; the presence of motion sickness or vertigo, dizziness or osmophobia accompanying the pain; and comorbid atopic disorder are characteristics that should to be discussed and considered as additional diagnostic criteria (covariates) in the preparation of the final version of ICHD-III.

Tolosa-Hunt Syndrome: Appraising the ICHD-3 beta diagnostic criteria

Cephalalgia ◽  
2017 ◽  
Vol 38 (10) ◽  
pp. 1696-1700 ◽  
Author(s):  
Evan Mullen ◽  
Mark Green ◽  
Eliza Hersh ◽  
Alfred-Marc Iloreta ◽  
Joshua Bederson ◽  
...  
Keyword(s):  
Diagnostic Criteria ◽  
False Negative ◽  
Granulomatous Inflammation ◽  
International Classification ◽  
Headache Disorders ◽  
Hunt Syndrome ◽  
Cranial Nerve Palsies ◽  
Beta Version

Introduction The term Tolosa-Hunt Syndrome was first used more than half a century ago to describe painful ophthalmoplegia accompanied by cranial nerve palsies. In the decades since, its diagnostic criteria have evolved considerably. The beta version of the 3rd Edition of the International Classification of Headache Disorders narrows these criteria to require the demonstration of granulomatous inflammation on MRI or biopsy. We believe this may introduce challenges to accurate diagnosis. Discussion Requiring the demonstration of granulomatous inflammation for a diagnosis of Tolosa-Hunt Syndrome may introduce the potential for false negative and false positive diagnoses. Although the disorder presents secondary to granulomatous inflammation, MRI technology may not be able to identify it reliably, and biopsy is not always indicated for its symptomatology. Additionally, several cases have been reported of Tolosa-Hunt Syndrome diagnosed with MRI-confirmed granulomatous inflammation that later prove to be attributable to other pathologies. The emphasis on neuroimaging may therefore exclude some true Tolosa-Hunt Syndrome cases and include others resulting from other latent pathologies that are not visible on MRI. Conclusion We wish to offer several potential modifications to the International Classification of Headache Disorders guidelines for Tolosa-Hunt Syndrome, including making the demonstration of granulomatous inflammation on MRI or biopsy non-mandatory and lengthening patient follow-up to two years for cases in which MRI is unrevealing.

scholarly journals Children migraine syndrome: Definition and classification through the time

2008 ◽  
Vol 61 (3-4) ◽  
pp. 143-146 ◽  
Author(s):  
Marija Knezevic-Pogancev
Keyword(s):  
Current Problem ◽  
Medical Science ◽  
Classification Criteria ◽  
International Classification ◽  
Headache Disorders ◽  
Migraine Headaches ◽  
Knowing That ◽  
History Of ◽  
A Current

Introduction Even today, the migraine syndrome is not completely defined knowing that it does not have either clear laboratory correlate or objectively defining marker. There is a great number of differential diagnostic references to define and classify migraine headaches; from Galen to ICHD-II (International Classification of Headache Disorders), from September 2003. Migraine syndrome represents a current problem of both pediatrics and children *s neurology. The aim of this paper is to understand and define the migraine syndrome among children through the history of medical science, in order to enable the interpretation of the most acceptable defining and classification criteria of the children migraine syndrome. Definition and classification Sensory, vegetative and affective phenomena of migraine, recognizable only among people, with striking quantitative and qualitative variations depending on the patient, define the migraine syndrome of children in general. There are no completely reliable principles or guidelines which would enable the accurate, precise and quick diagnosis, or differential diagnosis of children's migraine syndrome. Vahlquist is the first one to give special criteria to diagnose children's headache. His criteria were invalid because of insisting on headaches being unilateral. Classification criteria for migraine in children were given by Bille in 1962, Prensky in 1976, Deubner in 1977, Congdon and Forsythe in 1979, Tomasi in 1980, Sillanappa in 1982, Kurt: and Barlow in 1984, Hockaday in 1988. 1HS classification was brought by consensus in 1988, and it was last modified in September 2003, when a consensus was reached about applying the ICHD-II International Classification of Headache Disorders. Conclusion Being insufficiently defined and incompletely etiologically, clinically and therapeutically clear, children's migraine syndrome represents a striking example of interdisciplinary, scientific, health, practical and clinical entity. The degree of interest in children's migraine syndrome is directly dependent on the level of social and health standards within the society.

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