One of the difficulties encountered at times when discussing Migraines occurs when a Migraineur is given a diagnosis that isn't actually accurate in diagnostic terms, but is really a descriptive term. Such terms may be used fairly frequently, but they fall short of a diagnosis and may also be used differently from one doctor to another. That's one reason why most doctors diagnose based in the International Headache Society's International Classification of Headache Disorders, 2nd Edition (ICHD-II). A "standard" diagnosis also makes communications and transitions easier when patients need to consult other doctors or change doctors.
There are several terms that are sometimes used, supposedly as Migraine diagnoses, that involve visual symptoms. Most of them aren't actually standard Migraine diagnoses. Retinal Migraine, however, is an actual Migraine diagnosis. What becomes confusing about it is that it's sometimes misused, resulting in a misdiagnosis. The term "retinal Migraine" is often misused to mean any Migraine that involves any visual symptoms or a Migraine with visual symptoms but without the headache phase of the attack.
Retinal migraine symptoms:
Retinal migraine is migraine where there are repeated attacks of visual disturbances preceding the headache phase of the migraine attacks.
A retinal migraine attack begins with monocular visual symptoms that can include:
The headache phase of a retinal migraine begins during or within 60 minutes of the visual symptoms. The headache phase presents symptoms consistent with migraine without aura:
1. unilateral location
2. pulsatile quality
3. moderate or severe pain intensity
4. aggravation by or causing avoidance of
routine physical activity such as walking or climbing stairs
The primary differentiating factors between retinal migraine and migraine with aura are:
Diagnosing retinal migraine:
There are no diagnostic tests to confirm migraine disease. Diagnosis is accomplished by reviewing the patient's personal and family medical history, studying their symptoms, and conducting an examination. Migraine is then diagnosed by ruling out other causes for the symptoms. With retinal migraine, it is essential that other causes of transient blindness be fully investigated and ruled out.
For infrequent attacks medications used for other forms
of migraine are often employed to relieve the other symptoms. These medications can include NSAIDs, antinausea
medications, Midrin, ergotamines the triptans. The choice of medications is somewhat
affected by the age of the patient. When migraines are frequent, the
same preventive therapies used for other migraines can be explored.
The more technical explanation:
In the ICHD-II, retinal migraine is described as,
Repeated attacks of monocular visual disturbance, including scintillations, scotomata or blindness, associated with migraine headache.
The diagnostic criteria for retinal migraine under ICHD-II are:
The relevant diagnostic criteria for migraine without aura are:
For more information:
"The International Classification of Headache Disorders, 2nd Edition." Cephalalgia 24 (s1). doi: 10.1111/j. 1468-2982.2003.00824.x
Randolph W. Evans, Nina T. Mathew. "Handbook of Headache, Second Edition." Philadelphia: Lipincott Williams & Wilkins. 2005.
Published October 16, 2006
Sunday, March 28, 2010 • © 2004 - 2010 Teri Robert
All content on this site is physician reviewed by Dr. John Claude Krusz.