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Neurological Disease
Published in John S. Axford, Chris A. O'Callaghan, Medicine for Finals and Beyond, 2023
Diagnosis is based on the type, character and pattern of the headache. Typical migraine is a unilateral throbbing headache that may be associated with nausea, vomiting, photo- and phonophobia and is often preceded by visual or sensory auras; the pattern of the attacks is often stereotyped. Migraine can occur with (classical migraine) or without (common migraine) aura; and migraine aura can occur without headache (also known as ‘acephalgic’ or ‘silent’ migraine). Clinical examination is usually normal. When no headache is reported, the differential diagnosis, especially in the elderly, includes TIA. The presence of positive visual and somatosensory symptoms (tingling), of malaise, nausea and fatigue, and of a prior history of common or classical migraine all suggest migraine rather than TIA, even in the elderly.
Retinal Tears and Detachments
Published in Amy-lee Shirodkar, Gwyn Samuel Williams, Bushra Thajudeen, Practical Emergency Ophthalmology Handbook, 2019
Migraine: Flashing lights and zig zag patterns are perceived by patients suffering from migraines. The preceding aura associated with a migraine can often involve multi-coloured flashing lights and squiggly lines, which can obscure vision. Resolution of the flashing lights and visual obscuration once the migraine attack has subsided are classic signs of migraine aura. The key association of a headache and normal vitreous and retinal examination rule out retinal pathology and neurological causes should be excluded.
Migraine: diagnosis and treatment
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
The migraine aura is a complex of focal neurologic symptoms (positive or negative phenomena) that precedes, accompanies, or (rarely) follows an attack. Most aura symptoms develop over 5–20 minutes and usually last less than 60 minutes.8 The aura can be characterized by visual, sensory, or motor phenomena, and may also involve language or brainstem disturbances (Table 6.4).
A Case of Transient Visual Field Defect following Administration of Pfizer-BioNTech COVID-19 Vaccine
Published in Ocular Immunology and Inflammation, 2022
Almila Sarıgül Sezenöz, Sirel Gür Güngör, Seda Kibaroğlu
Patent foramen ovale is a remnant of the fetal circulation, which normally closes within the first year of life. However, being the most common congenital heart defect, it persists as a cardiac communication between the left and right atria in 20% to 30% of the general adult population. In most people, it remains asymptomatic and therefore unnoticed for life.17 However, studies have shown that there is a possible connection with PFO and migraine and embolic events.17 In our case, our patient had a small PFO. The imaging studies we ran did not show any evidence of a possible embolus that might have predisposed by the presence of PFO. Therefore, we do not think that the patients’ complaints were directly linked to the PFO. Also, our patient has no personal or family history of migraine or aura before or after, and the one we report is the only episode, which has very close time link to vaccination. Also, the visual complaints of the patient lasted longer than a usual migraine aura. Based on these, we think that aura without migraine type headache or retinal migraine are less likely diagnoses in our case.
The eye in migraine: a review of retinal imaging findings in migraine
Published in Clinical and Experimental Optometry, 2022
Allison M. McKendrick, Bao N Nguyen
Acute migraine attacks are typically characterised by moderate to severe headache with accompanying nausea, vomiting and sensitivity to light (photophobia) and sound (phonophobia).3 People with migraine may also experience premonitory4 and postdromal5 symptoms, such as fatigue and mood changes, in the hours or days leading up to and after an attack. The most common form of migraine is ‘migraine without aura’, where the predominant feature is the headache. Some people may also experience an additional suite of completely reversible neurological symptoms known collectively as ‘aura’ (‘migraine with aura’). Of these neurological disturbances, visual aura symptoms are by far the most prevalent (up to 99% of migraine aura) compared to sensory (~35%) or language (~10%) disturbances.6 Comprehensive diagnostic criteria for migraine are found in the latest edition of the International Classification of Headache Disorders (ichd-3.org/1-migraine).3
Evaluating and managing severe headache in the emergency department
Published in Expert Review of Neurotherapeutics, 2021
Michelangelo Luciani, Andrea Negro, Valerio Spuntarelli, Enrico Bentivegna, Paolo Martelletti
Strategy of the diagnostic evaluations of an unusual headache is summarized in (Figure 1). Head computed tomography (CT) scans are commonly used to assess headaches because of their rapid accessibility and excellent diagnostic accuracy, but unnecessary scans lead to radiation exposure [21], longer stays in the ED [22], and increased medical costs [23]. The use of CT scans for non-traumatic headaches in the US has doubled over the last 20 years [24] and head CT scans have accounted for almost 50% of all CT scans [25]. Up to 31% of patients with headache undergo imaging [24] and patients who undergo a head CT scan during initial access to ED are about half as likely to return to ED within 30 days than those who do not have CT scans [26]. Moreover, head imaging has a positive influence on patients’ fear and anxiety levels [27]. However, almost 95% of the CT scans performed in the United States over 10 years showed no pathological results [2]. Convincing evidence suggest the possibility of safely reducing the use of CT scans for patients with severe headache; a recent study found that a 9.6% decrease in the number of head CT scans was not followed by an increase in deaths or missed diagnosis [28]. The routine use of neuroimaging is not justified for adult patients with recurrent episodes of migraine (including with aura) without a recent change in pattern, no history of seizures, and no other focal neurological signs or symptoms [29]. Positive visual symptoms may be a migraine aura but they can be also attributable to a focal epileptic seizure or occipital lobe ischemia [30].