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The pathophysiology of primary headache
Published in Stephen D. Silberstein, Richard B. Upton, Peter J. Goadsby, Headache in Clinical Practice, 2018
Stephen D. Silberstein, Richard B. Upton, Peter J. Goadsby
Most patients never have aura,21 so clinical and theoretical models that assign a unique sequential stage for migraine aura cannot be truly generalizable. The experience of visual disturbances, such as the scintillating scotoma (flashing lights that move across the visual field), paraesthesias, or other focal neurological signs, are so dramatic that they have been been a focus of attention.
Practice Paper 9: Answers
Published in Anthony B. Starr, Hiruni Jayasena, David Capewell, Saran Shantikumar, Get ahead! Medicine, 2016
Anthony B. Starr, Hiruni Jayasena, David Capewell
A scotoma describes an area of visual field loss within a field of normal vision. The blind spot is an example of a scotoma that is present in every human. Pathological scotomata can be caused by problems of the retina or optic nerve, e.g. multiple sclerosis, optic nerve glioma, glaucoma and vascular lesions. A scintillating scotoma describes an area of flashing lights within the field of vision, often seen in migraine. This can take the form of zigzag lines, in which case it is known as a fortification spectrum.
Should “Retro-ocular Pain, Photophobia and Visual Acuity Loss” Be Recognised as a Distinct Entity? The ROPPVAL Syndrome
Published in Neuro-Ophthalmology, 2021
Francesco Pellegrini, Erika Mandarà, Daniele Brocca
Migraine is a common type of headache and the third highest cause of disability in young people.3 One-third of patients suffering of classical migraine may experience visual symptoms (visual aura) like “dark holes” in the visual field (negative scotoma) or bright scintillating positive scotoma before the occurrence of the headache.4 Moreover, headache may also accompany the visual aura,5 thus pain and visual symptoms may coexist during each attack. As the visual symptoms often involve central vision then visual acuity can be expected to decrease. Importantly, in classical migraine with visual aura, symptoms are reported as binocular and homonymous suggesting their cortical origin. Conversely, in ROPPVAL syndrome patients experience unilateral and generalised vision loss with reduced BCVA, thus resembling (and for this reason often misdiagnosed as) ON, and not a blind spot or a scintillating scotoma like in migraine.
A systematic review with expert opinion on the role of gepants for the preventive and abortive treatment of migraine
Published in Expert Review of Neurotherapeutics, 2022
Andreas A. Argyriou, Elisa Mantovani, Dimos-Dimitrios Mitsikostas, Michail Vikelis, Stefano Tamburin
Aura starts shortly before a migraine attack and in most cases is characterized by a series of focal transient disturbances but remains an increasingly complex narrative that requires further elucidation. Many patients experience visual aura, but other sensory and olfactory symptoms, and speech difficulties are commonly reported, either in conjunction with or independently from visual aura. Visual aura is typically reported as black and white scintillating scotoma [33] and it is thought to be initiated from multiple distinct sites and propagate to a variable extent within the visual cortex [34].
Palinopsia Accompanied with Migraine Attack After Having Occipital Brain Abscess
Published in Neuro-Ophthalmology, 2019
Yutaro Takayama, Junya Iwata, Akio Kojima
A 55-year-old male visited our department with complaints of headache, vertigo, and fever. His past history included sinusitis and long-standing migraine, although family history was unremarkable. He had been prescribed zolmitriptan for his migraine attacks. Apart from mild fever of 37.7 °C, initial examination of his physical and neurological profile, including visual field, showed no abnormality. Blood examination showed leukocytosis, white blood cell count of 11,000 /µL and neutrophil count of 8140/µL without elevation of C-reactive protein. Brain T1-weighted contrast-enhanced magnetic resonance imaging (MRI) revealed a ring-enhanced space-occupying lesion located in the right occipital lobe, diffusion-weighted imaging showed high intensity in this lesion (Figure 1(a)). Based on these findings, he was diagnosed with brain abscess, and administration of multiple antibiotics was begun on the day of admission (day 1). The cause of abscess was unknown, although the previous sinusitis might associate with the occurrence. On day 3, he complained of progressively worsening headache and MRI showed growth of the brain abscess (Figure 1(b)). He was performed abscess drainage on day 4. The left homonymous hemianopia appeared on day 11, with appearance of a new cystic lesion contiguous with the drained lesion (Figure 1(c)). Continuous antibiotic therapy was effective as shown by reduced size of the drained lesion, and was stopped at day 59 under our judgment of remission of the brain abscess. The new cystic lesion also diminished spontaneously without cyst fenestration (Figure 1(d)) and subsequently the left homonymous hemianopia was healed. He remained well until day 117, when throbbing headache appeared. Scintillating scotoma also appeared on day 120. He took 2.5 mg of zolmitriptan based on his understanding that the episode was migrainous, and his headache was relieved. On the next day, he experienced various afterimages of the object he had seen very recently in his visual field despite the absence of headache. These afterimages appeared for a couple of minutes in each episode, and recurred intermittently for about 24 h. These episodes were considered to be his first episodes of palinopsia (Table 1(a)) and characterized by vivid colors and clear contours. On day 193, he had a migraine attack with preceding scintillating scotoma after looking at a ceiling light at a supermarket. On the next day, he experienced blurred afterimages in his left visual field without resolution of headache (Table 1(b)). These afterimages appeared for a brief second in each episode, and recurred intermittently for about 24 h. They were considered to be the second episodes of palinopsia. Serial MRI demonstrated no changes when he complained of these symptoms. There were not any issues about ophthalmologic findings such as extra-ocular movements and the condition of the optic disc. Electroencephalography showed no epileptic spikes. The two episodes disappeared spontaneously and similar symptoms have not appeared since then.