otherwise known as ophthalmic migraines, anterior visual pathway migraines, or ocular migraines
causes monocular visual loss for 10–20 minutes which can be associated with diffuse or unilateral headache (1)
often there is also a history of one of the more conventional forms of migraine, and exercise may precipitate the attacks (2)
cause of the amaurosis of ocular migraine is thought to be vasospasm of the retinal circulation or ophthalmic artery
retinal migraine is an extremely rare cause of transient monocular visual loss
cases of permanentmonocular visual loss associated with migraine have been described. Appropriate investigations are required to exclude other causes of transient monocular blindness
Diagnostic criteria:
A. Attacks fulfilling criteria for Migraine with aura and criterion B below
B. Aura characterized by both of the following:
1. fully reversible, monocular, positive and/or negative visual phenomena (e.g. scintillations, scotomata or blindness) confirmed during an attack by either or both of the following:
a. clinical visual field examination
b. the patient’s drawing of a monocular field defect (made after clear instruction)
2. at least two of the following:
a. spreading gradually over >= 5 minutes
b. symptoms last 5–60 minutes
c. accompanied, or followed within 60 minutes, by headache
C. Not better accounted for by another ICHD-3 diagnosis, and other causes of amaurosis fugax have been excluded
Notes:
some patients who complain of monocular visual disturbance in fact have hemianopia. Some cases without headache have been reported, but migraine as the underlying aetiology cannot be ascertained
Reference:
Burger SK et al. Transient monocular blindness caused by vasospasm. N Engl J Med 1991;325:870–3
Jehn A et al. Exercise-induced vasospastic amaurosis fugax. Arch Ophthalmol 2002;120:220–2.
Headache Classification Committee of the International Headache Society (IHS). The international classification of headache disorders, 3rd edition. Cephalalgia 2018; 38: 1-211
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