The Visual System in Migraine: From the Bench Side to the Office

Abstract

This paper achieved its goals of addressing and condensing information on the pathophysiology of the visual aspects of migraine and its clinical aspects, especially with regards to therapy, making it useful not only for those unfamiliar to the theme but to experienced physicians as well.

Correlation of neurochemical and imaging markers in migraine

“…The location of correlating diffusion measurements suggests involvement of the visual system, many aspects of which are affected in migraine. 37 Photophobia is a prominent accompanying symptom present in a large percentage of migraineurs, and bright light is known to exacerbate migrainous headache. The phenomenon is thought to originate in part from intrinsically photosensitive retinal ganglionic cells 38 that express PACAP38 to be used as a cotransmitter in retinohypothalamic projections.…”

Patients With Migraine Have Substantial Reductions in Measures of Visual Quality of Life

“…5 Visual auras can also occur in the absence of headache, with a lifetime prevalence of 3% in women and 1% in men. 10,11 Finally, there is evidence to suggest that chronic migraine is associated with increased symptoms of dry eye, in addition to structural changes in the trigeminal corneal nerve endings. Visual snow, characterized by a persistent, static-like disturbance of the entire visual field, is commonly associated with a history of migraine (59%) and may begin with a headache, with or without a visual aura.…”

“…7,8 Prolonged auras and other migrainous persistent positive visual phenomenon have been described, 9 and transient vision loss associated with severe attacks or retinal vasopasm. 10,11 Finally, there is evidence to suggest that chronic migraine is associated with increased symptoms of dry eye, in addition to structural changes in the trigeminal corneal nerve endings. 12 Despite the recognition of these different visual symptoms, no previous attempt has been made to quantify how these various eye and vision-related symptoms affect visual quality of life (VQOL).…”

Case Report: New‐Onset Retinal Migraine After Transseptal Catheterization

“…6 Vasospasms have been proposed to be a possible contributor or epiphenomena in retinal migraine. 9 Spreading depression of retinal neurons has been discussed as well and has been noticed in vitro in the avascular chicken 10 and frog retina. While spreading depression has never been demonstrated in vascularized mammalian retina so far, 11 this does not per se exclude a potential contribution of this mechanism in humans.…”

“…However, since no further episodes occurred, the ICHD-3 diagnostic criteria for retinal migraine (requiring at least 2 attacks with monocular visual disturbances) were not met. 9 Spreading depression of retinal neurons has been discussed as well and has been noticed in vitro in the avascular chicken 10 and frog retina. 7 Furthermore, the ICHD-3 diagnostic criteria for migraine with aura are met as well (even despite the fact that the patient never reported headaches).…”