Clinical Features of Patients Complaining of Visual Symptoms and Diagnosed with Migraine

Joong Sik Koh; Seong Joon Kim

doi:10.3341/jkos.2015.56.12.1933

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Koh and Kim: Clinical Features of Patients Complaining of Visual Symptoms and Diagnosed with Migraine

Original Article

J Korean Ophthalmol Soc 2015;56(12):1933-1938.

Published online: 29 August 2015

DOI: https://doi.org/10.3341/jkos.2015.56.12.1933

Clinical Features of Patients Complaining of Visual Symptoms and Diagnosed with Migraine

Joong Sik Koh, M.D¹, Seong Joon Kim, M.D, PhD^1,^2,

¹Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea

²Seoul Artificial Eye Center, Biomedical Research Institute, Seoul National University Hospital, Seoul, Korea

Address reprint requests to Seong Joon Kim, MD, PhD Department of Ophthalmology, Seoul National University Hospital, #101 Daehak-ro, Jongno-gu, Seoul 03080, Korea Tel: 82-2-2072-1979, Fax: 82-2-741-3187 E-mail: ophjun@gmail.com

‗ This study was presented as an e-poster at the 113th Annual Meeting of the Korean Ophthalmological Society 2015.

Received 3 July 20153 September 2015 Accepted 29 October 2015

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To describe the characteristics of patients who visited Korean ophthalmology clinics complaining of visual symptoms and were diagnosed with migraine.

Methods

A retrospective study was performed by evaluating the patterns of visual symptoms, timing of headaches, and results of ophthalmologic examinations in 31 migraine patients who were recruited from a neuro-ophthalmology clinic.

Results

The patients consisted of 9 men and 22 women, with a mean age of 38.1 years (range, 12-71). The average age of symptom onset was 35.7 years (range, 12-64 years). The most common three visual symptoms were blurred vision (35.5%), blind spots (22.6%), and flashes of bright lights (22.6%). Visual symptoms disappeared within 5 minutes in 16 patients (51.6%) and 13 patients (41.9%) experienced visual symptoms before the onset of a headache. Brain magnetic resonance imaging find-ings in 14 cases revealed normal results and the remaining three patients showed minimal small vessel disease. Except for one patient who had exotropia, there was no other specific abnormality observed upon ophthalmologic examinations.

Conclusions

Most of the migraine patients who first visited an ophthalmology clinic with visual symptoms had no definite ocular abnormalities. Thus, ophthalmologists must be aware that migraines could first present with various visual symptoms in order to make an early diagnosis of migraine.

Keywords: Blurred vision, Migraine, Migraine without headache, Primary headache, Visual aura

References

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Table 1.

ICHD-3 classification of migraine

ICHD-3 code	Diagnosis
1.1	Migraine without aura
1.2	Migraine with aura
1.2.1	Migraine with typical aura
1.2.1.1	Typical aura with headache
1.2.1.2	Typical aura without headache
1.2.2	Migraine with brainstem aura
1.2.3	Hemiplegic migraine
1.2.4	Retinal migraine
1.3	Chronic migraine
1.4	Complications of migraine
1.5	Probable migraine
1.6	Episodic syndromes that may be associated with migraine

ICHD = the International Classification of Headache Disorders.

Table 2.

Baseline characteristics of patients (n = 31)

Demographic data	Data
Sex (n, %)
Male	9 (29.0)
Female	22 (71.0)
Age (years, range)	38.1 ± 16.0 (12-71)
Age at onset of visual symptom	35.7 ± 13.9 (12-64)
(years, range)
Values are presented as mean ± SD unless otherwise indicated. n = number of patients.

Table 3.

Distribution of patients according to visual symptoms (n = 31)

Characteristics of visual symptoms	n	%
Blurred vision	11	35.5
Blind spots	7	22.6
Flashes of bright light	7	22.6
Flickering lights	3	9.7
White spots	1	3.2
Small bright dots like stars	1	3.2
Curved forms	1	3.2
Laterality
Bilateral	22	71.0
Unilateral	9	29.0

Table 4.

Timing of visual symptoms (n = 31)

Timing of attack	n	%
Timing of visual symptoms
Before the headaches	13	41.9
At the same time with the headaches	6	19.4
Do not know	2	6.5
No headaches			10	32.3
Duration of visual symptoms
<5 minutes	16	51.6
5 to 30 minutes	7	22.3
31 to 60 minutes	6	19.4
>60 minutes	2	6.5

Table 5.

Results of ophthalmologic examination (n = 31)

Ophthalmic examination	Data
BCVA (log MAR)
OD	0.009 ± 0.23
OS	0.005 ± 0.15
IOP (mm Hg)
OD	14.44 ± 3.35
OS	15.00 ± 3.69
Ocular motility (n, %)
Orthotropia	30 (96.8)
Exotropia	1 (3.2)
Refractive error (n, %)
Emmetropia	9 (29.0)
Myopia	21 (67.7)
Hypertropia	1 (3.2)

Values are presented as mean ± SD unless otherwise indicated. BCVA = best corrected visual acuity; log MAR = logarithm of the minimum angle of resolution; OD = oculus dexter; OS = oculus sinister; IOP = intraocular pressure.

Table 6.

Results of MRI and EEG

Neurologic study	Data
MRI (n = 17, %)
Normal	14 (82.4)
Focal cerebral vascular disease	3 (17.6)
EEG (n = 4, %)
Normal	4 (100)

MRI = magnetic resonance imaging; EEG = electroencephalogram.

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