Migraine

MIGRAINE EQUIVALENT
Most people with migraine headaches are recognized as such and are treated by primary care. A vision disturbance lasting 10 to 45 minutes followed by a one sided throbbing frontal headache, possibly with nausea is the classic presentation.

There are others who have Migraine Equivalents - no headache yet have a visual disturbance only or a vision disturbance accompanied by nausea, fatigue or by a sense of things being ''not quite right.'' These patients may present to the ophthalmologist or optometrist with the conviction that there is a problem with the eyes.

The classic description of the visual disturbance is that of a gradually expanding scintillating hemianopic scotoma lasting 20 minutes (range of 10 to 45 minutes). That is: a one sided event seen in both eyes (often confused with the one eye on that side) in which the vision is obscured or partially obscured by a zig-zag jumble of lines which start centrally and expand to the periphery on that side. Often there is a sensation of looking through water rather than zig-zags.

Though the vision is affected the eyes are not the cause of migraine. It is thought that the occipital cortex (the vision portion of the brain) has a temporary disturbance of oxygen supply or a localized metabolic disturbance which limits the processing of information sent by both eyes (representing the corresponding area of the field of vision). As the conditions return to normal, so does the vision.

Migraine affects about 15% of the population at some time during their lives. Often it seems to be present in the early years, absent in the middle years only to return with a differing manifestation in the later years of life. It does not signify a stroke or brain tumor and generally does not have any lasting effect on the vision.

There are medications that can modify the frequency of migraine but are rarely called for with migraine equivalent (no headache). Prudence is advised: pull off the road if driving and await the return of normal vision.

If your symptoms change or persist longer than one hour - seek a medical evaluation.

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